Navigating Stage 3 Lung Cancer Treatment: Key Questions and Concerns

Issues regarding treatment for stage 3 lung cancer...! A decision on whether to proceed with targeted therapy needs to be made in the next two days?

The father is 60 years old and has been experiencing swelling in the jaw and neck (so severe that the neck is almost not visible) along with shortness of breath.
He was admitted to the emergency room in early October this year.
The next morning, the doctor indicated that he had neck inflammation and needed immediate surgery.
In the afternoon, we were informed that there were shadows in the chest, indicating lung cancer affecting both the right and left lungs as well as the lymph nodes.
The tumor in the right lung has grown to 5 cm, compressing the cardiac venous vessels, which has caused upper body edema and subsequently shortness of breath (can compression of the cardiac venous vessels cause shortness of breath?).
During this period, he has been provided with oxygen, corticosteroids, antibiotics, and diuretics (are there other methods besides diuretics to reduce edema? What are the side effects of diuretics?).
The next step in treatment is a biopsy for cancer.
The father underwent a thoracoscopic needle biopsy, but no cancer cells were obtained.
The attending physician then suggested a surgical biopsy under general anesthesia, but this was postponed due to the father's arrhythmia and other issues.
Currently, the father has received 15 sessions of radiation therapy, but the 5 cm tumor has neither increased nor decreased in size.
The attending physician has noted that the father has insufficient hematopoiesis, which may be due to radiation therapy damaging the bone marrow and affecting blood production, so radiation therapy has been halted, and the father has been given a blood transfusion.
However, during the first transfusion, he did not receive antihistamines, resulting in a severe allergic reaction, leading to confusion and tremors, which only resolved the next day (will this cause long-term side effects?).
The second transfusion was administered with antihistamines and proceeded normally.
The attending physician has noted that the father has fluid in the lungs, the edema has not improved, and he has a slight fever, so targeted therapy will be implemented for 7 days (can targeted therapy be administered without a cancer biopsy? If targeted therapy is incorrectly judged and the wrong medication is used, what could be the consequences? Has the father's condition deteriorated? I discussed with the attending physician that there seems to be no way to avoid chemotherapy, but it feels like the physician is insisting on chemotherapy...).
Is the father’s condition suitable for management by a hematologist? Are there any inappropriate aspects of the treatment methods mentioned above? Please respond, Dr.
Chen...
Thank you.

Xiong, 30~39 year old female. Ask Date: 2009/11/12

Dr. Chen Junyi reply Oncology

In theory, treatment should proceed only after obtaining a definitive pathological report.
However, due to the more tolerable side effects of targeted therapy, the attending physician may decide to initiate treatment in critical situations.

Reply Date: 2009/11/12

More Info

Navigating the complexities of Stage 3 lung cancer treatment can be overwhelming, especially when faced with multiple health issues and treatment options. Your father's situation, characterized by significant swelling in the neck and jaw, respiratory distress, and the discovery of lung cancer with lymph node involvement, presents a challenging clinical picture.
Firstly, the swelling in the neck and jaw, along with respiratory difficulties, can indeed be attributed to the compression of the superior vena cava (the large vein that carries blood from the head, neck, and upper body to the heart) by the tumor. This condition, known as superior vena cava syndrome, can lead to significant complications, including respiratory distress, as it impairs venous return and can cause fluid accumulation in the upper body.

In terms of treatment, your father's management has included oxygen therapy, corticosteroids, antibiotics, and diuretics. Diuretics are commonly used to manage fluid retention, but they can have side effects such as electrolyte imbalances, dehydration, and kidney dysfunction. Other methods to manage edema may include dietary modifications (like reducing salt intake), compression garments, and in some cases, therapeutic paracentesis or drainage procedures if fluid accumulation is significant.

The decision to perform a biopsy is critical in determining the appropriate treatment plan. While your father underwent a thoracoscopic biopsy that did not yield cancer cells, the recommendation for an open surgical biopsy may be necessary to obtain a definitive diagnosis. However, the risks associated with anesthesia and his existing heart rate irregularities must be carefully weighed.

Regarding the radiation therapy your father has received, it is not uncommon for tumors to remain stable in size during treatment. The concern about bone marrow suppression leading to anemia is valid, as radiation can affect hematopoietic cells. Blood transfusions are a common remedy for significant anemia, but allergic reactions can occur, as you experienced. The administration of premedication for allergic reactions is standard practice to mitigate such risks.

As for the initiation of targeted therapy without a confirmed biopsy result, this is generally not advisable. Targeted therapies are designed to act on specific genetic mutations or markers present in cancer cells. Administering the wrong targeted agent could lead to ineffective treatment and potential side effects without any therapeutic benefit. It is crucial to have a clear understanding of the cancer's molecular profile before proceeding with targeted therapy.

Your father's current condition, including the persistence of symptoms and the need for further interventions, does suggest a need for close monitoring and possibly a reassessment of the treatment strategy. Engaging a hematologist or an oncologist specializing in lung cancer may provide additional insights and options, especially if there are concerns about blood disorders or the need for more specialized care.

In conclusion, it is essential to maintain open communication with the healthcare team, advocate for thorough diagnostic procedures, and explore all available treatment options. Support from family and friends, as well as mental health resources, can also be invaluable during this challenging time. Your father's health and comfort should be the priority, and any treatment plan should be tailored to his specific needs and circumstances.

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