Small Cell Lung Cancer Metastasized to the Brain

James M. Metz, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: January 13, 2002

My mother was diagnosed with small cell lung cancer in January of 2001. She has been through Chemo and radiation and the tumor in her lung did shrink to approx 1 1/2 cm. She was doing well, went back to work part time.

In November, she began to have tremors. I took her to the Emergency room where we were told that she has 4 tumors on her brain. Radiation was started immediately.
My question is this:
I thought that the LAST place that this cancer went was to the Brain. My mother very literally took this as a death sentence and I would like some supporting documentation that this is not the case. Anything you can do to direct me would be most appreciated - we are as very discouraged and afraid that Mom does not have too much longer with us.

Thank you.

James M. Metz, MD, Editor-in-Chief of OncoLink and Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:

This is a very difficult situation to say the least. Unfortunately, it is very common for lung cancer, particularly small cell lung cancer, to spread to the brain. The chemotherapy used for the treatment of small cell lung cancer cannot penetrate the brain due to a protective barrier (blood-brain barrier). Lung cancer cells that spread to the brain before the diagnosis and initial treatment than grow into tumors and may take months or even years to become symptomatic.

The standard treatment for multiple brain metastases is radiation therapy. Unfortunately, when more than one tumor is found in the brain with lung cancer, the situation is generally incurable. The tumors may initially respond well to radiation, but unfortunately they will come back in time. It is difficult for doctors to predict how long a person will live with a diagnosis of brain metastases, but it is generally on the order of months.

It is important to note that many patients with brain metastases continue to live for a number of months with excellent quality of life. It is normal for patients to become upset, sad, angry and even depressed initially. When these feelings persist it is important to get counselors involved who specialize in the treatment of cancer patients. Sometimes it is easier for a patient to discuss these feelings with a counselor who is objective and has experience in helping other cancer patients' work through similar issues.