Lung Cancer, Stage 1b

My brother, who is 57 y/o was recently diagnosed with lung cancer stage 1b (5cm) and the oncologist recommended adj chemotherapy of 4 sessions./ 12 wks. We are in the process of seeking a second opinion at Sloan Memorial in NYC. With so much information on various websites, it's confusing what to go by, as some sites state that chemo with 1b is not indicated. Also, he is an albino and we are concerned about the side effects of chemo (platelet) level.

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In Nov. 2006, my husband was dx Stage 1 B. He has surgery at NYU (Dr. Harvey Pass) and subsequent to surgery Adjuvant Chemo at NYU (Dr. Abe Chachoua). My husband has been NED ever since. I am very glad he had the Adj. Chemo even though it was an ordeal. Good luck to your brother.

BTW, our ins. (the Cancer Resource Network) provided FREE cancer care at Sloan. We chose to PAY our 20% and deductibles at NYU because we were so very impressed with Dr. Pass. If you are looking for a second opinion, I suggest you consider the NYU Cancer Center.

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My husband was diagnosed with stage 1B NSCLC. He had surgery FIRST and IMMEDIATELY to get it OUT! Then he had chemotherapy.

He remains NED after 2 1/2 years. Thank you God!

It is a special blessing to find LC at such an early stage.

Love and blessings to your family.

Khari

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Depending on where it's located, the chemo may be necessary first before surgery for shrinkage and to make it easier to remove. Go for that second opinion. It never hurts. Good luck to you all. Take care, Judy

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If the cancer is truly at 1b there will be no need for chemotherapy before surgery, and indeed the science is not strong in relation for the need for post-operative chemotherapy.

In this unique case, I would certainly be seeking a second opinion.

Further, many experienced medicos would recommend having his circulating tumour cells examined to see if there are sufficient numbers to justify any further treatment post surgery.

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Thanks so much for your responses. I don't feel so alone in this journey. This is a great forum.

ACS: did you have chemo, and if so, what stage were you in? I am going to ask the second doctor at Memorial Sloan Kettering about examining his circulating tumor cells.

D1: It's great that your husband has been NED since 2006. BTW, what size was his tumor? I wonder if doctors recommend chemo for Stage 1b based on the size of the tumour; my brother's is 5cm. According to the first doctor, who is affiliated with Mt Sinai in NYC, his tumor is off by 1cm, which would then place him in the Stage 2A category.

Overall, i am concerned of the side affects of chemo in light of his albinism.

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Hi I was diagnosed with stage 1b LC 2 years ago. My tumor was 11 cm. Had my left lung removed at Moffitt in Fla. Had 3 opinions, 1 at Sloan. They all said chemo because of the size. Took cisplatnum and gemzar. The side effects were not fun but glad that I did it. Only problem I have is hearing loss from the cisp. NED 2 years. Hope this helps and good luck. K

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Thanks so much Kammy7. Your response was helpful. What other side effects did you have? How soon did you recuperate from chemo and go back to a normal life style, physically, etc?
thanks

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I was 1b and had a lobectomy .was told no need for follow up treatment .that was 3 years ago and i have been clear of cancer since Ihave x rays every 6 months no scans .

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Read a few studies about this when I was diagnosed 1a. I decided not to have adjuvant chemo, but also decided that if I was 1b, I would. Here's the conclusion from one study: Adjuvant chemotherapy significantly reduces all-cause and lung cancer mortality in stage IB NSCLC." (Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 7019).

I did some quick research and found a more up to date source that said (sorry for the length): "Adjuvant chemotherapy, with or without postoperative radiotherapy, improves survival in patients with operable non-small-cell lung cancer, according to a March 24th online report in The Lancet.

“Meta-analyses showing significant survival benefits with adjuvant chemotherapy have included many trials and patients,” said Dr. Sarah Burdett, from MRC Clinical Trials Unit, London, and her coauthors. “We aimed to assess the effects of adjuvant chemotherapy, with or without postoperative radiotherapy, in two new comprehensive meta-analyses of individual patient data.”

The first meta-analysis, which compared surgery plus chemotherapy versus surgery alone, featured 34 trial comparisons with 8447 patients (3323 deaths). Surgery plus chemotherapy increased 5-year survival from 60% to 64%.

The second meta-analysis was similar to the first except that patients in both treatment arms also received radiotherapy. In this analysis, based on 13 trial comparisons and 2660 patients (1909 deaths), adding chemotherapy to treatment improved 5-year survival from 29% to 33%.

The type of chemotherapy, patient subgroup, and other trial characteristics had minimal impact on the results in both analyses, the report indicates.

“Today’s meta-analysis adds further support to the use of adjuvant chemotherapy in patients with resected non-small-cell-lung cancer,” said Dr. Gregory P. Kalemkerian from the University of Michigan, Ann Arbor in a related editorial.

He added, “Although the survival benefit seems small, worldwide adoption of adjuvant chemotherapy could save up to 10,000 lives every year.”

Hope this helps

Courage

Chum

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Kentmere
thanks for your response. BYW, what size was your tumor?

