terminal small cell lung cancer

My mother in law was diagnosed in January with small cell lung cancer with widespread metastasis to her pancreas, bones, and liver. She has since developed brain metastases that are very widespread, there are so many tumors they can't even count them. She had ten days of radiation for the brain tumors with little effect. Now, she is in constant severe pain, she is on both a Fentanyl patch and Oxycontin and they don't even touch the pain, and she has lost the use of both legs. She is unable to stand or walk, and the legs just drag and are totally useless. Is the loss of the use of her legs from the brain tumors? Or is it possible she has cancer in her spine now? She has another CT scan next week. She is going downhill so fast that I really believe that she will be gone in a couple of weeks, if that long. She can't remember things, is very confused, never knows what day it is, etc. Every day she is worse off than the day before, and she is in bed most of the day and night now. What is your opinion Dr.?

[PaulMD]

Hi.

Small cell lung cancer is really one of the aggressive cancers.  If unable to receive treatment, the course can indeed be rather fast.  From what you are describing, it seems that she is in the terminal stages of the disease, and the best option for her now is to maximize supportive care through adequate pain management.  The inability to use her legs may be explained by the brain lesions since these are compressing on the neurons controlling the leg muscles.  I hope that her pain can be adequately managed.  Pain specialists (anesthesiologist specializing in pain) should be consulted.

Regards and God bless.