Chemotherapy and Radiotherapy vs. Surgery

OncoLink Team
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 7, 2013

Question

Yesterday, my father was diagnosed with adenocarcinoma type of non-small cell lung cancer. A tumor the size of a lemon was found on his right lung and found to have spread to his lymph nodes. He will be receiving more tests next week to determine if has spread to his brain. The doctor recommends starting chemotherapy twice a week, every three weeks without removal of the aforementioned tumor.

I have read your list of "frequently asked questions" and it is my understanding that someone with an expertise in lung cancer surgery should give my father an examination. My mother and father although have although already "decided" not to see another doctor saying that they already have a "good doctor". Also, on the same token, my mother and father have refused an opportunity to have an examination at a major cancer institute.

Of course I believe that my father is seeing a "good doctor", but I would like my father to keep an open mind with regard to his treatment. Please let me know how I can honor my father's decision not to see other doctors but also make sure that he receives the best possible care.

Answer

Joseph B. Shrager, MD, Thoracic Surgeon, responds:

It is not clear from the information that you have given whether your father would be best served by chemotherapy and/or radiotherapy alone or if he is a potential candidate for surgery. First, if he has involvement of his lymph nodes by the cancer, I would make sure that this has been documented by obtaining tissue from the lymph nodes by a biopsy. Sometimes, it is assumed that enlarged lymph nodes on a CT scan or PET scan mean that they have cancer in them, and this is not always the case. Secondly, if he does not have other severe medical problems, and if his lymph node involvement is only minimal (i.e., only on the same side of his chest as the tumor, and with the nodes being only slightly enlarged but not bulky), then he may benefit from surgery after chemotherapy. You could pose these questions to your father's current doctor, and if you are not satisfied with the answer, he should be seen elsewhere to render an opinion. It is always a great idea to get the opinion of a surgeon, as well. However, I am sure that this is a very difficult time for your father, and supporting him and his wishes is also important. I hope this will be of help to you.