Stage 4 Non Small Cell Adenocarcinoma in the Lung - 1262601

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laya2012
Stage 4 Non Small Cell Adenocarcinoma in the Lung - 1262601

Hello, unfortunately my husband and I found out about 3 weeks ago that my Mother in law has stage 4 lung cancer (non small cell adenocarcinoma). The cancer has taken over the RUL and RML completely, and matastisized to the lymph nodes and a very small spot on the kidney, it is pushing on her esophagus as well. She is only 70.9lbs (62ywars of ago) at this time and went through 1 treatment of chemo 1 week ago. Last week, 2 days after the chemo she was taken to the ICU for dangerously low sodium levels. She seems to have recovered well, but the family is still very concerned. It is the big elephant in the room and we all want to ask, but no one is comfortable. So I am hoping we can get some sort of guidance from someone on here. We would like to know

1. What is our time frame looking like (we want to spend as much time as we can with her)?
2. Will the radiation therapy they might do cause more damage?
3. If they do another round of chemo will she have the same reaction as the first round?
4. How much does her weight and current malnutrition have to do with her chance of survival?
5. Is it advisable to even do chemo and radiation with her current weight and malnutrition?

Thank you for all the help!

catdander
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

Hello Laya2, I'm very sorry about your mother in laws cancer. It's so difficult for us laypeople to be thrown into this situation and have any good understanding of what the best direction is. In truth your questions are so broad there's no way to give an answer about an individual person. It depends on a plethora of individual details. But we do have a library of resources that can help you and your family to get a better grip on what's happening so you can better understand her situation. I'm sure they will help narrow the scope of your questions. I've pasted links below. You can do a search using our search engine (note that you may need to log off to use search, It's browser specific.) The large green tabs above labeled general cancer info and focused cancer info lead to blog posts library.

The scope of stage IV life expectancy is so broad that oncologist are notoriously bad at guessing even for their own patients. It's weeks to 5 years for the most part.

Radiation in stage IV nsclc is used to control pain or relieve pressure when tumor is pressing on esophagus for example.

I love the post for its into pp plus it's an excellent resource to chemo info http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-therap...

http://cancergrace.org/cancer-treatments/category/lung-cancer/general-lu...

http://cancergrace.org/cancer-treatments/2009/02/16/acs-mgmt/

http://cancergrace.org/lung/tag/frail/

Palliative care shouldn't be confused with stopping treatment. http://cancergrace.org/cancer-treatments/2012/07/26/what-is-palliative-c...

I hope I've not overwhelmed with posts and hope they're helpful.
Please don't hesitate to inquire further.
All best,
Janine

FYI, We have a member, Laya so I've addressed you Laya2 if that's ok.
I changed she to mil and trashed the 2 post.

commodore64
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

II can only give my opinion based on what I saw with my motehr's battle with this disease and a few other peopel I've met since then. But I know what it's like to be in your shoes, so I will try to give you some info to the best of my abilities, and this is only anecdotal, as catdander says everything is variable.

1. What is our time frame looking like (we want to spend as much time as we can with her)?
Gut feeling, I think a few months. Maybe less. Spend all the time you can with her, now...until you have a better feeling for how t
2. Will the radiation therapy they might do cause more damage?
They probably want to radiate the tumour in her esophagus in hopes of some palliative comfort. It will make her tired, but I wouldn't expect it to be the extreme exhaustion of whole brain radiation treatment (WBRT) like my mom had, so that's a silver lining.
3. If they do another round of chemo will she have the same reaction as the first round?
Possibly. What chemo did they give her? Taxol/Carboplat?
4. How much does her weight and current malnutrition have to do with her chance of survival?
Probably a lot. I think the fact that it has spread to other organs might be some of the reason she is in her condition.
5. Is it advisable to even do chemo and radiation with her current weight and malnutrition?
If she is strong enough, yes. It's her only chance of getting a few more good months, in all likelihood.

She sounds very similar to a case I know of through a friend. Similar diagnosis. Her mom didn't even make it to the first chemo. We talk a lot about that. After going through what I went through with my mom, which was a horrible 6 month battle, I was kind of jealous. And she felt the same about me because I got a few months of hope at least with my mom.

All that said:

1. What chemo is she on? Sometimes these cancers can respond very well to systemic chemos.
2. Has she been tested for ALK rearrangement or EFGR mutations? There are targeted therapies that could work.

cards7up
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

I agree that her tissue should be tested for mutations. If she has one of them, EGFR or ALK then she could take a targeted pill that's less toxic. Though they have their own side effects, they're still less than chemo. I'd want to know what they're radiating. Is she in pain anywhere? Wishing you all the best.
Take care, Judy

Dr West
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

1) As you've heard from the thoughtful comments above,survival with advanced non-small cell lung cancer can vary from weeks to several years. However, to provide a bit more insight, I'm sorry to say that it sounds from your description that her survival is more likely to skew on the shorter end of that spectrum, given her poor nutrition and frailty. Her doctors could provide far more insight, but it sounds more likely to be in the range of weeks to a few months than months to years.

2) Any cancer treatment may potentially cause harm, but radiation is typically among the best tolerated forms of treatment. In all cases, it comes down to a question of anticipated risk vs. anticipated benefit, which is a very individualized decision based on a particular case.

3) Unfortunately, there's no way to know. We don't know enough about why her complications to say whether that might happened again. Her doctors might have a better idea, but they may not.

4) Being underweight with advanced lung cancer is associated with less favorable survival. The treatments require some physiologic reserve, and people who are very underweight are less able to tolerate the standard treatments. At the same time, in many cases weight loss is a reflection of the aggressiveness of the cancer, so it's not clear whether being malnourished is a more a cause or an effect.

5) As I said in the answer to #2, the decision of what to pursue is one based on carefully considering the risks vs. benefits of the various options available. That is such an individualized question that it's really only possible for the doctors directly involved to make that judgment, not people in an online forum who don't know the patient or the specifics of her particular situation.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

laya2012
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

Thank you ALL so very much for all of your information and replies. Your answers confirmed much of our fears and suspicions with what has been going on. All we can do now is pray for as much time as God will grant us with her. We will keep you and all your families in our prayers and thoughts, as these times are difficult for us all. Thank you again!

commodore64
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

My sister sent me this link today. It's worth reading.

http://www.npr.org/blogs/health/2014/03/04/285762401/palliative-chemo-ca...

JimC
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

Thanks for posting that link, commodore 64.

A few years ago, our late GRACE moderator Catharine posted a link to an excellent discussion of this issue from The New Yorker. Here is that link, together with her very appropriate warning:

Warning: It is not easy reading from the emotional standpoint of someone who has cancer or is caring for someone with cancer, but it is worthwhile if you want to tackle it.

http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?curr...

That article sparked an extensive discussion by GRACE faculty and members: http://cancergrace.org/forums/index.php?topic=5558.0

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

catdander
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

How lucky we are to have such thoughtful input given by dear members. It's very important to hear from those who've been there.

aunttootsie001
Reply To: Stage 4 Non Small Cell Adenocarcinoma in the Lung

I was going to agree with Card7up about the mutation testing it isn't that serious procedure but with how frail she already is I'm not sure she would survive until test results and the process of receiving the medication. As Dr. West is more familiar with situations similar to hers it is sad. Please except my Prayers for her and you as well! Lorrie from Ohio