Brain Metastasis and Lung Adenocarcinoam - 1249803

savaniv
Posts:6

Hello,

My Father is diagnosed of Brain Metastasis and Lung Adenocarcinoam. Cancer is suspected to be in adrenaline gland as well. Some lesion is seen there as well. FNAC test was done for the lungs. Doctors are telling that its the fourth stage. He is 65 years old and he has already lost a lot of weight. 13 sessions of radiotherapy had been given to him for the brain. After this his balancing problem is gone and he is able to walk properly. But he is getting angry at everyone, and he does not want to eat anything. He even tries to avoid medicines. We have to force him to take.
After looking at his physical condition doctors are not in a position to give chemotherapy. So, my question is what else can be done for curing this? We are just giving medicines to decrease the symptoms, but nothing to cure it.

Doctors are telling that it will spread out. And they are not suggesting full bot CT scan as they do not have any cure.
Now he is having pain in lungs, throat and stomach. So, we feel probably its spread over there as well.

Please suggest what should be our next step? We can not just sit and see his deteriorating condition. Is there some way chemotherapy can be given? Can we prepare his body for chemo?

Thanks in advance,
Savani

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Reply # - November 2, 2012, 06:28 AM

savaniv
Posts: 6

Further I want to add that my father was a smoker for more then 30 years.
The approximate size of the lesion in brain is 3.3cm X 3.6cm X 2.5 cm. And it is in right cerebellar hemisphere.

Reply # - November 2, 2012, 06:33 AM

catdander
Posts:

Hello Savani,

Welcome to Grace. I'm very sorry your father is going through this. I think we can help you understand what is going on and provide information about the most common ways (and not so common) used to address the issues.

I hate he is having such anger but can certainly understand it as well, it's the worst position to be in. It is typical to hear of lots of mood changes as the mind struggles to understand that he is so sick. Stage 4 cancer is not curable but it is treatable such as his brain radiation. If and when his condition improves he will have a chance to try other treatments such as chemo to shrink his tumors. In the mean time there are other treatments to help with pain and other symptoms.

Your right that more extensive CTs may not show the doctors anything that will change his treatment at the moment. Scans to look at other parts of the body may be used in the future but the doctors can usually get the information they need by chest CTs and brain MRIs.

It would be helpful to know what symptoms the doctors are saying are keeping him from further treatment. He may just need to recuperate from brain radiation before he moves on the systemic therapy or there may be something specific. There is always room for a second opinion at a large medical center that can help with understanding what is going on. A second opinion may also help with new options such as trials. But I'm sorry to say, it is impossible for us to guess at the answers without knowing more about what's going on. Perhaps a more specific description of the symptoms the doctors are saying keep him from moving forward with chemo would help us help you.

I will post links in the next post for you to learn more about systemic therapy like chemo for patients including frail patients and the link about second opinions.
Much hope,
Janine
forum moderator

Reply # - November 2, 2012, 06:46 AM

catdander
Posts:

Here are 2 links to faculty blog posts. At the end of them are more links to more informative posts. The first below is about first line treatment. The second is on the many benefits of second opinions. I hope this helps get you started.

http://cancergrace.org/lung/2010/09/18/lung-faq-ive-just-been-diagnosed…

http://cancergrace.org/cancer-101/tag/second-opinion/

Reply # - November 2, 2012, 10:40 PM

Dr West
Posts: 4735

Savani,

I think Janine has offered some great links about the general ways we think about how to treat someone with metastatic non-small cell lung cancer (NSCLC). Whether a patient can realistically tolerate chemotherapy is something that needs to be judged by someone actually seeing the person, so I think if you have doubts about the first opinion you received, a second opinion from someone who can evaluate your father directly will be more instructive than trying to receive recommendations from people on the internet.

We would be happy to try to address any specific questions you have after you read more about the basic concepts of how we approach metastatic NSCLC.

Good luck.

-Dr. West

Reply # - November 3, 2012, 11:13 PM

savaniv
Posts: 6

Thank you Dr West and Janine. I have gone through those links and felt that they are useful for us.

Somebody has suggested Cyberknife Robotic Radiosurgery for both brain and lung mets. But we are apprehensive about this. Radiotherapy has already been given. SO will this cyberknife radiosurgery be useful? Further, he has lesion(mass) in the lungs. Its not a tumour. Is it effective only on tumour or on lesion as well? Are there any side effects? Should it be given or not and how much effective will it be?

Thanks in advance.

Kind Regards,
Savani

Reply # - November 4, 2012, 05:22 AM

catdander
Posts:

Savani, I'm sorry you're still not getting input from the oncology center to explain the situation. We can't tell you what you should do. Decisions are all too often hard to make even with a team of your own doctors. We can explain what the most common treatments are given in certain situations.

