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Chemo for Lung Cancer Archive Questions

Below are Dr. Edelman’s answers to Chemo for Lung Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 77.

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Q : 1

If lung cancer is often detected by X-rays accidentally, why is it not a part of a yearly exam like mammograms?

While lung cancer is detected occasionally on chest X-rays ordered for other reasons, controlled trials have consistently failed to demonstrate a benefit for routine chest X-rays. Recently, the National Lung Screening Trial (NLST) demonstrated a benefit for low dose spiral CT scans in high risk patients (smokers, former smokers, over age 55) who were evaluated in experienced centers. This has led some professional organizations to recommend CT scans in similar populations.

Q : 2

If the biopsy sample obtained from a NSCLC lung cancer patient is insufficient for further typing, what does an oncologist typically do? Request a repeat biopsy? Use whatever sample is available for mutation testing? Or handle it the same as a NSCLC-NOS resulting from inconclusive tissue marker IHC data?

It depends on the purpose of the biopsy. If surgery is anticipated, then there is no need for an additional biopsy. If the patient has advanced disease and chemotherapy or other systemic treatment is contemplated, then additional biopsy should be considered, as it may change the choice of regimen.

Q : 3

Does the timing of sample collection change the interpretation of pleural fluid cytology in lung cancer?

Pleural fluid cytology can be falsely negative if too much time elapses between the sample collection and fixation for cytology. In general, if a patient has a diagnosis of lung cancer and the pleural fluid is high in protein and/or white cells in the absence of other reasons (e.g. infection, recent instrumentation), then it is considered positive even in the absence of malignant cells.

Q : 4

Are you familiar with the use of somatostatin to medically treat carcinoid tumors in the lungs (regional metastases from one lung to the next and lymph node positive on one side as indicated by bronchoscopy)? Does anybody with a primary tumor that is operable ever choose somatostatin therapy (where the masses/nodules are octreotide positive) over surgery? Or is surgery the standard of care?

Surgery is the standard of care for potentially curable disease.

Q : 5

I am a 51-year-old male, slightly overweight but healthy overall. I have never smoked, have never worked around hazardous chemicals nor have I traveled to places where TB is a risk. Just last week during a routine physical my doctor did a baseline chest x-ray. The x-ray showed a faint nodule density, 1.7 cm, on my upper left lung. I am having a follow-up x-ray this morning to determine if this is, in fact, a nodule, or a shadow or the tip of a rib. What is the likelihood that this nodule could be a malignancy?

A lot depends upon the character of the nodule and whether it has been present previously. It is important to compare to older films if available. If not and the nodule is confirmed, then a CT or CT/PET is indicated. Depending upon the findings, appropriate management can include observation with sequential scans, biopsy, or resection. While lung cancer in never smokers is much less common than in smokers, it is not a rare disease (>20,000/year in the US; about 10-15 percent of all lung cancer). Therefore, this needs to be taken seriously.

Q : 6

My mom recently found out that she has cancer of the lung. There are 30 or so nodules in various places. They say it may have spread from her colon cancer that was detected 7 months ago. She is 45 and in relatively good health. What are the likely treatment methods and what are her chances?

This sounds like metastatic colon cancer as opposed to a primary lung cancer. If there is any question, then a biopsy should be performed and compared to the prior specimen. She should be seen by a medical oncologist as the correct treatment is systemic chemotherapy. Prognosis depends upon a number of issues, including other health issues, extent of disease and current symptoms and should be discussed with the oncologist.

Q : 7

I had lung surgery 7 months ago and just finished radiation and chemo. The tumors are gone, but I have excruciating pain on my right side. My doctor said the nerve was cut during surgery. Can a cut nerve be repaired? I have been referred for pain management and was told that physical therapy wouldn't help. Do you have any additional suggestions?

Pain after lung surgery (post-thoracotomy pain) can be a very difficult problem. It is not a matter of a single cut nerve and cannot be repaired surgically, though sometimes nerve blocks (anesthetic) can be useful. There are a variety of approaches that can be taken, including drugs, physical therapy and nerve blocks. I agree with the referral to pain management.

