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Death after stage 2b lung cancer diagnosis?

Lung Cancer discussions, another of the most common forms of cancer

Death after stage 2b lung cancer diagnosis?

Postby atzel » Sun Apr 03, 2011 2:43 pm

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Death after stage 2b lung cancer diagnosis?

Postby adamek14 » Sun Apr 03, 2011 2:44 pm

Hi Traci,

First and foremost I am sorry for your loss, please accept my condolences. This answer might be a little long and I apologize but I will explain a few things first.

Staging: Stage 2 describes cancers that have spread to nearby lymph nodes or are larger then 3cm or near the main bronchos or have invaded the pleura (sac that covers the lungs). This staging is then divided into two either A or B. The "A" means that the tumor has spread to nearby lymphnodes and B means that it has spread to more distant lymphnodes or presents near the bronchos or lining of the lungs. Unfortunately the 2B does not tell me what kind of lung cancer it was. This is further subdivided into Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer or SCLC (previously called oat cell carcinoma)

NSCLC is further subdivided into 3 main types:

Prognosis of NSCLC really depends on if surgery is possible as well as staging etc. As a rule Stage 1/2 can be cured with surgery in about 50% of cases. Stage 3 are sometimes curable but it decreases dramatically to about 20-30% of cases. Stage 4 is basically quality of life treatment.

SCLC is a very aggressive and fast growing cancer that usually involves the primary or secondary bronchi (main air tube). Staging in this is a little different usually "Limited" or "Extensive" stage. Considering the physician reported Stage IIB this is most likely not the type.

Prognosis is extremely tricky idea to deal with because it depends on so many factors. Considering the poor health your family member was in (no surgery possible, chemotherapy was almost impossible) then unfortunately this greatly complicates the situation. Although it may feel as if they had given up on him this is rarely ever the case. Most physicians do not just give up, we try to find the best solution and have the best of intentions for the patient. I believe that the treating physician saw a grave situation and determined that the best course of action was to actually do nothing. From personal experience, when we see blood results indicating very poor prognosis and then suddenly see vast improvement not only through lab results but also clinically this typically means death is imminent. The truth is I cannot explain why this occurs but it is very common. Also one of the problems with lung cancer is that by the time the person has any real symptoms it is usually a little late. Another thing to keep in mind is that patients especially those in the ICU have episodes of what is called "ICU psychosis" in which patients lose touch with reality. I have had more then one patient try to hit me and others try to bite me. I have also had many patients tell their loved ones that we were trying to kill them etc. This is never the case please understand that. There is no reason to lie because there is nothing to gain in these situations.

I hope this helps you out on your road to mourning. I wish you and your family the best especially in this terrible situation.


Dan MD.
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Death after stage 2b lung cancer diagnosis?

Postby armaan83 » Sun Apr 03, 2011 2:48 pm

- - - - or - - - -
* The tumor is larger than 7 centimeters.

You do not tell us whether the histology was small cell or non-small cell lung carcinoma. This matters because non-small cell lung cancer (squamous cell, adenocarcinoma, and other types) do not respond well at all to any chemotherapy while small cell lung cancers often will respond well for a time. Different chemotherapy regimens are utilized for the different types.
As the answer above notes, surgery is the only real chance for people with non-small cell lung cancers. A non-small cell lung cancer would not be expected to respond dramatically to chemotherapy. That would have left radiation therapy as the only palliative option.

You also do not tell us what staging tests were done to rule out stage IV disease. He would need a CT scan of the chest and abdomen looking for extent of disease in the chest and possible spread to the liver and adrenal glands. A bone scan is needed to rule out bone metastases. A CT scan or MRI scan of the brain is needed to rule out brain metastases. If he did not have all of these tests, it is quite possible he had stage IV lung carcinoma which is always fatal - often in a short period of time.

We do not know the extent of his co-morbid medical problems - chronic lung disease from decades of smoking, chronic heart disease, and diabetes with possible vascular / kidney disease. Heck, we don't even know his age ! Some people with severe chronic lung damage from smoking cannot tolerate very much morphine, so that could have slowed his breathing and contributed to his death. The doctors ordered the morphine to ease his suffering and to make him comfortable. Comfort is often the best we can do when people present so late in their disease course and have a bad heart and lungs plus pneumonia and a collapsed lung at the outset of treatment. It is common for family members to seek someone or something to blame in these situations. The primary blame is most likely decades of cigarette smoking. That is the cause of over 90% of lung cancers. Lung cancers cause 31% of all cancer deaths in men. Tobacco associated malignancies are the most difficult to treat successfully with chemotherapy.

I have seen hundreds of people die with lung cancers. Many of them have died very soon after the diagnosis like this. The problem is that the disease is so far advanced and the patient is so sick when the cancer is found that it is already too late to try to turn things around.
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Death after stage 2b lung cancer diagnosis?

Postby cuddle35 » Sun Apr 03, 2011 2:52 pm

Lung cancer is a horrible disease. As of yet, there is no good screening test available to catch it at a stage where it can easily be cured, although there are some promising screening tests on the horizon. The vast majority of cases are caught after the cancer has already spread, and the chances of cure go down dramatically once the cancer has already spread. Stage 2b is actually a fairly advanced stage, meaning the cancer has already spread to surrounding lymph nodes. The "b" means the cancer has surrounded a major breathing tube in the lung or a major blood vessel, making surgery MUCH more complicated and risky. Without surgery, there is very little chance of cure in lung cancer. I assume your family member had the most common type of lung cancer, non-small-cell adenocarcinoma. Considering how sick your family member already was with heart disease and diabetes, I am not at all surprised by his course of events. It really does sound like all the medical personnel did everything possible for your family member. It sounds like if they had taken him to surgery for his cancer, his chances of dying on the operating room table were extremely high. They did the right thing by letting him pass peacefully in hospice.
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