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Have stage 4 lung cancer. Developed cough and started coughing up phlegm. Life expectancy?

Apr 2013
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Answered by

General Surgeon
Practicing since : 2008
Answered : 9349 Questions
Thanks:) My mom is 71 and she has stage 4 lung cancer. She has survived 4 years since diagnosis and ran out of chemo options about 9 months ago. So far, even though she was diagnosed at stage 4 the cancer until now was slow growing. We could barely see it on the xray. But now in the last 6 weeks it has grown to fill a quarter of her lung. The doctor decided it was time for hospice. She immediately developed a cough and is coughing up phlegm:( As she meets with hospice for the first time today-she called me saying she has a fever:( is this part of the process? She just drove to the pharmacy yesterday. Both my brother and I live far away. We thought we would have s few more months. Does this seem unrealistic? Can you guess how much time she might have? Thank you. XXXXXXX
Posted Fri, 26 Apr 2013 in Lung Cancer
Answered by Dr. Ivan R. Rommstein 2 hours later
Hi XXXXXXX and welcome to XXXXXXX
Fisrt I am sorry about your mother and such serious diagnosis. As you know this is the worst stage of disease and one of the worst cancers in general. But considering that she lived for 4 years since diagnosis means that she is a fighter.
YOu know that it is not easy to predict such things, I can only tell you about statistics from my literature. life expectancy depends on many factors such as age,type of cancer and general health. Science says that her life expectancy would be about 6-8 months, and if you think that she is in good general health beside cugh and fever you can hope for it ,especially if she is treated properly and it means that all complications must be treated: stage 4 lung cancer is not usually curable, it is treatable. These treatments may not improve survival, but will help with the symptoms of lung cancer and make it easier to stand. So if she has fever and cough it might be lung infection which must be agressively treated by antibiotics, phlegm coughing can be improved by certain medicines and physical therapy. I am sure that doctors wll give their best, but no matter chemo cant be performed, rest of her life can be made easier and may be prolonged for month or 2 and it means a lot for you and her.
Hope I have answered your query. If you have any further questions I will be happy to help
Above answer was peer-reviewed by
Follow-up: Have stage 4 lung cancer. Developed cough and started coughing up phlegm. Life expectancy? 36 hours later
Dear Dr. Ivan-
Thank you so much for your kindness and your reply. You have probably answered as best as you can under the circumstances. It was helpful to hear about the medicines (basic info) that could help. I did find out that the hospice people (who are brand new and I don't know yet) ordered some anti-bios immediately for her.

Is there a way to tell if the fever is coming from the tumor or if her immune system is just weak? I was also wondering about the likely hood of her developing pneumonia from this and what that might be like- how does it change for someone who has lung cancer AND pneumonia?

Also- I was wondering how much cancer does it take to have in the lung before one dies? Does the lung have to "fill up" entirely? Or at a certain point does it just spread (we've heard: brain, bones, and liver) for lung cancer.

The health care system my mom is in is set up so that really her oncologist (who really likes her- it's impossible not to like my mom- she is one of these people on the planet who is overwhelming lovable- bad points and all:) Anyway- he won't see her any more. At least not officially. Her only contact with medical people are now the hospice people. She doesn't need to go to the hospital (and doesn't want to) They will just bring everything, including a hospital bed, to her home.

She is such a fighter, my mom- she's already over lived by 4 years all the medical prognosis' given. She has emphysema as well- only one side of her lungs really work. She is already on a portable oxygen machine 24/7.

So- there isn't a way for my brother to talk to her doctor anyway- although I'm hoping to speak with a hospice nurse before long. In the US, unless you have a lot of papers, even if you are a relative, because of the big insurance problems here, Doctors are unwilling to talk to anyone but patients. It's been hard not to be able to speak with someone about all of this- all these questions.

I want to fly out to see her as soon as I can- but I also have my life with my family and husband. I've traveled so much to take care of her in the last 2 years that I now have my own medical problems, with a big body breakdown and being now diagnosed with Chronic Fatigue Syndrome- which was a big surprise to me. So I have to judge my time carefully in order to be with my mom. I don't really have enough energy to keep flying back and forth.

I realize you can't tell me about when she will die...which is such a bittersweet and hard thing to be dealing with anyway. But I would like to know the answers above if you can help with them. And it really helps to write you these questions. If it's ok, I will stay in touch with you through this life process with my mom. Thank you- XXXXXXX
Answered by Dr. Ivan R. Rommstein 4 hours later
Hi again madam XXXXXXX

Well first, I am sure your mum is extraordinary woman,because she has such a careful and motivated children. Believe or not, I see too often how children neglect their parents or try to send them as far as they can just not to have responsibility for their treatment. Sometimes for hospital patients I cant even contact their families because noone respond to my calls. So I am very glad that you are interested about her condition and that you want to ensure your mother that she feels complacent in these hard days. She is some kind of miracle could be a theme of scientific case studies because less than 2% such patients survive more than 4years.
I am trying to be honest, dont wanna give some unreachable hope but just advice as best as I can.
This is really terminal malignant disease...there is no doubt about it.
I think you dont need to have any doubts about necessarity of hospice. Many people think that hospice means that hospital doctors are trying to "get rid" of someone and that there cant be carried out adequate treatment. This isnt true.Hospital and hospices have different indications for treatment. Palliative treatments are used to minimize symptoms or improve comfort. There is no purpose of leaving her in hospital where she can get only some exotic and lethal infection and where is a lack of educated staff who can care not just for physical but emotional and palliative health as well. So she doesnt need oncologist or sugeon now. She needs a nurse who know how to move her,walk with her, show breathing and sitting techniques,improve nutritional status, someone who will show enough empathy for her condition. also there she will be surrounded by patients who will understand her feelings and needs. I am sure that any life threatening condition wil be recognized there and that she will have proper medical care.

