Q: My 69 years old father has been diagnosed with small cell carcinoma of the left upper lobe of lung (pan coast tumour). Fine needle aspiration cytology (FNAC) was done and it showed small cell carcinoma, chest CECT, bone scan and bone marrow biopsy were non metastatic, blood counts TLC - 7800, lactate dehydrogenase (LDH) is raised to 650 and haemoglobin is 11%. Ultrasound of abdomen showed a cyst in liver, a large hypoechoic lesion of 2.1 x 2 cm in the region of body of pancreas. Another hypoechoic lesion was seen in tail of pancreas. Now, the doctor asked us to undergo a CECT abdomen. Is it necessary to undergo contrast enhanced computed tomogram (CECT) abdomen for pancreas? The doctor has suggested us to undergo chemotherapy plan - day 1 - Carboplatin auc 5 1v, day 1 – day 3 – (Etoposide 100 mg) / m2 1v. Is chemotherapy plan alright? I am also very apprehensive about chemotherapy side effects as my father has reduced his oral intake. He has become very weak. He is taking Morphine for pain. Lyrica and Amitryptiline have been stopped due to drowsiness. He is also suffering from hoarseness of voice and speech difficulty? How can it be cured?

A:Small cell lung cancer is, as you rightly say, aggressive very often. From your description it appears that it is of a limited stage. In that situation oncologists generally prescribe chemotherapy as you have listed. Often radiation is also required. The pancreatic abnormality is concerning although without more information it may be difficult to conclude on what it is. An endoscopic ultrasound guided biopsy or a CT guided biopsy is an option in some situations. If it does turn out to be another malignancy it will need to also be evaluated. Treating the lung cancer is important to prolong his survival but chemotherapy does have side effects unfortunately. Nutrition is important and if he is having swallowing difficulty he may need an artificial feeding tube inserted.

This may mean that he needs treatment initially started in a hospital. Sometimes if his general medical condition is not adequate some oncologists will not give chemotherapy - that may however mean that the lung cancer will spread. The hoarseness may be from vocal cord paralysis from the cancer.