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Medical Forum / Diseases and Disorders / Cancer / September 2006questions about stage IV cancer
My sister died only 3 months after being diagnosed with stage IV cancer. It was found in her lungs and brain; however, radiation had shrunk the tumours and lesions, and she regained use of her hands. She seemed to be improving. She then got pneumonia in the hospital, and when that was cleared up, she got flluid in her lungs that they said was from the cancer. Yet the cancer in her lungs, I was told, was the size of a pea. Her complications included diabetes and previous heart trouble (ten years ago she had congestive heart failure and was on medication for that). She was on a lot of pills for these things and had been living a full and active life. She suddenly lost use of her hands and legs, the cancers were diagnosed, radiation and pills made her better. Then she died suddenly because of fluid in her lungs building up and I was told she refused to be intubated even though she had had her lungs drained several times. She had a do not resuscitate order, but in my discussion with her when she wrote the document, that applied to only if two doctors agreed her condition was fatal. She did not want to be kept alive in a coma by artificial means. She wasn't in a coma though. It made no sense to me that she would refuse the draining of the lungs after having it several times. Earlier in the day she had shown no signs of confusion or worsening of any symptoms. In no way did she want to die. I also was told her blood sugar was over 500. Yet she was being given insulin injections. Previously she handled her diabetes with pills and diet. They told me the radiation treatment interfered with her diabetes. When I asked about these things her children became hostile. They didn't want an autopsy. For me it is a mystery why she could die in just 3 months, and die suddenly in such a way. Is this normal for stage iv cancer?. I was told she died of a heart attack or heart failure, as her heart gave out when she could not breathe. They only gave her oxygen because of her refusal of the intubation. To me it seems unbelievable they would not intubate her since she accepted it before. It was not on her list of "do not do". Have any of you heard of this type of cancer causing fluid buildup in the lungs; of someone dying this way? It doesn't look like it was the cancer, it looks like a misunderstanding of the meaning of her "do not resusitate" orders. I live far away and her daughter was in charge of her care, but I am just concerned about the scenario as it was told to me. > My sister died only 3 months after being diagnosed with stage IV cancer. It > was found in her lungs and brain; however, radiation had shrunk the tumours [quoted text clipped - 31 lines] > orders. I live far away and her daughter was in charge of her care, but I am > just concerned about the scenario as it was told to me. Hello. I'm sorry to hear about your sister. Mom died of lung cancer approximately 3 weeks after diagnosis. It was not in her brain. There was an autopsy, because they got caught with "their pants down". She'd been in hospital for 3 or 4 weeks, before they determined that the problem was cancer. Her body was too worn out, too many other health issues, too tired to fight and certainly not enough time. She died of cancer. I know about how a cat dies from congestive heart failure. Mine did a few years ago. Dad died after years of having infections, at first, yearly and had to be hospitalized. He lived quite well, for quite a few years, until he got penumoia and it kept coming back. They had to withdraw his getting fluids/drinking, since it kept collecting in his lungs. His body was worn out, too tired to fight. I think they put "natural causes" on his death certificate, but i forget at the moment. So there's possibles of why she refused lung draining, pneumonia kept coming back and/or the cancer kept causing more fluids in her lungs and/or the CHF was also causing fluids to keep coming back again and she just plain got tired, her body was too tired to fight anymore and she realized that. As to the cat, the additional heart med just couldn't keep up with all the fluid.. Point being: same happens with humans.. I"m sorry if some of this seems offtopic about the cat and/or I'm going on too long to explain, but each ties in to your sister's situation and why I feel she made the decision that she made. Maybe i could said this shorter: With the history of pneumonia, being in hospital, history of congestive heart failure and the lung cancer, there's probably no way to know which was causing the fluids, possibly all three, so it was a "losing proposition" to try and control the fluids. Really there was little more they could have done for her (that would have had a lasting effect without discomfort) but pain meds and the diabetes shots. And if I recall correctly, Steph's told us, once in the brain, 3 months is about the average/median time. Some live a bit longer, some not so long. I don''t know if this answers your questions? J Thank you - yes, it did help me understand. I see that I was misled by false hopes when originally she was given a year to live. And when they told me how small the lung cancer was. It was all minimized. It would have been much better to tell us all the stark facts from day one so we could know time was of the essence. I thank you so much for your reply. >> My sister died only 3 months after being diagnosed with stage IV cancer. >> It [quoted text clipped - 120 lines] > I don''t know if this answers your questions? > J > Thank you - yes, it did help me understand. > I see that I was misled by false hopes when originally she was given a year > to live. And when they told me how small the lung cancer was. It was all > minimized. It would