You have a cancerous tumor on one of your lungs. Can a doctor operate to remove it or do you have to do chemo?

Answer 1

Stage I
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Surgical resection is the best treatment for stage I NSCLC.

Cure can be obtained in as high as 60-80% of cases, depending on the size of the tumor.

If the patient is very high risk for surgery, radiation therapy is the next best choice, with cure in approximately 15-25%.

If a peripheral nodule removed at the time of surgery turns out to be a SCLC, then adjuvant chemotherapy is indicated, with cure obtained in approximately 35% of such cases.

Stage II
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Surgical resection is the best treatment for stage II NSCLC.

Cure can be obtained in 30-45% of cases.

There is good evidence that radiation therapy added to surgery will reduce the chance of recurrent disease inside the chest, but no evidence to prove that the chance of cure will be increased.

Chemotherapy in patients with Stage II non-small cell lung cancer should be given within a controlled study, since there is no proof that such therapy enhances survival at this time. JBR10 Phase III Intergroup is a prospective randomized study of adjuvant chemotherapy with Vinorelbine and Cisplatin in completely resected NSCLC in T2N0M0 and T1-2N1M0 patients, (Stages IB and IIA) designed to determine whether adjuvant chemotherapy will improve recurrence rate and/or survival. I am offering this study to patients in my practice at City of Hope.

Tumors with chest wall invasion are classified as T3. Such tumors were previously in Stage IIIA. In the new staging system of 1997, such tumors are in Stage IIB.

The following computerized tomogram is from a patient with NSCLC with invasion of the parietal pleura. The tumor was completely resected by lobectomy combined with resection of portions of three ribs. The chest wall defect was repaired with 2mm. polytetrafluroethylene (Gortex).

Treatment of Stage IIIA lung cancer is controversial.
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Patients with Stage IIIA with chest wall invasion are candidates for surgery, with resection of the lung cancer plus removal of the ribs invaded by tumor and reconstruction of the ensuing chest wall defect.

If the cancer invades the uppermost portion of the rib cage, "superior sulcus tumor" preoperative radiation therapy is indicated. Cures in this group of IIIA patients are in the range of 20-35%.

Stage IIIA NSCLC with mediastinal node involvement is a more difficult issue. Most surgeons in the U.S. feel that this stage of tumor should not be treated with surgery alone. After proving N2 status with mediastinoscopy, most patients are treated with radiation therapy alone or with radiation therapy and chemotherapy. In my experience such treatment results in a five year survival of 3%. Because of this low survival, it is my belief that carefully selected patients with IIIA N2 disease should have surgical resection, followed by radiation therapy or chemoradiation therapy within a research protocol. The selection is based on the extent of disease as seen on CT scan. This decision must be made by an experienced surgeon.

Surgical resection of limited N2 disease is safe and feasible, and results in cure of approximately 25% of such patients. Adjuvant radiation therapy is indicated. Because the risk of distant metastasis is very high in these patients, it is my practice to refer them for consideration of adjuvant chemotherapy in an approved research protocol.

If the N2 disease seen on CT scan is "bulky" then the chance of complete resection at the time of surgery is very small and surgery is not indicated.

Neoadjuvant chemotherapy or chemo-radiation therapy for patients with "bulky" N2 disease or IIIB disease has been proven to be feasible in a number of studies, which suggest an improvement in survival over historical experience. Such neoadjuvant therapy is still unproven and should be done within the confines of a research protocol if possible.

It is also important to understand that this treatment has a higher risk and should be done at a center with an established team of experienced surgeons, radiation therapists and oncologists.



Image: Recurrence of NSCLC in right paratracheal lymph nodes following wedge resection of a right upper lobe lung cancer.

Stage IIIB
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I am not aware of any surgical center in the United States where primary surgical therapy of IIIB lung cancer is advocated.

There are a few centers in Japan where such surgery is done.

Best treatment would be radiation therapy.

Chemo-radiation therapy or neoadjuvant chemotherapy and surgical resection are experimental approaches currently being investigated in clinical trials. There is some early information that is encouraging.

Stage IV
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Stage IV lung cancer, with distant metastasis, is treated with chemotherapy or with supportive care.

Sometimes, a patient with lung cancer and a solitary metastasis to brain, bone or adrenal can have surgical resection of the metastasis, as well as the primary tumor, with cure.

Medical oncologists are divided on whether chemotherapy should be routinely offered in patients with Stage IV non-small cell lung cancer.

Effective chemotherapy does exist for all stages of small cell lung cancer, and all such patients should be evaluated by an oncologist.

Although cure cannot be achieved in most cases in this stage, quality of life can be maximized by skillful medical and nursing care, with careful attention to proper pain management and nutrition.

Continuing efforts are ongoing to find a curative chemotherapy for lung cancer, through clinical trials testing new forms of chemotherapy.

Exciting new discoveries in molecular biology of cancer offer the hope that new types of treatments using immunotherapy, gene therapy using anti-sense constructs and ribozymes and other new types of biological treatment of cancer will be available in the future

Answer 2

Depends on the type of cancer. My aunt had it, and it was a self-contained tumor. They removed the upper lobe of her one lung. She still had to have a few rounds of radiation, but didn't need to have the chemo since the surrounding lymph-nodes where clean. You might want to check out this site for other options and info on lung cancer. But always go with your physician's recommendation.

Answer 3

I would assume it would depend on the size of the tumor, the type of tumor, and the place it is in.
Sometimes they can be removed...but even if they are most people are still treated with chemo to make sure all the cancer cells are dead.

:)

Answer 4

Depends on many factors:
- size of the tumour
- location of the tumour
- general health of the patient (can they undergo surgery?)
- age
- presence of metastatic disease elsewhere in the body

If it is a very localized tumour, then surgery would be a good option. If it has spread to the nodes and other parts of the body, chemotherapy may be the better choice. A lot of times a combination of surgery, chemotherapy, and radiation therapy is used to cover all bases.

Answer 5

definately depends on the malignancy, if its invasive or not, the size, if it has spread, the potential it has to spread. it is usually recomended to use chemo either pre op or post op w/ or w/o radiation treatment. but it depends mainly on the tumor.

Answer 6

First go for a second opinion, a person can live with one lung, my uncle does, he had to have radiation, is on air supply some of the time and is going on a 2 week vacation from Kansas to California. ATTITUDE matters very much on your well being. Good luck!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Answer 7

That will be the Dr's decision.