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- Mon Mar 23, 2009 7:25 pm
My 68 yr old father recently had a CT scan where 3 nodes in his lungs were detected. Based on the results (shown below), the oncologist is suggesting for him to have his chemotherapy port reimplanted for treatment. No biopsies have or will be taken due to the size of the masses (to small to biopsy according to doctor).
I have a few questions:
1. Please correct me if I am wrong, but based on the results, this is stage 1A. At such an early stage, where it has not yet affected the lymph nodes, is it reasonable to administer chemotherapy? Aren't there more efficient ways (i.e. RF ablation, cyberknife, etc.) to destroy these cells?
2. Is chemotherapy unavoidable in this situation? I don't know too much about cancer, but if the cancer has not spread into the lymph nodes, why use a systemic form of treatment like chemotherapy when we can go with a localized approach like RF ablation? Is it because such alternative treatments are too risky? I understand chemotherapy is used as a preventative measure, but is it really worth it in terms of the damage endured by other systems in the body?
3. How quickly should his CEA levels drop in order to determine that treatment has been effective? Is this a treatment-dependent response?
Here are the results:
Comparison is made to the prior CT of 08/24/2007
There is interval worsening with the appearance of three separate pulmonary nodules. The largest is in the left upper lobe measuring 1.4 x 1.3 cm. The next largest is also within the left upper lobe posterior segment. This measures 1.1 x 1.1 cm. The smallest is within the right middle lobe measuring 1.0 x .8 cm. There is no consolidation. No bronchiectasis. No pleural effusion no pericardial effusion. There is no mediastinal or hilar lymphoadenopathy. There are no lytic or sclerotic bony lesions.
Interval development of three separate metastatic nodules as described in the involving the left upper lobe and right middle."
Your help will be greatly appreciated! Thank you so much in advance!
| Dr. Tamer Fouad
- Sat Mar 28, 2009 11:39 am
I am sorry to hear about your father. After reading your post, I think it would be wrong to assume that this is lung cancer. Rather this is colon cancer that has returned and spread to his lungs. As such, the good news is that his doctor thinks that his condition is good enough to warrant chemotherapy.
Usually chemotherapy is used when any cancer has spread (metastasized) since the only way that it would have reached the lungs is by spreading through the blood. Hence, it makes sense to give treatment in the form of chemotherapy that ultimately reaches the blood.
Again, depending on an elderly patient's condition several chemotherapy options are available depending on how fit he is and what therapy he has previously received.
FOLFOX or a similar regimen FOLFIRI are the usual options for fit elderly patients. Infusional 5FU/LV is another option. Capecitabine (Xeloda) oral capsules are another valid option for those less likely to tolerate combination chemotherapy. Many avoid bevacizumab (Avastin) in elderly.
Several other options are available for second line chemotherapy which include cetuximab (Erbitux) and panintumumab (Vectibix).