Transcript
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Janet Freeman-Daily:
So we’ve talked a bit about diagnosis. Let’s talk a bit about treatment. What are the treatment options for people with early stage lung cancer? So I—I’ll start with Nisha.
Dr. Mohindra:
So early stage can mean anything from I would say stage I to stage III. And that, basically, comes down to the size of the tumor and what lymph nodes, if any, are involved. And when we look at our early stage patients, what we’re trying to decide is is there a role for surgery, how best to try to possibly cure a patient, if that’s in the realm of what we can do. And I—I’ve let Dave kind of take it. But stage I and II, often, we go for surgical resection if that’s feasible. If not, then Tim may be involved with radiation.
And our stage III, that’s where a lot more of the multidisciplinary approach comes in whether this is a patient that could get surgery after some chemotherapy or whether they’re better served with radiation and chemotherapy together.
So it’s the question of can we cure it and how do we go about doing that?
Janet Freeman-Daily:
Okay.
Dr. Odell:
I think framing it as stage is something that we all intrinsically do as clinicians because the stage is kind of our playbook for treatment. I think at—at—at a conceptual level, it really is very simple. If you have a—if you have disease that’s kind of confined in one area, in this case, disease that’s confined in the lung, then a localized treatment has the potential to be very effective to remove that area of disease, and, to the best of our ability, free the rest of the body from that. And a lot of our testing beforehand is trying to figure out is this disease confined in that local area of the lung? In which case, then it becomes a kind of technical question of can we take it out?
If we take out that area and that area of lung around it, is the patient going to have enough residual lung function to be able to breathe and do the things that they need to do? If that disease has spread beyond the area locally in the lung, doing something locally only is not going to necessarily provide the greatest benefit, because you will still leave disease behind in other parts of the body.
And that’s where we talked about more systemic treatments like chemotherapy to try to sterilize as much of that disease. Sometimes, with the goal of downstaging, bringing it back to where we can talk about an operation or talk about…
Janet Freeman-Daily:
Downstaging is?
Dr. Odell:
Downstaging is, basically, taking areas where we’ve seen evidence of disease outside of the primary site, outside of the lung, and clearing it of demonstrable disease, so very simple, granular example. If you have a lymph node along the airway that’s positive on a biopsy, giving chemotherapy, perhaps giving radiation as well to sterilize the lymph node treating the body systemically to sterilize any tumor that’s—that’s left the local area, reassessing it either with imaging or with another biopsy.
And if we’ve rid—we’ve rid that area of cancer, then, being able to come back and think about surgery to deal with the local problem.
Janet Freeman-Daily:
Is removing a lymph node surgically the only option? Or you mentioned sterilizing it with radiation.
Dr. Kruser:
Well, yeah. To—to kind of dovetail what Dave was saying, when talking about localized or early stage disease, surgery and radiation are both local modalities whereas chemotherapy goes everywhere. So it’s often a combination, or a discussion between whether surgery or radiation is preferable for a patient with early stage disease or some combination. And it just depends on the patient, their—their medical problems they might have, where the disease is, how advanced within the chest it might be. So those—that’s why a multidisciplinary discussion is—is needed for early stage patients.
Published By :
Patient Power
Date :
Nov 18, 2016
