Prognosis

[memah]

My father turns 89 tomorrow.  He had successful radiation and chemo last year for base of tongue cancer.  He has been on a feeding tube for over a year.  He has now been coughing terribly, a choking cough which often leaves him short of breath.  His doctor has suggested the cancer has metastasized to both lungs because a CT scan showed numerous nodules (more than ten) on his lungs.  His oncologist said that it may or may not be metastasis from the tongue, but it is a stage IV something, prognosis grim (six months, more or less).

My question is, well, I guess I have no question.  It's just such a hard time.  Stage IV is the worst, right?  Oncologist said it is metastatic.  Does that mean it has spread from tongue, or not necessarily?

Looking for some emotional support here.  Thank you.
m

[Dennis MD]

Hi Maggie,
I agree with the oncologist’s plan of determining whether the lung nodules are metastases from the tongue cancer or from a new primary lung cancer.  When that is known, various treatment strategies can already be started.
There are so many treatment protocols for lung cancer.  Non-small cell lung cancer (NSCLC) is managed somewhat differently from small cell lung cancer (SCLC) in terms of chemotherapy drugs used.  There are many available drugs now available, but platinum based (Cisplatin or Carboplatin) are most often used in combination with other drugs.  In general, treatment side effects include fatigue, body weakness, anorexia, and weight loss.  
If the lung nodules are metastases from the tongue cancer, your father may be given chemotherapy.  Taxanes would be appropriate.
Regards.

[memah]

Thank you, Dennis.  I haven't previously thought of him as being symptomatic, although I knew, of course, that he was.  You frame it differently, and helpfully.  My father does want treatment.  When the oncologist finishes his testing to determine whether this is metastasis from the tongue cancer or whether it's a new cancer, he will talk about possible treatment.  Can you tell me a little about various treatments for lung cancer?  What would be the side effects?  At this point it is unknown whether this is small cell or non-small cell, and more is unknown than known.  I wonder if, once confronted with results of the PET scan and brain MRI, my father will decide against treatment.  His primary care physician has said treatment would likely be chemo, as it is difficult to irradiate such a large area.  
My father weighs 140, up from a recent 130, which was up from a previous 121.5.  He is 6' tall.  At this point he is weak, and I wonder if he could tolerate chemo.
Thank you for your response.
Maggie  

[Dennis MD]

Hi M,
Your father at present is symptomatic (cough, shortness of breath) and his CT scan showed numerous nodules on both lungs.  It is possible that these nodules are metastases from his base of the tongue cancer.  The decision to give or not to give further cancer treatment/s will depend on a lot of things.  Consider the age of the patient, risks and benefits of treatment, possible side effects, and end point in making a decision.  For now, your father needs the best supportive care he can get.  
Take care.