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This question was answered on Sat 07, Jun 2008 01:03pm by Dr Bobby V, MD

Lung Cancer How fast does it spread and when is it untreatable?


    
Asked by missemma (Male; 77; Has Gout, High BP and cholesterol; Relevant drugs:Simvistatin, Lisinopril ) on Sat 07, Jun 2008 11:18am

I read the question from Terry, dated Mar 01, 2008...My father also has Stage IV lung cancer...He suddenly had severe pain of left lower back and left thigh, couldn't walk without crutches (April 2008). Based on 2MRI's (Apr. 16 and 21, 2008) cancer was suspected, biopsy scheduled for Apr. 28. Had to take him to the emergency room on Apr. 26 because of severe pain and elevated HR. A CT Scan showed it was also in the left lung, the adrenal gland above the kidney and the liver. Lab indicated abnormal counts. 2 biopsies later (lung and thigh) it was confirmed, lung primary site . Has had loss of appetite since Apr 18 and basically on TPN since hospitalized..He had one treatment of chemotherapy using Cisplatin and Etoposide, day 1, 2 and 5, ending May 11, 2008. Since then he has basically gotten worse, can no longer be treated because he is too weak. . ..Doctors suggest hospice. What exactly is non small neuroendocrine cancer, can it travel to all the areas I gave, how fast does this type of cancer spread and when is Stage IV considered untreatable?
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Answer by Dr Bobby V, MD  on Sat 07, Jun 2008 01:03pm:

Hi, I am sorry to hear about your fathers pain and loss of appetite. He has advanced Stage 4 lung cancer, which has spread to the bone and adrenals. Lung cancers are of two broad categories. One is called the "Small Cell Lung Cancer" (SCLC) because of the small oat-like cells present in the cancer tissue of such patients. SCLC has a distinctive biology and treatment. The other broad type consists of all the other types of lung cancers, lumped together as "Non-Small Cell Lung Cancer" (NSCLC). The cancer biology and treatment approach of this group is distinct from SCLC. NSCLC consists of many types of lung cancer including adenocarcinoma, squamous cell cancer, large cell, neuroendocrine type etc. A neuroendocrine NSCLC is usually a sub-type of the large cell type. It is known to spread to the liver, bone, adrenals, brain, and to almost any other part of the body in advanced stages. Current therapy will probably not be able to cure your father completely. However, there are many palliative approaches that may make his remaining time more comfortable. He may benefit from palliative radiotherapy, pain control measures, supportive care, counseling, dietitian consultation etc. If his medical oncologists feel, they may like to try a second-line chemotherapy. Bisphosphonate injections (Zometa) will also probably benefit him. Medroxyprogesterone acetate is also known to improve appetite in a few patients with advanced cancer. I wish you and your family good luck and strength.

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Comment by Nancy on Mon 18, Jan 2010 11:08pm: Dr. Bobby, My son's fiance's mother is dx with Lung Cancer. She has taken several rounds of chemo/radiation. Just in the last week, she was dx with mets to the brain and spine. My understanding that there is no cure. Treatment consist of pallative chemo and/or radiation. Please correct me if I'm wrong. I am a hospice nurse that has dealt with many patients with a dx of cancer. I am afraid her physician is explaining the whole story to the family. How do you handle that situation?
Comment by Bobby S, MD on Mon 25, Jan 2010 02:30pm: Hi, I am sorry that you are having to face with this grim situation. The mother of your daughter-in-law-to-be is indeed in a very advanced stage of cancer, and no cure is known for such patients. However, much can be done to relieve her pain and discomfort. The treating doctor must stress on availability of many effect pain medications, and interventions that may be undertaken to ease her suffering. Psychological support, not only for the patient, but also for the caregivers is very essential at this time. Please be strong. All the best, and God Bless!

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