Small Cell Lung Cancer

My mother was diagnosed with SCLC which has mesasatized to her Brain, she has a small a spot on the bone of her skull and also there are two lesions the size of 1.5 on her brain.  They said that her cancer was in extensive stage and that they want to do brain surgery on the two spots as soon as possible and then follow a path of chemotherapy.  I am confused as to why they would do brain surgery when this cancer is in this stage and also is it true that at this stage of cancer a person could survive only a few months without treatement and less than a year with treatment, and if this is the case, why would they take the time to do brain surgery if there was not much time for her.  The doctor is stating that keeping these lesions on the brain is more risky than not taking them out.  The lesions are located on th e outer layer of the brain.  Also, she is having severe back pain, could this be caused by the cancer. HELP, I want to do the best thing for my mom and if she does have only a small amount of time left I want to make the most of it for her.

[Fernando Roque, MD]

Hi.  Although your mother has extensive small cell lung cancer, she still stands to benefit from having those brain tumors treated.  Treating the brain metastases will prevent future neurologic complications (changes in sensorium, numbness and weakness of arms and legs) from occurring, as well as help prolong her survival.  What I do not agree with is the choice of treatment.  It might be better to do whole brain irradiation rather than surgery.  Surgery alone might not be able to remove any micro-metastatic lesions to the brain since these may not be visualized during the operation.  I agree that chemotherapy should be done after.  

It is true that SCLC patients with extensive disease usually survive for less than a year if left untreated. But when properly treated, the survival rate can be significantly prolonged (2-5 years), and the quality of life improved.

Your mom's back pain may be a sign of bone/spinal metastases and may also need to be treated. Aside from chemotherapy, drugs called bisphosphonates can help alleviate this condition.