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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 45925
Experience:  Board Certified Oncologist
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Hi! My relative- male 66years old was diagnosed with poorly

Customer Question

Hi! My relative- male 66years old was diagnosed with poorly differentiated non-small cell lung cancer 2 weeks ago. The doctor didn't offer any treatment - said that this cancer very aggressive and better not disturb it. I'm trying to get a second opinion on that decision. Would you be able to help me- I have CT scan of chest and abdomen,X-Ray, fibro- bronchoscopy results with me if you need more information. Thanks!Paula.
Submitted: 2 years ago.
Category: Oncology
Expert:  Dr. David replied 2 years ago.
Dr. David :

This is Dr. David

Dr. David :

yes, I would be happy to review the CT scan and biopsy information.

Dr. David :

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Dr. David :

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Dr. David :

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Dr. David :

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Customer: CT scan:
Customer: CT scan: -lungs fields in the correct form.
Dr. David :

hello?

Customer: CT scan: - lungs fields in the correct form . There are polysegmental soft tissue multiple tumours,( right 98*84 mm with cavity decay. Left 41*38 mm in C3). Pleural sinuses are free. Large bronchus of the correct shape and not deformed. There is no significant dysfunction of the air flow. Heart arteries are in tact. Single paratrachial lymph is seen size of up to 15mm. Conclusion: multiple metastasis of lungs. BIOPSY: Tracheal carina and cartilage rings are visible. Hyperaemia mucosa proximal branchy not expressed. From inner side of upper proximal bronchi on the right side appears a round shape tumour with uneven smooth surface dark red colour covered with blood clots,increased contact bleeding. Slight amount of mucous expectoration on the wall of branchy bilaterally. Sanction. Catheterisation of bronchi: Aspiration for cytology from tumour surface and from branches of B-2-3 right lung. CYTOLOGY : group cells poorly differentiated non-small cell cancer.
Dr. David :

does he have a smoking history?

Dr. David :

there needs to be more testing of the biopsy to know if it is a squamous cell or adenocarcinoma type of non small cell cancer.

Customer: Sorry took a bit long - had to type it all.
Dr. David :

in these situations, where there are multiple masses in the lung, we consider it most likely stage IV lung cancer.

Dr. David :

the brain needs a scan to check for metastasis to the brain.

Dr. David :

that was good work typing.

Dr. David :

he should have the option to receive chemotherapy to fight his lung cancer if he wishes to fight the cancer.

Dr. David :

some rare adenocarcinoma type non small cell lung cancers can have special EGFR or ALK1 mutations causing the cancer, especially if he was not a smoker.

Customer: He was smoking for a long time before he stopped 8 years ago. Unfortunately that is all what I have.
Dr. David :

I see

Dr. David :

is he willing to receive chemotherapy?

Dr. David :

hello?

Customer: The doctor said that that it is to dangerous to start the chemotherapy because they don't know how the tumours will behave.
Dr. David :

that sounds like a cop out sort of statement.

Dr. David :

which is like, I don't want to cross the street because I could get hit by a car.

Dr. David :

chemotherapy is used to fight lung cancers like this.

Dr. David :

in the UK NHS system

Dr. David :

doctors are always looking for ways to cut cost and not have to pay for expensive treatments.

Dr. David :

chemotherapy has been shown to extend survival by a few months in patients who have metastatic lung cancer.

Dr. David :

but chemotherapy can also have side effects and toxicity.

Customer: Unfortunately he is not in UK ,and i was asked to find out second opinion.
Dr. David :

so it is up to him if he wishes to pursue with chemotherapy or not.

Customer: What about biological therapy- is it better than chemotherapy ?
Customer: Or chemotherapy is the only option?
Dr. David :

biological therapy can only be started after more testing is done on the biopsy specimen to see if there are those mutations I mentioned above.

Dr. David :

some rare adenocarcinoma type non small cell lung cancers can have special EGFR or ALK1 mutations causing the cancer

Dr. David :

so if he has the EGFR mutation, he would be a candidate for Tarceva or Irressa therapy.

Dr. David :

if he has the ALK1 mutation in his lung cancer, then he should be getting Zykadia or ceritinib.

Dr. David :

those are biological treatments which are used for certain patients who have certain genetic mutations in their lung cancer.

Dr. David :

you should go with him to his oncologist appointment and ask for these genetic tests for his biopsy.

Dr. David :

do you have other questions?

Customer: The main question is if he'll start any treatment will he prolong his life or in the end it will be the same. I mean if he has 4 month to live is it worth to try a treatment or better just 'enjoy' time what left?
Dr. David :

that is a personal question that only he, the patient can answer.

Dr. David :

different people have different priorities in their lives.

Dr. David :

some want to fight the cancer.

Dr. David :

some want to go on holiday

Dr. David :

so it is up to him and his doctors and family to try to help him make the best decision for him.

Dr. David :

does this make sense?

Dr. David :

best of luck to you and him.

Dr. David :

let me know if you have other questions.

Customer: How long would you say he has left?
Dr. David :

I can't see him or examine him.

Dr. David :

no doctor can say how long a cancer patient will live for

Dr. David :

it doesn't sound like he has had a brain CT scan

Dr. David :

or an abdominal CT scan to check for brain and abdominal metastasis

Dr. David :

he needs a bone scan as well to check for bone mets.

Customer: I don't think he has this CT scan. I pretty sure they did it for bones and he doesn't have it.
Dr. David :

that is good.

Dr. David :

best of luck to you and him.

Dr. David :

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Customer: Thanks a lot for your help!!!!!!
Dr. David :

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Dr. David :

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Dr. David :

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Dr. David :

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Dr. David :

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