Expert: Claes-Gustaf Nordquist, M.D. - 3/28/2011

Question
QUESTION: I had a seizure on 1/11/11 ambulance picked me up at my home, only sign prior to this was some speech problems started on Christmas Eve went to doctor said it was anxiety and sent me home did not take Lexapro as prescribe. I hadn't been to doctor in 3 years prior to this. Doctors found mass in my left temple lobe an a small mass in left lung. Had a biopsy on the lung 1/13/11 found nothing but scar tissue 1/18/11 had lemon size tumor removed found to be Stage 4 Adenocarinoma Lung Cancer with lung being primary. Went home on 1/21 had to take steroids and seizure meds which where beyond awful on the side effect. Started one minute radiation on 2/17 finished 3/14 had 15 treatments other than losing my hair again no side effects drove myself to appointments last week. I was still having problems from the steroids and seizure meds I went 3 weeks with only 3 to 6 hours a week of sleep. Finally quit Levetiracetam 500 and Dexamethasone 4 both on 2/25/11 took till 3/14 till I started sleeping right again with help of Lorazepam 1mg then switched to .5 by middle of week which I took for only a week. On 3/15 got port a cast for chemo start that on 3/28 for lung 1 1/2 hours first treatment tumor is small as dime expecting 4 to 6 months chemo at low dose. My side effects no meds no treatments at this time, I have OCD never had before cleaning everything, have to document everything with recorder or notes,  blurred vision my glasses are not working right (lost left eye at age 5 now have a prosthesis) will not put up with lien or get agitated at anyone who want be straight with me, never cried before now I cry at commercials, no sex drive since September always had one, use to except family and friends for who they are now point out what wrong and how to fix them and get very agitated when they don't follow my advice. I've almost quit dealing with my family even one of my two daughters because she thinks I'm crazy now along with my family even tried to have me legally committed which did not work. Now living alone only letting friends visit or help out but hardly even that, would rather be alone and take care of it myself which I've always been like that being a mother of two and not getting child support or finical aid but was always the life of the party and still am with friends not family. I have these knots coming up on my scar on my head doctor says not to worry and I fuss with my doctors over everything especially about medications want take them unless life threatening. I do allot of research online which is all contradicting so please help me. I know I've changed I except that I know I will have problems with chemo and I'm willing to go through that but I'm tired of doctors knowing what they think I can handle and what I can't, I know my body better than them and I don't need allot of medication my body rejects them. I don't drink or do drugs never have but I smoke a pack a day have been since I was 16. I prefer manual labor over easy and I hate not working in my carpet mill job even though I bitch about it when I was there missed 2 day in 3 years due to kids being sick. I know my side effects could be worse but I want to know what I can do about what I'm going through. Vicky

ANSWER: You have an adenocarcinoma of the lung (a kind of lung cancer in fact not related to smoking in spite of your smoking habit) that has spread to your brain (not uncommon for such cancers). You have had standard treatment (surgery and radiation therapy). That treatment also gave you the common side effect of brain swelling which has been given the standard treatment of cortisone. Since your cancer had spread it is automatically a stage 4 lung cancer. Such a cancer unfortunately usually has a bad prognosis. Since you have had both brain surgery and whole brain radiation therapy it is normal that a number of side effects appear as they also have in your case. Those effects largely depend on the location of your treated tumor and its size. Apart from the treatment of the tumor itself there is unfortunately not much that can be done about them. So I'm sorry, but there are no easy available solutions. Furthermore, not much time has passed since your treatment so you are still in your immediate post treatment period. For more help of any kind you must discuss your situation either with your neurologist or neurosurgeon and/or your oncologist/radiation therapist.



You can also reach me at: http://www.liveperson.com/professional/expert-profile.aspx?gsBMQvSJ0S4K1haAm6AtH
There is no limit to the number of questions there. Please note: NEW SITE!



---------- FOLLOW-UP ----------

QUESTION: Please explain the following statment you made and be frank with me:
Such a cancer unfortunately usually has a bad prognosis.

Answer
It means exactly what it says. Stage 4 cancers are at present incurable. So are most lung cancers even those that are not yet stage 4 tumors. Cancers that have spread to the brain have as bad a prognosis as primary malignant brain tumors of high grade (very malignant), most of these are incurable and eventually fatal with limited survival times - with few exceptions. But there are exceptions though rare and few. More than that is impossible to say at present.



You can also reach me at: http://www.liveperson.com/professional/expert-profile.aspx?gsBMQvSJ0S4K1haAm6AtH
There is no limit to the number of questions there. Please note: NEW SITE!