a****y
发帖数: 91 | 1 国内亲戚得了肺癌,4期有转移,刚做过手术.
大家能建议一下治疗方案吗?有知道在美国这边怎么治疗的吗?
万分感谢! | f****o
发帖数: 2770 | 2 哪一种肺癌?小细胞or 非小细胞
转移到那里
手术是切了什么？ | a****y
发帖数: 91 | 3 小细胞,转移到胸腔壁.晚上问问手术切了什.
谢谢! | l*h
发帖数: 4124 | 4 this begs the question why he was operated on. there is no indication for
surgery if sclc is metastasized to the pleura. pleural metastasis is not
hard to see on CT.
the traditional view was surgery had no roles in the management of sclc.
with the improvement in early diagnosis and of surgical techniques, some
sclc can be operated on, which results in some improvement in outcomes. in
the US, fewer than 5% sclc patients are eligible for surgery.
i heard many late stage sclc patients are operated on now in China. it seems
the "doctors" just seized on the sentence "surgery has a role in sclc
treatment" and don't care about what it means.
【在 a****y 的大作中提到】
: 小细胞,转移到胸腔壁.晚上问问手术切了什.
: 谢谢!
| a****y
发帖数: 91 | | a****y
发帖数: 91 | 6 肺低分化腺癌
手术切去了左侧肺下叶, 有第11组淋巴和胸壁转移, 是IV期. 现在术后在家修养, 等待
下一步治疗.现在有咳嗽, 乏力的症状. 原来没有, 是在术后出现的.
有什么药物或方案可以帮助的?
谢谢!
【在 f****o 的大作中提到】
: 哪一种肺癌?小细胞or 非小细胞
: 转移到那里
: 手术是切了什么？
| f****o
发帖数: 2770 | 7 honestly, i don't know what to tell you. i am sure you know at stage IV,
there is not much we can do.
If the cancer cell has specific mutation, there are erlotinib/gefitinib and
crizotinib that are targted therapy. Only if your relative has those
specific mutation. Those meds are expensive and only prolong survival. There
is no cure for stage IV lung cancer. 5 year survival is only 1-2%
realistic speaking, your relative should do whatever he/she wants to do
while still alive
palliative care/symptom management, such as for pain, GI movement, cough,
fatigue should be incorporated into treatment to improve quality of life.
咳嗽 is very common in lung cancer, is there sputum/mucous or dry cough?
乏力 may be related to anemia, what's hemoglobin level? | g***e
发帖数: 1256 | 8 你是个好心的医生吧。经常看见你的很好的回帖。我不是医生，但是有些关心健康方面
的问题。很赞同你的观点。
我觉得第４期癌症已经是最后的阶段了，病人还不如不做手术而直接进行放疗／或者靶
向化疗，做手术反而更降低生命活力了。
and
There
【在 f****o 的大作中提到】
: honestly, i don't know what to tell you. i am sure you know at stage IV,
: there is not much we can do.
: If the cancer cell has specific mutation, there are erlotinib/gefitinib and
: crizotinib that are targted therapy. Only if your relative has those
: specific mutation. Those meds are expensive and only prolong survival. There
: is no cure for stage IV lung cancer. 5 year survival is only 1-2%
: realistic speaking, your relative should do whatever he/she wants to do
: while still alive
: palliative care/symptom management, such as for pain, GI movement, cough,
: fatigue should be incorporated into treatment to improve quality of life.
| a****y
发帖数: 91 | 9 Thank you so much for all the suggestions!!!
and
There
【在 f****o 的大作中提到】
: honestly, i don't know what to tell you. i am sure you know at stage IV,
: there is not much we can do.
: If the cancer cell has specific mutation, there are erlotinib/gefitinib and
: crizotinib that are targted therapy. Only if your relative has those
: specific mutation. Those meds are expensive and only prolong survival. There
: is no cure for stage IV lung cancer. 5 year survival is only 1-2%
: realistic speaking, your relative should do whatever he/she wants to do
: while still alive
: palliative care/symptom management, such as for pain, GI movement, cough,
: fatigue should be incorporated into treatment to improve quality of life.
| a****y
发帖数: 91 | 10 Yes. You are right. I don't know why the doctor want to do the surgery.
【在 g***e 的大作中提到】
: 你是个好心的医生吧。经常看见你的很好的回帖。我不是医生，但是有些关心健康方面
: 的问题。很赞同你的观点。
: 我觉得第４期癌症已经是最后的阶段了，病人还不如不做手术而直接进行放疗／或者靶
: 向化疗，做手术反而更降低生命活力了。
:
: and
: There
| | | l*h
发帖数: 4124 | 11 since it's adenocarcinoma, it appears there was a justification to have
surgery, if it was to reduce tumor burden without much adverse effects on
lung functions.
the pleural invasion itself is sufficient to put it into stage IV, M1a. in
the US, about 40% non-small cell patients are at stage IV at the time of
diagnosis. the 5-yr survival is around 2%.
future treatment depends on various factors. generally speaking, it should
center on improving the quality of life unless the patient him/herself
strongly wants to do aggressive treatment.
