Inoperable Lung Cancer
My brother-in-law was recently diagnosed with lung cancer. It has already spread to his brain, and they have told him it is inoperable. Could you tell me exactly what this means? If there is no hope of curing it, why does he have to go through chemotherapy and radiation therapy?
Barbara Campling, MD, Medical Oncologist, responds:
Your brother-in-law has been diagnosed with inoperable lung cancer that has spread to the brain. He has been advised to receive chemotherapy and radiation therapy, and you are wondering why it is necessary to undergo this treatment if there is no possibility of curing the cancer. An inoperable lung cancer is one that cannot be surgically removed. It may be inoperable because of the extent of the cancer within the chest, or because it has spread outside of the chest. A surgeon generally would only undertake a major lung cancer operation if he/she felt that the tumor could be cured with surgery. Generally speaking, once lung cancer has spread outside of the chest, it is not considered curable with any form of treatment. Do you know whether it is a "small cell" or a "non-small cell" lung cancer? Small cell lung cancer usually spreads more rapidly when not treated, and it responds more dramatically to chemotherapy than does non-small cell lung cancer, even when the treatment is not curative.
Your brother-in-law has probably been advised to undergo radiation therapy to the brain. Brain irradiation can help to relieve the often disabling neurological symptoms caused by brain metastases, and there is also an improvement in the length of survival with this treatment. Chemotherapy is the mainstay of treatment in small cell lung cancer, and it has clearly been shown to significantly improve symptoms as well as survival. Chemotherapy is also recommended for the treatment of metastatic non-small-cell lung cancer when the tumor is not considered potentially curable with either surgery or radiation. Large clinical studies of chemotherapy in advanced non-small cell lung cancer patients have shown that there is an improvement in survival (although not by very many months) for the patients who receive chemotherapy compared to those who do not. And importantly, there appears to be an improvement in quality of life in those patients who receive chemotherapy, despite the sometimes unpleasant side effects of treatment. However, when patients are so sick that they are unable to get out of bed, then chemotherapy is less likely to be effective, and it may even make patients sicker.
Your brother-in-law does not have to undergo either radiation therapy or chemotherapy. The decision as to whether he has any treatment, and what type of treatment he takes is up to him and his family, and it should be based on a careful consideration of potential risks and benefits of therapy. Even though his cancer is not curable, his doctors are probably recommending treatment because they feel that it will improve his symptoms and prolong his survival.