We are now considering obtaining a second opinion from the London Oncology Clinic.

Additionally, here is some information my sister has managed to gather to aid us in our decision as to what route to take.

Stage 4 (Cancer Research)

Stage 4 is the most advanced stage, where the cancer has spread. Understandably, the survival statistics are lowest for this stage. Unfortunately, lung cancer is often diagnosed late. Almost half of all those diagnosed with non small cell lung cancer already have stage 4 disease.

People diagnosed at this stage are mostly treated with chemotherapy to relieve symptoms. Between 15 and 35 out of every 100 people (15 – 35%) treated for stage 4 lung cancer will be alive a year later. For those not fit enough to have chemotherapy treatment, this figure drops to about 10 out of every 100 people (10%).

On average, only about 2 out of every 100 people (2%) diagnosed with stage 4 non-small cell lung cancer would be alive 5 years later.

Commonly used Cisplatin, Carboplatin & newer one Gemcitabine (Gemzar). Find out which they will use in the the local hospital.

In June 2001, the National Institute for Clinical Excellence (NICE) recommended that chemotherapy should be considered for people with non small cell lung cancer who were not likely to be cured of their cancer. They say that chemotherapy with either gemcitabine, paclitaxel (Taxol) or vinorelbine, together with a platinum drug (for example carboplatin or cisplatin) should be the first choice for people with advanced non-small cell lung cancer (stages 3 and 4), as these are likely to be the most effective drugs. If you have had chemotherapy before and the cancer has continued to grow or spread, they recommend treatment with docetaxel (Taxotere). Your doctor will talk to you carefully about the possible risks and benefits of further treatment. Not everyone is suitable for it. It will depend on how fit you are, and how able you are to cope with side effects of more chemotherapy.

In June 2005, erlotinib was licensed in Europe for patients with advanced non small cell lung cancer that has continued to grow despite having chemotherapy. We won’t know how widely available erlotinib will be on the NHS in England and Wales until NICE (the National Institute for Health and Clinical Exellence) publish their final guidance on this treatment. In June 2006 the equivalent body in Scotland, the SMC (Scottish Medicines Consortium) approved erlotinib on the NHS in Scotland for treatment of advanced non small cell lung cancer. Your doctor can only prescribe erlotinib in this situation if you’ve already had at least one chemotherapy treatment before that hasn’t worked. You must also be able to have chemotherapy with docetaxel (Taxotere).

Anaemia – To constantly make red blood cells and haemoglobin, you need healthy bone marrow, as well as iron and certain vitamins. Question what it means by the report on Dads bone marrow, is the cancer causing it?

http://www.tiscali.co.uk/lifestyle/healthfitness/health_advice/netdoctor/archive/002208.html

Unfortunately the chemo drugs Ive mentioned also exacerbate anaemia, need to find how to alleviate it, whether intravenous iron will help or a blood transfusion.

I have posted a little request for more information on www.cancerforums.net. I have been very grateful for the replies received.

Please check out the post http://cancerforums.net/about7167.html

On the 21st August my father, myself and brother in law attended an appointment with the Lung Specialist. It was the news that we were dreading, praying and hoping not to hear. The biopsy results confirmed that the large grapefruit like mass was as suspected a grapefruit sized malignant tumor. The same sqaumous non-small cell cancer cells had been detected as in the brushings obtained during the broncoscopy the week before. The consultant was of the opinion the cancer had been gestating for the last two years.

We felt like the world had ended as the consultant spoke. Then things went from bad to worse.

The consultant showed us the CT scan pointing out the tumor. It looked very big and he was fairly sure that the lymph nodes were infected preventing the first option of the 5 he then gave.

Options:
1. Surgery
The size and position of the tumor as well as the strong possibility that the lymph nodes are affected prevents us from choosing the surgical route. Even if the tumor is removed, the lymph nodes would in time infect the other lung. How much time, well the consultant spoke of months rather than years. Additionally, the tumor is very close if not on the lung lining making surgery an even riskier prospect.
2. Radical Radiation Therapy
This is an option, an option that was given during the panels MDT meeting. The premise being, reduce the size of the tumor and the lymph nodes killing the cancer thus buying more time. The drawback, in the process of doing so, as the lymph nodes are located in the centre of the chest there is a high possibility that the gullet would be permanently damaged rendering my father unable to swallow. In addition to this, there will be some major scarring of the left lung which will impact my fathers breathing and extreme tiredness. The consultant was unable to tell precisely how much, but basically said, ‘some patients can suffer some shortness of breath, others can be wheel chair bound. Chances of success are between 20%-30%, success is an increase of around 4 months life. Before moving forward with this option, a PET scan is required to access whether the cancer has spread.
3. Chemotherapy
As this is sqaumous non-small lung cancer, from past experiences radiation therapy is more effective. chemotherapy can be used perhaps afterwards to kill any existing cancer cells in the body.
4. Gentle/Palliative Radiation Therapy
This is to reduce any symptoms such as shortness of breath and allow my father to improve the quality of life. The aim is not to extend life but to provide a better life. The side effects are tiredness and some shortness of breath.
5. Do nothing
My fathers symptoms will really begin showings and he will most likely survive up to 6 months.

The consultant advised that there was a lot to think about and honestly gave my father between 6-12 months survival. We highlighted that at present the only symptoms my father is displaying is some very mild shortness of breath and daily sweating and some fever. The actual pain is originating from his arthritic knee which he has been treating with painkillers for the last two year whilst waiting for replacement knee surgery.

The consultant agreed with us that the knee is having a large impact on the quality of my father’s life and has decided to write a letter to the knee specialist advising that he urgently progress this as soon as possible before my father begins treatment for his cancer. We are prepared to do this privately if required.

So the plan is as follows:

1. Replacement knee surgery / Make appointment for PET Scan
2. Change my fathers diet drastically to increase the strength of his immune system
3. Begin large dosage of cancer fighting supplements
4. Obtain fathers test/medical records and see consultant at Dove clinic to talk about IV Vitamin C therapy.
5. Once knee is relatively healed, begin mild radiation therapy moving on to radical radiation therapy.
6. Investigate chemotherapy option.

We are also hoping to obtain a second opinion once we have a copy of the medical file.

Today, or yesterday if you look at the time on this entry, my father went through a ct assisted biopsy.

We arrived at the hospital at 10.30am sharp, and the actual procedure took around 20 minutes. As the procedure bore the risk of a punctured lung or air leakage he had to stay in hospital for a further 4 hours allowing the doctors to monitor his pulse and blood presure. After a final CT scan he was given the all clear to go home at 4pm.

My father went into hospital for a blood test today. He is due to have a CT assisted biopsy tomorrow at 10.30am at our local hospital.

A CT assisted biopsy is required to establish 100% whether he has Lung Cancer. At present, they are 95% sure based on samples taken from the lung during a Broncoscopy.

The procedure will entail my father resting under a CT scanner whilst they insert a needle into the tumor through the bottom section of the lung. Thankfully, the said growth is at the bottom of the left lung, this will reduce the risk of a collapsed lung. He will need to stay in Hospital for approx 4 hours after the procedure to make sure he does not suffer any internal bleeding or a collapsed lung.

I’ll be heading over to be with him in the morning.