Surgery for stage IV Lung Cancer

[Debs322]

My hsuband (54) had a PET scan because he has a 2cm mass in his upper left lobe.  The PET scan showed "activity" in the upper left lobe and "activity" in the left adrenal gland.  He will be having a lymph node biopsied next week.  In what I've been researching, it appears that once cancer leaves the lung and infiltrates another organ it's automatically Stage IV and that once it's labeled Stage IV all surgery options are out -- there's only chemotherapy and/or radiation offered.   Is this true?  

[Terpman]

Based on the aggregate NCI (National Cancer Institute) SEER (Surveillance, Epidemiological and End Results) data, it is incorrect to state, as is done here, that being labeled Stage IV lung cancer "by definition", precludes surgery. While only 2% of patients do in fact have surgery, it does happen: as a then-58 YO male never smoker I was diagnosed Stage IV 04/16/11, thanks to my basketball-playing middle Son who elbowed me in the chest while rebounding in a one-on-one pick-up game with his Dad, sending me six weeks later (I am a male, after all) to my primary care doctor for what I thought was a routine x-ray to confirm perhaps a cracked rib or sternum. Instead we found a primary tumor 4cm upper lobe right lung, metastasized to the sternum. Five infusions of cisplatin with permetrexed May-August 2011. Great response/minimal side effects to the chemo. First surgery removed upper lobe right lung 08/31/11, Second surgery 10/31/11 to remove 5 and half inches of sternum. Internal fixation and use of pectoral muscle to stablize the fixation. Scans every three months all "NED" (no evidence of disease) since. Next scans set of 12/17/12. Besides my otherwise good health, my big advantage was being cared for by an extraordinary team at Hopkins Medicine, Baltimore. I was born in this town, raised here, and with any luck will die here as well. When it comes to death and its temporal dimension, however, apparently this will not be in keeping with Stage IV mortality statistics. In sum, don't use statistics in a vain effort to predicate your individual outcome, and by all means do come to Baltimore, if not for the crabs, then for the Medicine.

[khkh]

My Father 68 just had surgery of complete removal of right adrenal gland after metastasis malignant tumor occured from the primary one which was originally removed from the lung a year ago. He is now schedualed to undergo 4 sessions of what oncologist described as preventative treatment chemo since no further spread is discovered yet. So is that still stage 4 and what are his chances. Is it true as one doctor told me that it is only a matter of time before further spread is discovered.. pls. advise

[HeinrikMD]

Hi,

By definition, stage 4 cancer precludes surgery. However, if there is reason to believe that the adrenal mass is not malignant – then this removes the stage 4 designation and surgery may be considered. However, adrenal involvement is commonplace for lung cancer and some centers would not evaluate further. If the size of the lung involvement is amenable to surgery then this would raise some doubt that the disease may not yet be metastatic. An imaging study like an MRI could raise further doubts and a biopsy of the adrenal could be done to make sure it is not really stage 4.

[litbee]

My dear girl,
I'm so sorry. Unfortunately this is true.