Q : 8

I have developed lung cancer from smoking. I have shown improvement with chemo, but was wondering if having a CT scan, PET scan or MRI could create any unwanted side effects if they're all done within a 4-6 month period.

There are no significant side effects from scans. Occasionally patients may experience reactions to the contrast agents utilized, i.e. allergic reactions, kidney problems and other rare complications. Scans are needed to assess the disease status and to determine when additional therapy is needed.

Q : 9

I am a 68-year-old woman and have a spot on the right apex of my lung. A CT scan revealed that it was just scar tissue. I smoked for 32 years and quit smoking in 1994. Should I periodically have a CT scan to monitor the scar tissue? If so, how often? Can scar tissue cause lung cancer?

A lot depends upon the prior scan. If the area is clearly not suspicious, than no further evaluation is needed. However, if it was read as a nodule or another abnormality, follow up for 2-3 years is recommended to assure stability. The recent results of the National Lung Screening Trial indicate that there is a benefit for periodic CT scans (up to three) in patients who are in your age group and have a significant history of smoking. You should discuss this with your doctor.

Q : 10

I am a 47 year old female, non-smoker. A few years ago, a 5mm lung nodule was found. This was followed for two years with CT scans which revealed that the nodule was stable. On the final scan, a new 3mm nodule was found but it has remained unchanged for the last year. My doctor thinks that I should have another CT scan to ensure the stability of the nodule. I have had many CT scans for other problems and am concerned that I have been exposed to too much radiation. Is it worth the risk to have yet another scan?

It is difficult to answer this question without actually reviewing the scans. You are clearly a relatively low risk patient. However, it is important that stability of pulmonary nodules is demonstrated and the risk of one additional scan is minimal.

Q : 11

My mother and two sisters have lung cancer. Is there anything I can do to reduce my chances of getting it?

Do you smoke? If you do, the first thing you should do is quit smoking. There is no proven value to herbal medications. Once you are no longer smoking, there may be value to the use of low dose aspirin. However, this should only be done under medical supervision as there are risks (gastrointestinal bleeding). Also, the use of low dose CT scanning has been demonstrated to reduce deaths from lung cancer. However, the first and most important thing is not to smoke.

Q : 12

My cousin who is 67 was just diagnosed with inoperable squamous cell carcinoma of the lung. PET and CAT scans revealed a large met in the pelvis and smaller mets in the tibia. How is it possible to reach such an advanced stage without symptoms?

Unfortunately, this is quite common in lung cancer as well as many other malignancies. Forty percent of lung cancer patients have stage IV disease at diagnosis and another 40 percent have locally advanced (stage III) disease. While it is possible that new approaches to screening may change these numbers somewhat, even the screened population had a significant frequency of death due to lung cancer. This is a disease that metastasizes relatively early.

Q : 13

I was diagnosed with Stage 4 Lung Cancer in March. I may be interested in learning about you clinical trials. How do I proceed?

We have a large menu of clinical trials in advanced lung cancer. Eligibility depends upon stage, prior therapy, organ function and your overall physical condition. Your doctor can refer you for evaluation by calling 410-328-7904.

Q : 14

What can you tell me about pulmonary toxicity caused by the drugs Alimta, Avastin or Carboplatin? Last year my fiance began treatment for stage IV non-small lung cancer using these drugs and developed worsening breathing symptoms. He was also on 2 liters of oxygen at home. It is very difficult for him to do everyday activities. He is in remission and his doctors have suggested that the chemo may be the cause of his breathing difficulties. What do you think?

There are many reasons for shortness of breath in patients with lung cancer. The most common causes are worsening disease, underlying (ie.non-cancer) lung disease related to smoking, blood clots and heart disease. None of the drugs are prominently associated with pulmonary toxicity, but many drugs can cause lung damage as a rare reaction.

Q : 15

If doctors discover a spot on your lung through X-Ray, does this automatically mean cancer?

No, many individuals have abnormalities on chest X-rays. Depending upon your physical exam, risk factors, symptoms and whether the abnormality was present on previous X-rays, further evaluation may need to be done. This could include CT scans, PET scans etc. Ultimately, the determination of cancer requires a biopsy.

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