Surgery for Stage IIIB Non-Small Cell Lung Cancer (NSCLC)
Our mother was just told that she has stage IIIB poorly differentiated non-small cell lung cancer. They cannot do surgery because it is too close to her aorta. We live in a small town and we are wondering if there is a chance that if we went to a larger hospital, or to a different doctor in a bigger town that they may consider doing surgery to remove the tumor? We are also looking for survivor rates for people with lung cancer. Any help that you can give us would be appreciated.
Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds:
Patients with non-small cell lung cancer whose primary tumor invades the aorta, great vessels of the heart, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or other central mediastinal structures are not considered candidates for potentially curative surgical resection. In these cases, the risks of surgery can be substantial, and it is very difficult or impossible to remove all of the cancer with a surgery due to the tumor invading into these critical normal structures. If your mother was told that she has IIIB cancer and has disease too close to her aorta, she likely has aortic invasion by the tumor, as well as evidence that the cancer has spread, or metastasized, to lymph nodes in the center of her chest or beyond (T4N2 or T4N3). Patients with N2 or N3 nodal metastasis are also often not candidates for curative therapy. The most commonly pursued treatment for patients with either T4 tumors or N2-N3 disease is chemotherapy and radiation therapy, often given concurrently.
However, you may consider asking the surgeon how he knows that the tumor is invading your mother's aorta. Although her tumor may appear to be invading the aorta on a CT scan of the chest, these studies are often difficult to interpret unless the invasion seen on the scan is indisputable. An MRI of the chest and other specialized studies can help to sort this out. Having a radiologist and surgeon both experienced in thoracic oncology review the imaging can be important, and getting a second opinion can always be worthwhile. If her tumor does not actually invade the aorta and her mediastinal lymph nodes do not have cancer in them, she likely has a less advanced cancer stage than IIIB, and she may still be a candidate for surgery. Lung cancer survival is stage dependent, so it is hard to give you a cure rate until we know whether she has been accurately staged. If she truly has stage IIIB disease, the cure rate, unfortunately, is less than 10%, and the median survival is only 10 months. There is, of course, a wide variety in survival depending on how good your mother's performance status is, if she has had significant weight loss recently, and other patient and tumor factors. If the tumor does not invade the aorta, however, her cure rate can be significantly higher.