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Hello I am from dhaka, bangladesh. My mother (54 years) was diagnosed with lung cancer 4th stage (metastatic adenocarcinoma) one month ago. She was going through dry cough for like 3 months so further investigation like biopsy confirmed it's lung cancer. But we didn't rely on our country's (bangladesh) report. So we went to apollo specialty hospital, chennai, india an ran pet ct scan followed by tapping as she had fluid in her lungs and then again biopsy. This time during the biopsy, my mother caught pneumothorax. So the doctor admitted her to emergency and inserted a tube in her backside. They called it drainage system. This will let the fluid come out of her lungs along with air that entered through pneunothorax. They kept the tube for 3/4 days and then released it. Now the doctor asked to do the chemotherapy. I get scared whenever I hear about chemotherapy. Is it the only way out? will this chemotherapy be effective for a long time? I did few researches over internet about the survival rate of lung cancer patient and it seems to be very low. Now I will write you the comments of pet ct scan and biopsy. 1. Pet ct scan: a) hypermetabolic primary mass in lingula b) hypermetabolic pleural metastases with effusion in left hemithorax. C) hypermetabolic metastatic paraaortic with non fdg avid left hilar nodes. D) no other demonstrable metabolically active disease in whole body survey. F) imaging is suggestive of bronchogenic malignancy in lingula segment of left lung with nodal and pleural metastases (t2an2m1a- stage iv) 2. Biopsy report: a) biopsy from left lung mass: consistent with adenocarcinoma, grade ii: ct guidedbiopsy from left lung mass. So what do you think, is it controllable? it is very worse? I want her to live. What kind of chemotherapy would you suggest? apart from chemo, is there any other way to treat or control it along with the chemo? I heard there is some drug called terceva. Internet says it treated their fourth stage cancer. I don't know but I am seeking your help regarding this

1 Doctor Answered
Thanks for providing good patient profile. From your reports, the only site of distant metastasis is paraaortic lymph nodes. Yes you are right that stage iv lung cancer has a poor prognosis. However a certain subpopulation of these patients still have a chance of favorable outcome. However this depends on number of things 1. Histology (adenocarcinoma favorable) 2. General condition of patient (performance status) 3. Presence of egfr mutations (favorable prognosis) 4. Absence of solid organ involvement (good prognosis). So egfr mutation study is next step. You have also asked any alternative option to chemotherapy. Yes there is a option. That is erlotinib (tarceva). But the tumor has to be egfr positive. Erlotinib is now recommended for egfr positive metastasic adenocarcinoma of lung (without any concomitant chemotherapy) until progression of the disease.
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