lung cancer

[jojokdz]

My husband was diagnosed with a Pancoast tumor on his lung.  He went thru chemo/ radiation and finally had surgery to remove the tumor.  It was successful.  He had more chemo for precaution.  After one year, the cancer came back into his Adrenal Gland.  It is also in his Lymph Nodes.  They put him on Tarceva( a pill he took everyday) And after 6-7 weeks, he had tests done which showed it didn't do anything.. the tumor has grown.  They said there is no other options.. no surgery/ no chemo/ no radiation.  Has anyone out there had a similar diagnosis and is there any hope for him.  I want a second opinion but do not know even where we could go.?

Joann

[HeinrikMD]

Hello again,

I am guessing that he had a platinum salt during the first chemo, then the Alimta, then the third is Tarceva.

In general, this would represent the recommended treatment options for lung cancer. There are no clear guides as what drug is best after 3 lines of therapy, hence the reluctance to recommend any treatment.

I am also guessing that the adrenal involvement cannot be removed with surgery, hence, this is not given as an option. You are right, that there are some people who even have brain involvement and undergo surgery, but these cases are really the exceptions more than the rule.

The direction of treatment at present I think is to limit symptoms, as there is no proven therapy to prolong life at this point. Discuss the goals of treatment with the doctors.

[jojokdz]

He works full time and he is a musician in which he is out playing every weekend.. So far he is able to do this.  There are times when he crashes.  During the week he comes home from work and sleeps in his chair until he gets up and goes to bed.  I can't remember the chemo drugs names.  All I know is he had Alimta when we first found out he had The tumor on his Adrenal Gland.  And it didn't work.  So he just took Lyrica for pain actually from his first surgery.  His weight is good and his appetite is excellent.  We just can't except that this is all they can do... no trying anything other than a clinical study?  When you say a University Hospital... we have Buffalo General and ECMC near us.  There is the Srong Hospital in Rochester..  We just want to get a second opinion.  I just don't know why they can't do surgery?  Or just do more chemo?   Thanks again!     JOANN

[HeinrikMD]

Hello again,

Is he up and about more than resting during his waking hours? If he is pretty  much confined to bed, then other chemotherapy options may worsen rather than improve outcomes.

What were the medications given before? Would you remember them?

If you are looking for another doctor, you could consider going to a university hospital,as these training institutions tend to have a cancer center and hence more oncologists.  

[jojokdz]

After we found out about the Pancoast tumor, he had radiation/chemo and did well.  He did have a reaction to one of the chemo drugs so they changed it.  Hardly no side affects.  They removed the tumor and a year later it returned to the Adrenal Gland.  He did have more chemo, then finally the Tarceva.  She said that it didn't stop the tumor from growing but it is a very slow growing tumor.  We asked about radiation/chemo/surgery and she said this was not a option.  But I read on here about others who had Lung cancer that went to the Adrenal Gland and brain etc.  and they had surgery or radiation?  Also do you know of a Doctor up here near Buffalo New York other than Roswell Hospital that we could go for a second opinion.?  Thanks for your help!

Joann

[HeinrikMD]

Hi,

You can discuss the option of trying some other form of chemotherapy. This would be dependent on how well he is able to do his daily activities (this is taken as an index of the burden of disease, meaning how much the disease is affecting his daily living), as patients who are very frail may not be able to tolerate the side effects of cytotoxic chemotherapy. Since he had some treatment before, then he would have some insight into how well he was able to tolerate the treatment before. If the choice of the Tarceva was based on this poor tolerance, then there are indeed no clear treatment options as to what to do.

One thing to bear in mind though is that the goals of treatment at the present time are likely different from before. Before, there was probably a goal of cure, this time, the treatment may be able to extend life, but would not be likely to free him of lung cancer. This means that controlling the disease is temporary - though there is a wide variability as to how long this actual time period is.

A second opinion is a good idea, but make sure that all the details are made available to the next doctor.

Stay positive.