Cancer: cure or control

Lung cancer is common and a fatal disease if not treated early and appropriately.  Quite a number of patient with lung cancer has physically normal lifestyle until the time of detection. The psychological trauma is no doubt great. With the improvement of drug and radiation treatment, more option is available on top of curative surgery. Are over treatment always produce good result and ensure good long term outcome?
This question has occurred more than couples of time for real cases.
Usually they are relatively young patient and locally advanced disease.

I personally would stick to traditional guide line but allow oncologist to have tailored made decision with different patients. Most oncologist has keeness for chemotherapy and less favor towards post operative RT. (of course they are exception)

So the cancer boil down to control or cure debate? Must all treatment be comprehensive to be exhaustive that near absolute cure is the best?  In fact life is in a cycle. No living organism is blessed with everlasting existence. Most persons are destined to have limited lifespan about 70 or 90 years.  If the treatment can restore our body to near normal life expectency, then probably this is already the best.  Say if the cancer recur at age of 90 or even 87, we would rather not treat but palliate the cancer. Cancer drug itself may be carcinogenic in long run. Too much treatment , if not necessary, may even do harm then good.

For a different group of cancer patients, they are elderly with moderately advanced disease. So the primary aim is opting for cure within the tolerance ability of the patient. Secondly, control of symptom will be more important than too aggressive treatment.  Minimally invasive surgery are therefore of most benefit to this group of patient.  I have done a few such cases with small wound for old patient. They all come around the surgery satisfactorily. In such group of patient, too aggressive chemotherapy may be of considerable side effect.

For terminal cases where palliation of symptom is most important. Control with oral anticancer or target drug is the best. Luckily, these drug are well tolerated even in elderly. However, the cost may be substantial. Recently I heard about interesting presentation stating thalidomide, metformin and some other old style drugs has anti cancer effect that their use can bring palliative symptom relief at low cost.

I am Dr SS Chung specialist in Cardiothoracic Surgery and expert in lung cancer treatment. My clinic no is 3160 8865