have been much better to tell us all the stark facts > from day one so we could know time was of the essence. I thank you so much > for your reply. Hello dear, Well I think sometimes one specialist or another gives out a prognosis based on the type (and stage) of cancer and there's 4 types of lung cancer. And others may give out prognoses based on their patients experidnce with same type/stage of cancer without considering co-morbities and others may give the maximum time the person has and others may give the "median" (which i explained earlier) or others may state a prognosis, based on many patients who had brain mets and lived longer with radiation therapy. For instance, Bob's here and he had a brain met and had RT and I think he's celebrated his 3rd year. See, it can vary? The doctors can't win, when giving a prognosis. If they give one too dire and the patient lives longer, the patient (or loved one) may feel they're out of the woods too soon and in your sister's situation, it worked the other way, a longer prognosis, that just wasn't to be. I have mom's autopsy here and she had widespread bone mets in her spine and the tumor was only affecting one lung. There was extensive spread to her mediastinum and numerous large mediastinal lymph nodes. There were several nodular mets, in the liver ; the largest measuring approminately 4 cms, in the right lobe. When I first read that, years ago, I was angry. It sounded (to me) that it should have been curable, if only they'd caught it earlier, but the knowledge i've gained, on this newsgroup, since, tells it was not to be, once in the liver and the number of mets. It took a long time to come to terms. What I'm saying is while it sounded minimal, I realize, now that her cancer burden was a lot more extensive than I realized at the time. I don't know when this happened with your sister, but if it helps you, stay with us. I'm here to listen and care, if you think talking more about it, will help you come to terms. * hugs * J My sister died only 3 days ago. I was not given all the details which is why I posted here; I'd been reading here for some time to try to learn about cancer but I never saw anything just like her case. I did some looking up online just now and found a few cases of brain and lung cancer (together) which don't seem as common as other types. In every case the person died almost right away, they were a matter of weeks. I wish I had known! But I also found out that my sister started having strange symptoms a year ago and she just let them go, and carried on with her life, and obviously the doctors did not find the cancer then. She had unusual nausea and abdominal pains, and tiredness. She just kept on going. This year we were active together on a family project until May when she suddenly lost the use of her hand and legs and went to ER. She could not write and our email correspondence was ended. But she had answered many questions about her childhood and helped me expand our genealogy. I have all her contributions as a lasting legacy. After she got the scans and tests it was diagnosed. She had thought it was a stroke but it wasn't. She became pragmatic and talked about dying, almost fatalistically, although she wanted to live, and believed she would get better; she was never her lively self again because of the drugs they gave her that made her a little depressed and tired. Yet, she was as sharp in her mind as ever till the very end. For me though, I couldn't believe she wouldn't live a long time, considering others in our family who lived longer with diabetes and heart disease. She was so full of life even with her coughing, when I would see her in the nursing home before they moved her far away from me. Her skin was beautiful, her ankles and legs and feet were no longer swollen. I saw no outward signs that would alarm me. I thought we still had time. And her mind was so clear. Well, every time we lost a loved one, she and I having lost a brother and our parents, we swore we would never let things go undone; we would cherish each other while we were still alive, and sort our family papers and put it in order as a heritage for our children. I am so glad that we worked to gether so much and communicated so much, as I still feel she is around the corner, in the next room, and can see her in my mind's eye. Now she's gone though from this earth and it's all up to me as I promised I would take care of her papers and write her biography, as she was a remarkable woman. I feel her peaceful and happy spirit with me now. >> Thank you - yes, it did help me understand. >> I see that I was misled by false hopes when originally she was given a [quoted text clipped - 57 lines] > * hugs * > J > My sister died only 3 days ago. I was not given all the details which is why > I posted here; I'd been reading here for some time to try to learn about > cancer but I never saw anything just like her case. I did some looking up > online just now and found a few cases of brain and lung cancer (together) > which don't seem as common as other types. In every case the person died > almost right away, they were a matter of weeks. That's consistent with what is said about lung cancer, although some live a year or more.. There are survivors who post here, but they're in the minority (of all lung cancers, diagnosed, in the world, because so many are diagnosed late/advanced). Those who've been cured (surgery and/or RT), have been caught accidentally early, but monitoring has to continue.. And of course, they get on with their lives, so we don't have a lot of them here, on a regular basis. Orping is one. He'll be posting about his wife (who had surgery) in October after next check up. He's Canadian. Was your sister in Canada? > I wish I had known! But I > also found out that my sister started having strange symptoms a year ago and [quoted text clipped - 6 lines] > childhood and helped me expand our genealogy. I have all her contributions > as a lasting legacy. That's so wonderful. After our parents died, I urged my sister to help do the same. She's done so, for one side of the family, but have't had a chance to go too far back. Just 4 generations and hopefully that will be continued (both forward and backward). I hear the Mormon church has the best compilation of records in all the world. And a person can go to any of the locations and research themselves. And if the records don't go far enough back, they can send out to other locations to acquire more. It requires some sleuthing and knowing some details about various relatives, long since gone. > After she got the scans and tests it was diagnosed. She had thought it was a > stroke but it wasn't. She became pragmatic and talked about dying, almost [quoted text clipped - 17 lines] > biography, as she was a remarkable woman. I feel her peaceful and happy > spirit with me now. I'm so sorry for your loss. I had a feeling it was recent. She sounds like a brave and beautiful person. Hold on to the good memories and the legacy's she left you (and the family). Grieving takes time; just when we think we're over it; something triggers the memories or we want to pick up the phone and call the loved one to share good or bad news and realize they're no longer there to speak with, that can trigger crying spells or urges to take time out for more mourning. I think that's healthy. I think you can call on other situations where you or she were there, for each other, to know what she'd say in a new circumstance. I'm so relieved that I still have my siblings. I would be devastated if any of them suddenly took ill with a deadly disease. On the other hand, we're getting to the age, when things can start to happen, so I'm hopefully prepared if bad news occurs. And PS: yes a person can have 2 cancers at the same time - your example: lung cancer and a brain tumor, but the more likely is lung cancer and met to the brain. It's unfortunate that the onc didn't tell her and/or the family about the 3 month+/-. But it does seem that they gave her the best of care and that you made the most of the time she had left. Let me know if I can help more. If a thought jumps out later and you want to share here, I'll try to help. If you find that grieving becomes chronic, talk with your doctor. I also recommend alt.support.grief. Daniel's sometimes there. His father passed away from cancer, so I'm sure he understands. (and there's problably others there as well, who understand and care). So you know you have a number of resources. *hugs* and remember to take care of you as well. J I have some questions about my friend who died of stage iv cancer a week before my sister. I did have a year's notice of his dying and 3 months notice of hers. But here's what happened with him. He had stomach pain, nausea and other abdominal and gastric symptoms for years. He was diagnosed with GERD and used antacids but they couldn't find anything else. But they found cancer of the esophagus only when he insisted on certain tests they had not done. Of course he was not pleased that they had misdiagnosed him and not done the proper tests in time, so that when they found it, it was already fatal. I think it had already spread to his liver. I don't have the details as I lost all his email in a computer crash so this is from memory. He had chemotherapy and recently the radiation and chemo stopped working so he was told there was nothing they could do but give him morphine. My question is why could he not have a liver transplant? Why was it "inoperable?" John Wayne had a lung removed and lived 15 more years...Elizabeth Taylor had a brain tumour removed about ten years ago and is still alive...these are the things that I don't fully understand. Are these operable cases stage 1 cancer? Is it because their doctors did discover it soon enough? I read that once it spreads, it is impossible to stop. Isn't that something they've been working on for years with all the cancer research? I didn't hear anything about either my friend or sister having cancer in the lymph nodes or anywhere else. Why don't they try to remove the cancer they find, rather than let them spread? One more question. My sister was a heavy smoker for about 35 years. Is it medically established that her cancer would be caused by smoking? My friend had smoked but quit 30 years before. Could that earlier smoking also have led to his cancer? I know that Dana Reeve had never smoked and yet died of lung cancer. >> My sister died only 3 days ago. I was not given all the details which is >> why [quoted text clipped - 133 lines] > *hugs* and remember to take care of you as well. > J > I have some questions about my friend who died of stage iv cancer a week > before my sister. I did have a year's notice of his dying and 3 months [quoted text clipped - 27 lines] > led to his cancer? I know that Dana Reeve had never smoked and yet died of > lung cancer. Gosh, I'm sorry to hear you've had so many losses recently. I haven't looked up the symptoms of esopheal cancer, but i would think bleeding and problems swallowing, unless his started lower in the esophagus, near the stomach. Perhaps that's why tests weren't ordered immediately. I don't mean to "excuse" doctors all the time, but sometimes they start with the simplest possible causes and monitor and if it worsens, order up the battery of tests. Of course, these battery of tests can't be run every month, so it's hard to say if he had the tests and nothing could be seen at the time, yet there were cancer cells growing there. The liver's what I call "bloody" (lots of blood in it and lots of important blood vessels running through it.) If I recall correctly, it has 2 lobes. (maybe Steph will correct me on any