The terms lesion, mass, and tumor mean the same and are interchangeable. In people with stage 4 lung cancer radiation is given when there are symptoms such as pain then it can be very effective. However it is usual to give standard radiation not cyberknife. The exception is the brain which your father had brain radiation that helped with his ability to walk. Sometimes cyberknife is given in the brain when there are one or 2 lesions.

I will add links as I find them.

I hope that clears up some of your questions.

Janine

Reply # - November 4, 2012, 03:06 PM

Dr West
Posts: 4735

I doubt there would be value in doing CyberKnife on brain metastases that were already treated with whole brain radiation (WBR): this would really only make sense for metastases that are growing or new after WBR. And there isn't usually a value in doing radiation to chest lesions in the setting of metastatic lung cancer, except to treat cancer causing someone symptoms directly from the mass, such as coughing up blood, or pain right in that area, or it's pressing on an airway and limiting the ability to breathe.

As Janine said, terms like mass, lesion, tumor, and cancer are used interchangeably but really can mean the same thing.

-Dr. West

Reply # - November 17, 2012, 09:36 AM

savaniv
Posts: 6

Thank you for answering to my queries.
Couple of things which I missed previously,
1. In July doctors had started tuberculosis medicine, because of fluid (pleural effusion) in lungs
2. Post test of the water, neither cancer nor TB was positive. Even then tuberculosis medication was continued by doctors.
3. After 2 months, he started getting vomits and body imbalance problem. MRI of the brain showed tumour.
4. After that FNAC was also done using tissue from lungs, which was positive for malignant.
5. For tumour in brain, Cobalt therapy (radiation) was done, which showed good improvement.
6. Recently doctor has started monthly Chemo treatment (only first dose given- carboplatin -150mg, pemetrexed -500mg), and suggested to continue for next 6 months.
Question: - We still have BIG confusion on whether these tumours are tubercular or cancerous. And should we go for some other tests as well? When we consulted other doctors, they suggested for EGFR mutation test. But our doctor is telling that for that biopsy is to be done, and his condition is not good enough for biopsy.
So what do you people suggest? I am unable to understand why biopsy can’t be done? Can we rely on FNAC results for diagnosis?
Thank you.
Best Regards,
Savani

Reply # - November 17, 2012, 01:19 PM

catdander
Posts:

Savani, thanks for the added history. It would be good to create a "signature" with it. You can do that by clicking on your "user name" savaniv to the left of your posts. That will take you to your "forum profile". Then click on "edit signature" to add the history. It will show up on the bottom of your posts and the doctors will have the context they need to answer your questions.

Malignant is another word for cancerous which provides a positive conclusion to the question. I'm very sorry your father and you are going through this but I think we can provide you with an understanding of what is going on and what the standard and new practices are. Most of us on the staff here are Americans so we are mostly ignorant about the regulations in other countries. But we do have members from across the globe that also have a great deal of information about various countries medical systems.

As for another biopsy, an FNAC biopsy probably didn't get enough tissue for mutation testing. However there is a nice loophole here; since your father is already taking first line treatment (carbo and pem) for 6 cycles he can most likely move to tarceva treatment as second line without a positive mutation. So he doesn't need a biopsy. On a personal note and this isn't the norm but is common enough to consider before having a biopsy, my husband has had 3 core needle biopsies and a vats biopsy all of which never acquired any cancer tissue. They did finally get the positive biopsy but not before much much invasive and dangerous complications.
So for now your dad is fine and probably doesn't need a biopsy. One step at a time. We want the course to be as slow and long as possible and with as little discomfort as needed.

I'm going to ask a doctor to add some input to your queries so you should hear back within a day.

Janine

Reply # - November 17, 2012, 01:50 PM

Dr West
Posts: 4735

It sounds like the answer from the fine needle aspirate is pretty conclusive that his issues are from cancer and not tuberculosis. It could perhaps be feasible to another biopsy, but I don't see a clear need to if he has already started chemotherapy. An oral EGFR tyrosine kinase inhibitor (TKI) like Tarceva (erlotinib) would be an appropriate next treatment whether he has an EGFR mutation or not. Usually, when someone has started a chemotherapy regimen, we'd want to give them at least a couple of cycles and then check for response or progression. If he's doing well, then it makes sense to continue on the current therapy. If not, since EGFR TKI therapy would be an appropriate next treatment whether he has an EGFR mutation or not, it's hard to argue that there's a clear, compelling need to do another biopsy to send off that test, especially if the doctors involved in his care think it would be risky for him to pursue another biopsy.

-Dr. West

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