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I was diagnosed with nsclc, stage 1B in Feb '09 ( 3.2 mm). I had surgery to remove my right, lower lobe in March '09. One local oncologist suggested chemo treatment. I went to the Mayo Clinic for a second opinion and they said no chemo. I have been ned 17 months. I get a scan and dr. followup every 4 months for 2 years then probably every 6 months.

Get a second opinion for sure. Every person is different. Find a doctor you trust and get all the info you can.

Good luck.

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Sorry for the mistake. My tumor was 3.2 cm.

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10/08 IB 4.5 cm no chemo NED. Chemo is controversial for people who have tumors less than 5 cm. Keep in mind most of the older studies out there were before they changed the staging system, and IB included larger tumors also. Trouble is, 5 cm is right on the borderline. When i was dx, many drs were using 4 cm as the cutoff, but many were still recommending chemo for all IB patients.

ACE is right. The science is not strong. Check out my profile for additional reading. The one study that did seem to show significant improvement in 5-year survival with chemo also showed, at follow up beyond 5 years, more people were alive who did not have chemo.

In the end it's a personal choice between chemo and using your own natural defenses through adequate sleep, diet, exercise and stress management. Sometimes, drs give you limited info about studies, leaving you to make the decision. When this happened to me, my husband asked the surgeon whether he would have chemo if it were him, and he responded no. Good luck.

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NoAccident:
Thanks so much. Your information was very helpful, as well as the article.
haydee

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I tend to agree with ACS about there may not be any need for post-operative chemotherapy.

The Lung Metagene Predictor is a genomic test that is supposed to tell physicians which lung cancer patients will benefit from chemotherapy and which ones do not need to be unnecessarily exposed to toxic chemotherapy cocktails.

And accurately counting CTCs in blood to see through the gray zone between an effective course of therapy from one that is futile, is another new testing procedure. The results of the CellSearch technique can help to identify and enumerate CTCs, cancer cells that detach from solid tumors and enter the bloodstream.

These tests doesn't predict which patients will benefit from chemotherapy (i.e. which patients are chemosensitive or chemoresistant). Rather, it's like the Oncotype Dx test, which identifies patients who are unlikely to have a recurrence if treated with surgery alone. If you aren't going to have a recurrence, you don't need chemotherapy.

If the genomic test can help to find out if a cancer patient will benefit from chemotherapy or not, and if if a patient is in the "high-risk" group, the few who would benefit from chemotherapy can then be pre-tested with cellular tests to see what treatments have the best opportunity of being successful, and offer a better chance of tumor response, resulting in progression-free survival, while the rest of the group can be spared the unnecessary toxicity, particularly associated with ineffective treatment.

The combinations of these tests have enormous implications for the short-term future of cancer research in general, and is one of the truly great cancer breakthroughs of our time. For some cancer patients, chemotherapy is not really beneficial. There was no adequate information on who would recur. Hopefully, the new genetic tests (Oncotype DX, MammPrint, Lung Metagene Predictor, CellSearch and others) will weed out these patients.

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Thanks gpawelski for the thoughtful response and information. I will take all of this into consideration and discuss further with oncologists.

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I was diagnosed 1B in 2006. I had surgery and chemo after. I too thought about turning down chemo but after going home and researching side effects etc agreed to try it ( best chance to prevent return so why not) I was told that there was no need to have nausea as there were lots of drugs available - if one didn't work call and get another I did and had no significant problem with nausea. All my counts were checked every week for the 12 weeks. On Sunday my bloods were done ..if they were ok I proceeded if they were low ( it happened twice) we delayed treatement 1 week. I was given a protocol sheet. If temp went over 100 F I was to report to emerge with sheet which listed proecedure and tests to be run. This did happen and emerge doc couldn't say enough about benefit of the sheet. Because immune was so low they isolated me and followed the protocol to the letter and I was fine. other side effects were mild neuropathy in feet, and the most significant side effect was fatigue which was taken care with regular naps. A bit of chemo fog re memory my hair thinned but I never lost it all, Chemo is different for everyone but it wasn't nearly as bad as I thought it would beand the nausea drugs worked great. If I needed it again this time I wouldn't hesitate.

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my husband had a 2 cm nslc adenocarcinoma poorly differentiated. he had his left upper lobe removed. After seeing 3 oncologists, 2 local and 1 at Fox Chase in Phila. it came down to a personal choice. Because the tumor was touching the pleura and because statistics showed a 6% survival increase my husband decided to have chemo. One thing we were told was that poorly differentiated is more aggressive so you may want to get a copy of the path report before you make your final decision.
good luck

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tumour was 4 c m .Now i really look after myself .i swim 3 times a week go to the gym and eat only healthy fresh food i think this is so important .Ifeel so lucky i was able to have the operation .my health has been brilliant since .Hope you manage to make the right decision x

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yes the staging is based on the size of the tumor between 1a and 1b...The is an article on the web that discusses the criteria for staging..Google it...Most docs. recommend chemo. for 1b and not for 1a.....I had 1a and therefore no chemo., but I always wonder maybe I need it....It's a double edge sword I think!!! Don't know about how chemo. affects albinos, if it does...That would be what you need a real specialist for, someone who has dealt with that.
Good Luck to Your Brother, Laura

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