of what I'm saying because I'm not a doctor). Cancer can spread locally (outward from the esophageal tumor), through the lymph nodes and/or via the blood stream. Why not a transplant? Various reasons: Finding a compatible and healthy liver (or part of a liver) = availability. Anti-rejection drugs required? But the main reason, I think is that once it's in the liver, the more likely it's in the bloodstream and can show up anywhere else in the body, so considering the downtime for recovery from the surgery, there may be not much time gained by having such surgery. Why not surgery for the liver? Well, some do have a lobe or more taken out, but if it's in the liver, it's almost certain that it will show up in the rest of the liver. If there's one frank tumor in one lobe, some take the chance. It's not an "easy" surgery. Andy (Monkkey's Unkle) had it. We did hear from him after the surgery, but he's been mighty quiet since. (J hoping he's okay). Yes, a lot of solid tumor type cancers, can be cured with surgery if caught early enough. Surgery or surgery with radiation therapy. A lot of primary brain tumors can be cured with surgery or surgery with radiation therapy. Location and clear margins are important. Cancer behaviour hasn't changed over the years; research has provided some better medicines; Herceptin for one type of breast cancer; chemotherapies with less side effects, so some can take higher doses or take some longer. None of the common cancers can be cured with chemotherapy, once it's spread. Has to do with chemo resistance. Chemo plays a small role in (curing) cancers, if i recall correctly germ cell cancers and some lymphomas. Your sister wasn't a good candidate for surgery with the heart and other problems; besides it had already spread. Your friend's had already spread (answered higher up, in this post). Watch for any corrections from Steph, please. I'll address the rest later or tomorrow. J Thanks for giving me more information. More questions - my mother in law is over 80 and has smoked for about 60 years, strong unfiltered cigarettes, plus she drinks. She had a stroke 15 years ago that only affected her hand. They blamed her estrogen and she stopped taking it and to this day continues to have severe hot flashes. She has no other major ailments and seems about 10 years younger. Why no lung cancer for her, but for my sister who smoked only 35 years, filtered cigarettes? Did my sister's other conditions contribute to the cancer starting, spreading, and ending her life so rapidly? Do researchers yet know for sure about life styles that promote cancer more than others? I have read the usual advice about lowering the risk. But both these women smoked, both ate high fat, high sugar diets, both were only slightly active physically (walking) and one died far sooner. My mother in law eats just as many sweets as my sister did...yet she did not develop diabetes. I am fairly sure that is hereditary - several in my side of the family had it. But does diabetes increase the chance of getting cancer? Or are these things still unknown? It seems like a 100% certainty now that I will get diabetes or cancer and that is not a comforting thought. >> I have some questions about my friend who died of stage iv cancer a week >> before my sister. I did have a year's notice of his dying and 3 months [quoted text clipped - 106 lines] > I'll address the rest later or tomorrow. > J > Thanks for giving me more information. More questions - my mother in law is > over 80 and has smoked for about 60 years, strong unfiltered cigarettes, [quoted text clipped - 13 lines] > cancer? Or are these things still unknown? It seems like a 100% certainty > now that I will get diabetes or cancer and that is not a comforting thought. Hello, You can't compare your mother-in-law to your sister. It's a different generation and different genetics. Your sister was not a "product" of your mother-in -law's genetics. Example: My MIL lived in a mostly smoking household, for most of her life, and was almost 100 when she died, of natural causes. And she loved sweets and cooked fatty foods. However, if I recall correctly, a lot of meals included salads. And she baked her own bread (mostly white). How do I explain she didn't get cancer, nor heart disease, nor diabetes. I can't. (her husband died 30 or so years earlier of cancer). There've been people here who've gotten lung cancer who never smoked, nor spent time in a smoking environment. Unexplainable. I think when one has a few persons pass away from cancer, it brings up these types of questions and sometimes anxieties. I would think your best option is to discuss your family history with your family doctor. If he/she feels some screening should start, at certain intervals, that can be arranged. And/or check your HDL/LDL or getting a baseline glucose challenge. Not that I think you're at risk for any of this, but it opens the topic of screenings and family history. I don't know what the doctor situation is, where you are, but when calling for an appointment, you might want to mention a "Wellness checkup" and discussion about family history, so they know how much time to book, or tell you if they don't do that type of thing or what's not included. Where i live, younger (than the gov't recommened screening age) males, get their PSA's ordered up at walkin clinics and females go to a special gynae type clinic and can discuss (issues like) estrogen replacement and when they should have a mammogram, there, unless they have a family doctor who has time to address all issues. As to your last question/sentence, my view is we all die some day. Follow what your doctor advises, make sure you have fun along the road of life and don't spend too much worrying. We can't plan for everything that might cause our death. J |
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