Dr. Nagourney's Blog

For Cancer Patients: Inoperable Does Not Mean Incurable

By Robert A. Nagourney, MD

Patients, newly diagnosed with cancer confront the news with dread. For many, the worst possible news is that “the cancer is inoperable.” This is often interpreted to mean that there is no hope, but inoperable doesn’t mean incurable. Indeed there are some forms of cancer that are never operable.

Examples of Cancers That Are Often Inoperable

These include leukemias and lymphomas that are too widely disseminated at diagnosis to be treated with surgery. Beyond a biopsy or bone marrow aspiration, all the therapies for these cancers are chemotherapy, targeted agents or immune therapy and never surgery. Yet these are among the most curable of all cancers.

For others the term inoperable may be applied when a surgical resection cannot be accomplished safely, but that does not mean that other forms of treatment cannot provide benefit, even cure.  

Cancers of the stomach, pancreas and lung are often deemed inoperable at diagnosis, but these can be successfully managed with combinations of chemotherapy and radiation, known as combined modality.

Chemotherapy plus radiation can provide durable remissions even cures in anal, gastro-esophageal, small cell lung, pancreas, and other tumors. While operability has a satisfying ring, offering the physical removal of the tumor, surgical resection alone does not guarantee a cure. 

There is Often Hope Even in Advanced Cases

We have utilized intelligently combined treatments to provide durable remissions even in the most advanced diagnoses such as stage 4 pancreatic cancer, metastatic colon cancer and others.

In my book “Outliving Cancer” I describe a patient with extremely advanced, drug resistant ovarian cancer who failed first and second line therapy but achieved a complete and durable remission. Despite her “platinum refractory” status (a term applied to the most difficult cases) she remains alive and well today 18 years later.

Another patient with stage 4 (widely metastatic) pancreatic carcinoma responded to a simple three drug regimen and remains in remission now at 7 years. Additional patients with gastric, small cell lung and other cancers, who had no surgical options, continue to enjoy durable remissions. 

The task for medical oncologists today is to identify those patients likely to benefit from treatment regardless of their stage at presentation.

Every patient deserves the right treatment the first time. 

The Approach to Patients With Advanced (Inoperable) Cancers

If a patient can possibly undergo biopsy, even if they cannot be cured surgically, it may well be worth undertaking that procedure to identify the drugs and combinations most likely to work. While functional approaches (like our EVA/PCD assay) require a somewhat larger biopsy than those used for genomic tests, functional analyses provide a wealth of information and actionable findings that far exceed anything available with gene-based diagnostics.

The New Era of Cancer Therapy

We are now in an era of better treatments, better supportive care and ever expanding options.  Patients must disabuse themselves of the concept that inoperable means incurable, and take charge of their disease regardless of the stage at diagnosis.

As always, I appreciate your thoughts and comments.

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