Lung adenocarcinoma with lung metastasis stage 4

OneDayAtATimexxx111

Hello all haven’t posted a new post since March. I was diagnosed with stage 3a lung adenocarcinoma in January 2025, I had chemo/ radiation in March then had my follow up in May. My lung tumor shrank considerably and my lymph nodes were clear, but there were several growths in my liver. I just had an MRI on July 23, and have 2- 3 cm tumors, one on each side of my liver, which puts me at stage 4 b or 4 a not sure till I see my oncologist next week. I have the egfr gene mutation, so tagrisso is an option, but I don’t know what else they may want to do. I just finished chemo radiation at the end of April, and it’s only July, so I’m extremely anxious as I still haven’t completely got over my prior treatment?. Any thoughts, information , or good wishes would be appreciated, thank you , one day at a time, Dave

BattleStar

Take everything one day at a time. I have stage four non small cell metastatic carcinoma. your cancer sounds similar to mine. metastatic likes to spread. it did so in me and by the time I was diagnosed with cancer it was stage 4. hopefully treatment will beat the cancer back. well wishes and God bless

eDivebuddy

Sorry it’s turned out this way, Dave. My carboplatin and paclitaxel worked wonders on my l liver met. Just more proof we all respond differently.

One thing I’ve been wondering, why haven’t they already started you on Tagrisso?
It’s now standard of care for both EGFR-mutated NSCLC that responds to chemoradiation and Stage 4 EGFR positive NSCLC.

Unless it’s a rare EGFR mutation not sensitive to Tagrisso, I don’t understand the delay.

Just my opinion, but if the guidelines say:

Start Tagrisso within 6 weeks after finishing chemoradiation, or

Start Tagrisso for EGFR-mutated Stage 4,
Then you should have already been on it months ago.

I while liver metastases are common in EGFR-positive lung cancer, so are benign liver lesions. So until you hear it directly from your oncologist, it’s okay to hold onto some hope that these spots may not be what they seem.

But if they are cancer Tagrisso is very effective, including in the liver. Many people have had long-lasting responses and good quality of life on it. Hopefully your team gets you started on it or some other effective treatment option soon.

OneDayAtATimexxx111

hi DB nice to hear from you, and it sounds like you are doing great! When I was diagnosed Jan 27 of this year there was nothing in my liver it was clear, no brain of bone Mets either . Had treatment from March tenth through April 25, still no liver Mets but I hadn’t had my after treatment scan yet. This is Maine, remember the speed of a town like Mayberry ( Andy Griffith), and that’s the speed of health care up here lol. Had after scan (May 25th) . Tumor in lung was a third of the size now about an inch and my three nodes shrank, and seemed to be still shrinking! Unfortunately they found three masses in my liver, middle one cyst, and one on each side .Met with oncologist on July 30th, and meeting with radiation oncologist August 5th. We’re going to do some SBRT as it works really well with 8 masses or less ,smaller than 3 cm. My oncologist had already gotten the ball rolling on the Tagrisso so I will be starting pretty soon with that I’m not sure if in conjunction with the radiation or after, I’ll find out very soon!!! She was basing her decision on the fact that I had no liver Mets at the time and the cancer had stopped growing in lung and lymph nodes,I was still 3a until July 23 rd officially, so i understand her thought process. I have another mutation can’t remember but it’s in one of my earliest posts? People with liver metastases in conjunction with lung adenocarcinoma Have the worst numbers vs having bone or brain Mets. tagrisso works way better if I had brain or bone Mets. I think I read , the average is about 10 to 18 months before the Tagrisso stops working with the liver Mets vs up to 3 years plus with the metastasis elsewhere. I told my oncologist I need to do some flying and bus riding to visit relatives and friends, and she said probably the beginning of September as I have to do the SBRT, and I have to be monitored while starting tagrisso for 3 weeks or so to see if there are any issues. I am sorry I didn’t keep messaging you, as you are extremely knowledgeable and positive towards helping everyone in here from what I see. I do have one person on here that I have been communicating with on a regular basis, which helps a lot, as I am going through this solo for the most part. I will know all when I talk to my radiation oncologist in 5 days! Thanks for the thoughts and help DB, sincerely Dave

BattleStar

Cancer is a monster like no other. Never sure what you will deal with day today. I know when mine had spread it went into the bone. Any metastatic cancer is very unpredictable and bares constant monitoring. I wish everyone well who are having to deal with it. I understand the challenges. God bless and get well

eDivebuddy

I don't believe prognosis is a good predictor of survival. After all, I was only given 3 to 6 months at most, five years ago! I had metastases to my liver, brain, lymph nodes, and even my skin. You can look at my avatar—that's all cancer. And yet... I'm still here.

