Staging

[PPG1212]

The second week of July 2008, Mom had her left lower lobe removed and a sliver of the upper lobe.  The doctor said he was staging her lung cancer a T2 because of the tumor's size (over 3 cm) and the tumor's behavior (it transversed the pleura).  But, the tumor hadn't reached the chest wall.  Based on the pathology report, it is belived there was no lymphnode involvement nor any metastisis to any other organ.  What does "transversed the pleura" mean?  Prior to her surgery we thought it was a T1 in terms of staging.  Now, the doctor believes she will need chemo.  What type of chemo will she need and will it be a light course or a heavy course?  Thanks for your help.

[HeinrikMD]

Hi,

Patients with 1B have been included in trials evaluating chemotherapy, so the general answer is yes.

The goal of chemotherapy is to clear any residual cancer that may already be in circulation, or starting to deposit metastatic sites. Hence, the treatment is aimed at decreasing the risk of a recurrence and death from cancer. Chemotherapy however, cannot make the risk of recurrence or death = zero, and there are patients who would not actually benefit from it (as some patients would do well without treatment – the issue is the lack of a capacity to find out who they are, and hence, there is a value judgement made partly by the patient).

Inquire also about trials ongoing if treatment is being given in a cancer center. There are a lot more unanswered questions, and under the setting of a trial, there are more tests made available to better tailor which treatment is appropriate, or whether the treatment is appropriate at all.

[PPG1212]

Hi

Thank you for your response.  Can you tell me if chemotherapy is a recommended plan following surgery, with 1B squamous cell carcinoma tumors?  Assuming the doctor removed all of the cancer, what is the goal of chemo?  

Thanks once again for your kind reply.

[HeinrikMD]

Hi,

You can think of the pleura as a thin film that lines the outer edges of the lung. This is called the visceral pleura. The rib cage and its musculature would also have a pleural lining called the parietal pleura. By traversing the pleura, this means that the cancer has broken through the visceral pleura or has invaded it. This makes the cancer T2 not T1. If the parietal pleura is invaded, this is chest wall invasion, and would be T3.

If there is no lymph node invasion, then it seems to be a T2N0, making her stage 1B. Chemotherapy after surgery would generally consist of a platinum agent and vinorelbine or a taxane. The most experience is with platinum and vinorelbine, a 16 week treatment course weekly. What is deemed heavy or light is relative, but this treatment is a weekly course (in terms of participation and hospital consultations then, this seems heavier than once every three weeks treatment). In Japan, there is some experience with oral chemotherapy.