As you know cancer is always systematic disease, not just localized. Her whole organism if fighting and suffering at the same time. Every cancer especailly in late stages cause general weakness called cahexia. It includes weakness of immune system as well. Infection might be serious despite antibiotics. It can be infected tumor and in such cases more than one bacterias are involved and often are associated fungal infections found. It leads to pneumonia which honestly can be lethal. SO the only question is will there be improvement on this therapy or not. There is no "middle" if you understand. Her infection will progress till "the end" or recover completely...
But it is hard for me to consider all this without knowing findings.
Fever doesnt need to mean respiratory infection. It might be sign of sepsis,blood poisoning if >40C and this isnt a good sign...Respratory function is also affceted by pleural effusion,but it can be drained periodically.

I am not oncologist, but I have experience in thoracic surgery where we oftenly do lungs resection when tumors are operable. We usually remove one lobe or the whole lungs. People can live with only one lung,even 20-30% of lung function is enough for living(but you need to know this was measured in cured people with helathy rest of lungs). But there is no purpose of such calculations.Maybe is oxygen saturation findings measured by finger oxymeter good way to follow her condition. Lung cancer may have metastasis to almost every organ, but most of people die cause of respiratory failure.(I guess you dont mind me to talk openly about dying...). This is to be expected in your case because liver or brain failure need much more time to develop. There is possibility of heart incident always,I dont know condition of her heart. Respiratory failure is caused by tumor size, pneumonia,massive pleural effusion or bronchial obstruction. When it last long(and you said 4 years) then body have time to adapt to lower oxygen supply.

Doctors are not willing to talk about all this because they simply dont want to say something wrong in such difficult circumstances. It is hard to find right words and they dont know anything about it more than you. Noone cant predict anything in these situations,trust me.But I agree that they should give you some facts that I am trying to tell you.
Also just as physical symptoms and the exact cause of death, our loved one’s emotional response is hard to predict. Some people are strong, wanting to “fight” their cancer to the end. Others appear to accept death more readily. This also has direct effect on survival rate.

There is no need to visit her every time you can. She wont grudge you about it.SOmetimes visitors,even the closes family, may be even annoying for patient. You should just tell her everything that is on your mind and let her tell you her concerns. I suppose there is no something that she regrets in her life or something that she didnt have time to do.I am sure she is satisfied with her life,her children and all things that will be left after she pass away. Those cancer are often found in much younger people. You ll be proud in future if you know that you were there for her in the hardest moments.
Just to say about "final days" something. People usually want to spend final days and hours with patient. I am sure that nursewill call you after recognizing some physical sign such as lower body tempeature,mottling,confuson, shallow breathing,eatig and drinking stops and confusion. You can come then and be with her.Nature or God took care of everything,so dying process has elements which are useful for preparing a person to this moment. Person slowly becomes confused and unoriented and it makes her not to care and not to be afraid of pain and death. But usually there is unexplainable raise of mind brightness and energy hours or days before death which is the body’s way of allowing a dying person a last chance to say goodbye...

I hope I dont bother you with this philosophic aspect of medicine,but I also hope I am helpful and that you understand my english which isnt my mother language.
Looking forward to hear you again.
Above answer was peer-reviewed by
Follow-up: Have stage 4 lung cancer. Developed cough and started coughing up phlegm. Life expectancy? 21 hours later

Thank you SO much! That was all very helpful. I was able to share with my family and it helped. It also helped my mom to ASK for the anti-biotics for the in fever and infection- so that was great.

She is measuring her oxygen daily- and it really is a modern miracle that she is living. She is totally loveable and huggable, my mom- but she is extremely overweight, doesn't exercise. She's already had one heart-attack much earlier. We are all amazed she hasn't had one yet;) She is too but she laughs about it all the time. Plus, she is totally not interested in all the alternative things people try for extra health. My aunt and I do these things, but my mom is really quite happy with McDonalds. It's amazing and we don't try to change her any more, but just give her as much love as we can. It is her life:)

I don't have any more questions right now. I will write again, the next time I'm scared or don't know something;) Thank you for your kind words. And don't worry about your English- it's great. I'm working in a German speaking culture and trying to learn this very complicated language. I wish I could speak German as well as you write and think in English! My husband has a very good ear for languages and picks this up very quickly. I am still working very hard.

Anyway- I will read through the answers again and share the info with my brother too. The whole situation is so overwhelming, it takes awhile for me to be able to think with it. I will be in touch- thank you. Best- XXXXXXX
Answered by Dr. Ivan R. Rommstein 2 hours later
Well, the we can speak German next time.
Best regards.
Above answer was peer-reviewed by
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