DEAR DR. ROACH: I was diagnosed with small cell lung cancer (SCLC) in June through a yearly wellness check. I had no prior symptoms or issues. The cancer was in the limited stage and did not spread to the brain, nor any other part of the body. (I am 62, exercise three times a week with weights and have generally good health.)
I have gone through chemotherapy and radiation therapy (IMRT). All treatment ended at the end of September. I am now waiting for a full PET scan to be done at the end of December. My oncologist believes that since they caught it early, the treatment was curative. However, everything I have read and the people I have spoken to seem to indicate that this type of cancer always comes back and that the prognosis is still not great. Can you share some knowledge and your experience with SCLC, and what the future holds for those going through it? — F.D.
ANSWER: The majority of lung cancers are non-small cell lung cancer (80-85%), especially squamous cell and adenocarcinoma, and they behave and are treated very differently from small cell lung cancer (10-15%). Non-small cell lung cancer is treated with surgery if thought to be curable, whereas small cell is usually treated with chemotherapy and radiation. Usually, small cell lung cancer has already spread by the time of diagnosis, and although it initially responds well to treatment most of the time, it does usually recur, as your research has shown.
Still, there are people who are cured, and the amount of disease at the time of diagnosis is the most important predictor. For people who have limited disease like you, 15-30% will be alive in five years; among those who present extensive disease, only 1-2% will be alive in five years. Being free from disease at five years usually means a cure. Exercising and being otherwise healthy are other good prognostic signs.
DEAR DR. ROACH: My wife developed COVID with symptoms starting eight days ago. Yesterday was her sixth day of testing positive, while I have been negative throughout (go figure). We are planning to test ourselves again tomorrow. We are supposed to visit family in a few days, but two family members (in their 70s) each have one kidney due to cancer, while another (late 30s) is a colon cancer survivor. What is your opinion regarding transmission and risk in this situation? — A.B.
ANSWER: Your wife would be considered noninfectious on day 10, but the most conservative recommendation is to discontinue isolation only after a person has tested negative (ideally, two negative tests taken 48 hours apart) after day 5. The downside to this strategy is that it is clearly documented that some people can continue to be positive weeks (even months) after a COVID infection, but are very minimally, or not at all, infectious. People with severe immune system diseases (transplant recipients on active chemotherapy, for example) or who have had severe infections (hospitalized for a prolonged period or requiring intubation) should consult an expert to be sure.
If you both continue to have no symptoms and you have a negative test, I would say you are very unlikely to pose a risk to your family members. The big concern here is that you might have contracted an asymptomatic case from your wife, but repeatedly negative tests would make that very unlikely. You should certainly discuss it with the at-risk family members.
