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Have lung cancer and brain tumor. Got operated for fractured hip. How to extend life expectancy?

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Oncologist, Radiation
Practicing since : 2007
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My Mom suffering from stage four lung cancer and brain tumor about 45cm. she is 87 years old. she had a fracture on the hip which was operated on a high risk note today. please let me know what process shud i undertake to prolong her life expectancy

YYYY@YYYY
Posted Sat, 23 Mar 2013 in Lung Cancer
 
 
Answered by Dr. Dipanjan Majumder 1 hour later
Hi,
Thanks for posting your query.
I would like to inform you a few facts in this scenario.
- Lung cancer mainly of two types non small cell lung cancer, small cell lung cancer.
-non small cell lung cancer can be classified as squamous and non-squamous variety.
-treatment of small cell lung cancer with extensive disease mainly by chemotherapy.
-non-small cell cancer, when metastasizes, needs to be treated by chemotherapy but drugs selection will be different.

before selecting drugs, previous treatment history is necessary.

In case of your mother the FDG -pet scan shows Mass in right upper lobe( SUV max28.7gms/ml)- Malignant lesion.
Multiple parenchymal and subpleural nodules in both lungs( SUV XXXXXXX 20.3 gms/ml)
- Lung metastasis.
from this report it is evident that she has at least M1a disease.

Age is not a barrier but her other co-morbidity should be ruled out, specially diabetes, and altered renal function, because platin may be an option which can not be given in patients with altered creatinine clearance.

Second problem you mentioned is brain tumor. (45 cm brain tumor???)
probably you wanted to mention 45 mm, anyway can you inform the radiological impression of that tumor?

It seems to be metastasis to brain. If it is a brain metastasis, can be treated with surgery followed by whole brain radiotherapy.
or, gamma knife, cyberknife based radiosurgery.

If the tumor is other form of primary brain tumor then treatment to be chosen accordingly.

Please consult your treating oncologist, there is a definite chance of increasing her life expectancy. Keep me posted for further queries.
Above answer was peer-reviewed by
 
Follow-up: Have lung cancer and brain tumor. Got operated for fractured hip. How to extend life expectancy? 2 days later
please go thru the pet scan there r 3 files
 
 
Answered by Dr. Dipanjan Majumder 29 minutes later
Hi,

Thanks for follow up.

I have gone through the PET scan reports. There is isolated cerebellar metastasis (4.2/3.3 cm in size)
also associated with multiple cervical, hilar, mediastinal lymphadenopathy. She is suffering from stage 4 disease.

Treatment options are systemic chemotherapy and surgical resection of brain met.

At her age surgery may be difficult, therefore you may try for other option i.e. Gammaknife or cyberknife radisurgery. Typical indication of these procedure is tumor <3 cm. But researches are going on to form exact criteria.

In my opinion she may be the candidate for cyberknife treatment followed by whole brain radiotherapy. The main aim of this treatment will be improving the quality of life; there are also survival advantages.

Consult your oncologist for detailed discussion. I will be available here for guidance.

Regards
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Follow-up: Have lung cancer and brain tumor. Got operated for fractured hip. How to extend life expectancy? 47 hours later
After biopsy it was discoved that it is malignant.

Doctor has ruled out both gamma and cyber however ready to go for radioactive and chemo.of course in mild doses on periodic basis if she can tolerate it

Thanks for yor support and suggestions. By the way I am also from Kolkata ex Xaverian of St. Xaviers college

XXXXXXX
 
 
Answered by Dr. Dipanjan Majumder 1 hour later
Hi,
Thanks for follow up.

I have discussed about the gammaknife and cyberknife treatment.

your mom does not fulfill the exact criteria, but these are the other advanced technology available for treatment.

Anyway, you should follow your doctors' suggestion. Probably they have opted for the treatment like whole brain radiotherapy and chemotherapy, which is the current standard of care.

At the tertiary care hospital we also follow this protocol.

It is my pleasure to talk to an ex Xaverian. Hope the treatment will work. your mother can have some relief. wish you good health.
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Follow-up: Have lung cancer and brain tumor. Got operated for fractured hip. How to extend life expectancy? 10 days later
She is on following medication DEXONA PANTOPRAZOLE GEFITINIB
She resists to eat and even drink cold or warm water including liquid and semi liquid food and stubborn regarding same, she does not have nausea or vomitting tendency,she is drowsy and is not able to sit even, phsiotherapy is on for her hip fracture surgery, I have put her on airbed to prevent bed sore.
 
 
Answered by Dr. Dipanjan Majumder 3 hours later
Hi,
I am extremely sorry to hear about your mom's condition.

The symptoms you have mentioned are due to brain metastasis. I am not sure whether radiation has been offered or not, anyway whole brain radiotherapy may be tried.

Other supportive treatment has been correctly chosen by your doctors. Gefitinib is used in EGFR over-expression mutation in non small cell lung cancer. This decision also depends on your treating oncologist.

Probably the supportive treatment will help her. Hope for the best. Consult your treating oncologist for better guidance.
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Follow-up: Have lung cancer and brain tumor. Got operated for fractured hip. How to extend life expectancy? 24 hours later
Thanks for the assistance rendered, mom passed away today early morning at 0500hrs in her sleep peacefully. This for your kind info. noticed traces of blood in neck IV and urine.
 
 
Answered by Dr. Dipanjan Majumder 21 minutes later



I'm very sorry to hear about your loss. When we lose someone we love, it seems that time stands still. Although it's difficult today to see beyond the sorrow, may looking back in memory help comfort you tomorrow.
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Follow-up: Have lung cancer and brain tumor. Got operated for fractured hip. How to extend life expectancy? 48 hours later
My Mom was cremated today as I had to put her in mortuary in the hospital so that her near relatives and my brother from XXXXXXX can reach Mumbai

I appreciate your guidance for the said diagnosis and problem

XXXXXXX
 
 
Answered by Dr. Dipanjan Majumder 42 minutes later
Extending my deepest sympathy on the loss of your mother and praying that your faith will give you strength in this sad time. God bless you and your wonderful family.
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