Liver metastases are certainly not a good sign, but they don't necessarily carry the worst prognosis. Some people think they're the worst, but that's not backed by survival data.

Median Overall Survival by First Metastatic Site (NSCLC):

Liver: ~8–14 months[1]
Brain: ~6–12 months[2]
Skin: ~3–6 months (rare and often indicates advanced disease)[3]

I suspect skin metastases have a poor prognosis because they tend to appear when the disease is already widely spread, which mine certainly was. But here's the key point: when liver metastases resolve, the liver can regenerate and fully recover. The brain, on the other hand, cannot. Brain damage from metastases, surgery, or radiation often lasts a lifetime, leading to issues like seizures, visual field loss, and cognitive problems. But the liver? You can remove up to 75–80% of it, and what's left can regenerate to full size and function within weeks to months, even faster if it's otherwise healthy.

This resilience also applies to radiation therapy. Local control is greater than 90% at two years for small-volume disease [4], and there's a high likelihood of full liver function recovery, just as with resection [5].

If a doctor treats a suspicious liver lesion as metastatic without a biopsy, it's not an unreasonable approach. However, benign liver lesions are extremely common in the general population, up to 20%. It could be a hemangioma or something else harmless. Even so, I would rather treat a benign lesion than risk leaving a malignant one to grow.

I am living proof that a prognosis is a guide, not a destiny.

Sources:

[1]Kobayashi H, Uchino J, Takeda T, Uemura T, Oba T, Iwasaku M, Tsuji T, Naito T, Kishi K, Takayama K. Prognostic impact of liver metastasis in patients with metastatic non-small cell lung cancer: a real-world study. BMC Cancer. 2021 Jul 22;21(1):706. doi:10.1186/s12885-021-08474-w
https://pmc.ncbi.nlm.nih.gov/articles/PMC8264330/
[2] Brain metastases of non-small cell lung cancer: prognostic factors and management. 2018
https://pubmed.ncbi.nlm.nih.gov/30325482/
[4] Song, Z., Lin, B., Shao, L. et al. Cutaneous metastasis as a initial presentation in advanced non-small cell lung cancer and its poor survival prognosis. J Cancer Res Clin Oncol 138, 1613–1617 (2012). https://doi.org/10.1007/s00432-012-1239-6
https://link.springer.com/article/10.1007/s00432-012-1239-6
[5]Weykamp F, Hörner‑Rieber J, Buchele C, Rippke C, Regnery S, Debus J, Alber M, et al. Long‑Term Clinical Results of MR‑Guided Stereotactic Body Radiotherapy for Liver Metastases — Large Observational Registry Cohort. Cancers (Basel). 2023;15(10):2786. doi:10.3390/cancers15102786
https://pmc.ncbi.nlm.nih.gov/articles/PMC10216397/
[6] Ohri N, et al. Predictors of liver function decline after SBRT. Int J Radiat Oncol Biol Phys. 2021.
https://www.redjournal.org/article/S0360-3016(21)00096-7/fulltext

OneDayAtATimexxx111

Hey db, I also don’t believe prognosis is a good predictor of survival. Saw radiation oncologist today. He and my regular oncologist decided to just start the tagrisso, rather than SBRT right now as that way they will know exactly what results are from the tagrisso. If it works well we will just take that for now. If we’re not getting the desired results, we will do some SBRT and or ablation, but hopefully the tagrisso works for a while and who knows, maybe they will invent something even better by the time it stops working. Nobody knows but the man upstairs! Have a great day!

eDivebuddy

Sounds like a good plan to me too. Hopefully it's going to work wonders and keeps working.