1. search for distant metastasis.
2. adjuvant radiation therapy and chemotherapy. radiation therapy is
underutilized in China, but focused radiation therapy is often very
effective in controlling local lesions, including metastatic lesions,
thereby improve quality of life, and/or maybe also extend survival a little
bit. wide field radiation should usually be avoided. there is usually no
point in pursuing radical chemotherapy, but palliative chemotherapy can
improve patient's quality of life.
3. targeted therapy requires genetic testing. it is expensive, can be
effective for a certain time in patients with the targeted genetic
aberrations, but resistance develops in an extremely high percentage of
patients. once resistance develops, basically nothing works.
【在 a****y 的大作中提到】
: Yes. You are right. I don't know why the doctor want to do the surgery.
| a****y
发帖数: 91 | 12 Thank you so much for all the suggestions!!!
【在 l*h 的大作中提到】
: since it's adenocarcinoma, it appears there was a justification to have
: surgery, if it was to reduce tumor burden without much adverse effects on
: lung functions.
: the pleural invasion itself is sufficient to put it into stage IV, M1a. in
: the US, about 40% non-small cell patients are at stage IV at the time of
: diagnosis. the 5-yr survival is around 2%.
: future treatment depends on various factors. generally speaking, it should
: center on improving the quality of life unless the patient him/herself
: strongly wants to do aggressive treatment.
: 1. search for distant metastasis.
| a****y
发帖数: 91 | 13 大家能再给看看吗?
"现在还在术后修养, 对于术后治疗, 是化疗还是用靶向药物(吉民替尼, 检查出来是基
因突变,可以用这个药)"
真的非常感谢.
【在 l*h 的大作中提到】
: since it's adenocarcinoma, it appears there was a justification to have
: surgery, if it was to reduce tumor burden without much adverse effects on
: lung functions.
: the pleural invasion itself is sufficient to put it into stage IV, M1a. in
: the US, about 40% non-small cell patients are at stage IV at the time of
: diagnosis. the 5-yr survival is around 2%.
: future treatment depends on various factors. generally speaking, it should
: center on improving the quality of life unless the patient him/herself
: strongly wants to do aggressive treatment.
: 1. search for distant metastasis.
| j****d
发帖数: 123 | 14 let me give you a website in China - that shall be your relative's best
information source. There are a lot more lung cancer patients in China, and
some of them and their families are very well educated and experienced, and
you will find that patients are doing better overall in China than in the
USA, thanks to new drugs invented in the US but field tested in China.
http://www.yuaigongwu.com/
I might add - stay away from ignorance and arrogance.
| a****y
发帖数: 91 | 15 Very good website and thank you very much!!!
and
and
【在 j****d 的大作中提到】
: let me give you a website in China - that shall be your relative's best
: information source. There are a lot more lung cancer patients in China, and
: some of them and their families are very well educated and experienced, and
: you will find that patients are doing better overall in China than in the
: USA, thanks to new drugs invented in the US but field tested in China.
: http://www.yuaigongwu.com/
: I might add - stay away from ignorance and arrogance.
:
| l*h
发帖数: 4124 | 16 you should know much of the information on that website is untrue, unethical
or even purely criminal.
【在 a****y 的大作中提到】
: Very good website and thank you very much!!!
:
: and
: and
| l*h
发帖数: 4124 | 17 "patients are doing better overall in China than in the USA"
how shameless and ignorant do you have to be to make such claims?
and
and
【在 j****d 的大作中提到】
: let me give you a website in China - that shall be your relative's best
: information source. There are a lot more lung cancer patients in China, and
: some of them and their families are very well educated and experienced, and
: you will find that patients are doing better overall in China than in the
: USA, thanks to new drugs invented in the US but field tested in China.
: http://www.yuaigongwu.com/
: I might add - stay away from ignorance and arrogance.
:
| l*h
发帖数: 4124 | 18 be very careful if you want to take tyrosine kinase inhibitor. if you want
to do it, do it under a physician's close monitoring.
TKIs cause interstitial pneumonitis (this is a very serious condition,
prognosis worse than non-small cell lung cancer) in some patients. in Japan,
about one in every 20 patients on TKI develop this in a relative short time
of period but they are under close monitoring so are detected early and a
small percentage of them (still about 30%) at irreversible stage. in China,
there is no data on this. but from what i learned from chatting with some
doctors, roughly the same or higher percentage of patients develop
significantly decreased lung functions while on TKI. but doctors in China,
instead of thinking about this serious adverse effect, think the dose of TKI
is insufficient and then kill the patient by increasing doses.
this is a much smaller problem in Caucasians and African Americans (0.2-0.3%
only).
【在 a****y 的大作中提到】
: Very good website and thank you very much!!!
:
: and
: and
| l*h
发帖数: 4124 | 19 how effective are TKIs for stage IV NSCLC?
take erlotinib as an examples, median overall survival is ~250 days, and
progression-free survival is ~60 days for those patients with genetic
indications and on the drug. |
|
