What to Expect in End Stage Lung Cancer

The Abramson Cancer Center of the University of Pennsylvania
Last Modified: August 11, 2002

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Question
My mother has lung cancer for the last several years and now has brain cancer. She has undergone radiation treatment and is currently still getting chemo treatment for her lung cancer. Our family understands that she only has a little time left with us but no one seems to know what she can expect in her final months. I don't want to focus on the negative but we all realize what is going to happen and would like to know what is going to happen to our mother. Any information would be appreciated. 
Answer

Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of Pennsylvania, responds:

It sounds like your mother and your family are in a difficult situation. You say that your mother has had lung cancer for several years. Only a fairly small proportion of lung cancers are cured, and if she has been living with it for several years, she has probably already done better than most doctors would have predicted. Now she has brain cancer. Do you mean that the lung cancer has now spread to the brain? This is a very common site of recurrence of lung cancer. Generally speaking patients with lung cancer that has spread to the brain are not expected to live for more than a few months, but there are exceptions. The symptoms of brain metastases may include headaches, seizures, or neurological symptoms such as weakness or difficulties with mentation or speech. Usually brain metastases are treated with radiation to the brain often given along with a steroid medication. This treatment usually helps to control the symptoms for a period of time, but does not cure the problem. Eventually the brain metastases start to grow again, and are then more difficult to treat.

You say that she is still undergoing chemotherapy treatment for her lung cancer, which suggests that her primary tumor is active as well. Does she have spread of the tumor to other organs? Chemotherapy for lung cancer is often helpful in shrinking down tumors, relieving symptoms and even prolonging survival. It does not work well for brain metastases however.

It is hard to say what your mother and your family can expect next. She may have problems from the primary tumor within the chest or from the brain metastases. The primary tumor could cause difficulty with breathing or pain. Progression of the brain metastases could cause worsening neurological symptoms. Other symptoms could be caused by spread of the tumor to other organs.

People with advanced lung cancer often feel very fatigued and don't feel like eating. These problems can sometimes be very difficult to manage. But there is always something that can be done to help even when the goals are not curative. With effective pain medications, it should be possible for your mother to be comfortable and pain free for the remainder of her life. The support of you and your family should also help to make it easier for her. Because the treatment approach in this situation is palliative and not curative, you may wish to consider getting a hospice care team involved with your mother and family. The hospice care team consists of experts in palliative care and strive to support both the patient and family throughout this difficult time. Please visit the hospice section on OncoLink for additional information.



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