One of the most common questions. we receive is why people are told that surgery isn't an appropriate option for metastatic disease. If you can see the areas where there is active cancer, why can't you just take it out?

Here is the last of three interesting cases I discussed with Drs. Alex Farivar, thoracic surgeon at Swedish Cancer Institute here in Seattle, and Anne Tsao, medical oncologist at MD Anderson Cancer Center in Houston. This particular case is a man I saw a few years ago, with a solitary brain lesion and what otherwise appeared to be a very isolated lung cancer in the right upper lobe. His case brings up issues of the feasibility of treating someone with a solitary lesion with curative intent.

We'll cover the general management principles for the more typical situation of patients with multiple brain metastases from lung cancer soon, but today we’ll cover the special situation of the patient who has a brain metastasis identified as the ONLY area of metastatic disease (generally referring to NSCLC, since SCLC has such a high tendency to spread distantly early in its history). Recall that metastatic, or stage IV, lung cancer, is treated with a palliative approach, due to the inability to achieve prolonged survival except in very rare cases.