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Medical Forum / Diseases and Disorders / Cancer / March 2005

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my neighbor's cancer

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Sharon and Mike - 17 Mar 2005 06:42 GMT
I am new here, but thought maybe someone could answer a question.

I have a neighbor, who has just been diagnosed with liver cancer.  She
didn't even know she had cancer, and for a year she would have some back
pain, not knowing what it was.  So she was prescribed pain killers, and no
doctor ever went any further with it.  It just so happened that she went
with her husband, who is in remission from throat cancer, to his doctor and
told him of her pain.  She asked him if he would recommend someone for her,
and he did.

So she found out she had cancer cells in her liver, and surrounding lymph
nodes.  They believe it started in her ovaries.  But she kept up a normal
life for over a year, worked full time, and wasn't bothered by anything much
but some back pain, which was the cancer.

They have given her a year with treatment, which she takes once every 3
weeks.  She says she feels great, and intends to beat it and prove everyone
wrong.

My question is, is it possible that she could beat it?  I am hoping this for
her, because she is one who is a very positive person, and loves her life,
her garden, her family.  I want the best for her, but when she and I talk,
and she talks about how she will beat this, I don't know what to say.  If
there is a chance that she could beat it, then I could be more positive to
her.  If it were me, I would believe the doctors, but I don't say that to
her.

So do any of you guys think there could be a chance?  She's been given a
year, but says she's already feeling better due to the chemo treatments.
Her pain is greatly diminished.  Any information is appreciated.  I just
don't know that much about people who survive liver cancer.

Warmest Regards,

Sharon and Mike
J - 17 Mar 2005 10:09 GMT
> I am new here, but thought maybe someone could answer a question.
>
[quoted text clipped - 27 lines]
> Her pain is greatly diminished.  Any information is appreciated.  I just
> don't know that much about people who survive liver cancer.

Hello Sharon,
The back pain sounds like it's deep in the liver, as opposed to superficial
cancer lesions on her liver.
(but I'm not a doctor and obviously not there to read her chart and see her
functional status)
I would be inclined to believe the doctors. (and 50% do better and 50% do worse)

If she feels better on chemo (ie helps more than it hurts) symptoms, then so be
it.

It's a difficult thing to step lightly (being encouraging), without giving false
hope.
You can say positive things, where applicable such as:
I'm glad that you're up and around
Good to see you out in the garden; the garden's looking lovely this year.
I'm pleased to see that you are still able to (insert here activity - work, take
care of the home, attend church, visit with your grandchildren, go on a cruise,
etc).
I'm glad that your pain is better. etc.

The last 11 sections here might be of assist to you
http://www.cancersupporters.com/asc/part1.html
and as things progress, over time,
http://palliative.info/teaching_material/Prognosis.pdf (it's in Adobe format)
Chemo may well help some with her pain, if it shrinks her liver tumor.
Cheno can cause temporary fatigue and low blood counts, so she could have a drop
in functional status but not be near the end; ie rally between treatments.
There are certain signs like progressive loss of weight; signs of liver failure
which may be more telling of how long she has.

Perhaps that latter file would help you to know when to offer your help?

Again, I'm not a doctor. See if Steph, or madiba or Jeff have a comment.
J
Sharon and Mike - 18 Mar 2005 05:25 GMT
>> I am new here, but thought maybe someone could answer a question.
>>
[quoted text clipped - 81 lines]
> Again, I'm not a doctor. See if Steph, or madiba or Jeff have a comment.
> J

Dear J,
I took your advice and it worked extremely well.  Before in the past, my
neighbor, who is named Ruth, would act as if she were insulted if people
around her didn't agree that she would beat it.  So today when I visited
her, I complimented on how good she looks, and how nice her house looked,
and her pretty flowers.  This seemed to put her at ease, and we talked for a
long period of time, longer than we have before.  Before, I was
uncomfortable, because I didn't know what to say.  I watched my father beat
his cancer, which was caught in time.  So since she and him are friends, it
was like, your father beat it and so will I.  But today, your advice worked
wonders, and I got around talking about natural treatments, which I'm
uncomfortable discussing.  She sometimes brings that up to me, but I myself
know that my father was cured because of the medical treatment he received.
So I wanted to write and say thanks, I have a new way of approaching her
now, and a new way to get around talking about her beating it.  Maybe she
will, I don't know.  If not, I will take comfort that I had a great
relationship with her, and was a friend.
We are from the state of Georgia, and she's getting treated in a local
hospital.  She is still doing fine, and other than having to take Procrit,
she still has an appetite, and feels pretty well.
I myself am 35 years old, and have recently found out that my grandmother
died of ovarian cancer, that had spread also.  I am considering having my
ovaries removed, my husband and I don't want children.  We also suspect my
grandmother's sister died from ovarian cancer, and my mother had hers
removed due to them being so cystic.  I would like your opinion on that as
well, I suffer from ovarian cysts all the time, and they are quite painful.
I know you are a very smart person, from what I read, and if you could
advise me on this, or point me in a direction I could go to, I would be very
appreciative.  My doctor says not to have them removed, even though he knows
I have problems with them, but it's my body.
Thanks again,
Sharon & Mike
J - 18 Mar 2005 10:56 GMT
> "J" <plaid@example.com> wrote in message
> .
[quoted text clipped - 23 lines]
> >> there is a chance that she could beat it, then I could be more positive to
> >> her.

<snip>

> > It's a difficult thing to step lightly (being encouraging), without giving
> false hope.
[quoted text clipped - 7 lines]
> > etc).
> > I'm glad that your pain is better. etc.<snipped>

> I took your advice and it worked extremely well.  Before in the past, my
> neighbor, who is named Ruth, would act as if she were insulted if people
[quoted text clipped - 12 lines]
> will, I don't know.  If not, I will take comfort that I had a great
> relationship with her, and was a friend.

Hello Sharon, I'm pleased to read that my suggestion seems to be working well.
Treat her like a person first; a person with cancer next;  she'll be ever so
grateful to have you as a confidant.
I'm also pleased to read that so far Ruth's doing well.
I'm also uncomfortable with the "natural treatments" discussions for a number of
reasons:
1) false hope 2) costs which can snowball, if she realizes that cure isn't
possible, panic can set in and start a buying spree of every known "natural
treatment" anywhere in the world 3) potential interference by same with the
established treatment.

I suppose if she notices that you're skipping over the subject, you could say
"I'm not sure that you want to hear the reasons why". and if she does want to
hear why:
1) my father never took them
2) I'm not knowledgeable about them (there are 1,000's of products/claims)
3) I've talked to someone who reads about them (for many years) on various
newsgroups and who has read and posted (for many years) on 3 cancer newsgroups,
for years now AND who has never seen anyone cured by any of these products; and
has witnessed the devastation effects of "chasing rainbows" (in patient
testimonials who have since died; in friends/relatives who died despite wasting
time/money/hope on such products)
4) out of concern for you that you make sure that your oncologist knows exactly
what you are trying.
5) I don't want to destroy your hope but want to protect you from a big
disappointment

Sharon, it's very kind of you to befriend Ruth.
Please make sure though that you take care of your needs too.
Sometimes we can get too involved with others problems and one day wake up and
realize that our "own house" is crumbling; health/relationships/work (etc). Hope
you understand what I mean?
A separate reply is coming to you,
Keep in touch and let us know how you're both doing, OK?
If I'm not around, an option is to post to alt.support.cancer especially if
you'll be one of her main confidants.
J
J - 18 Mar 2005 12:20 GMT
> We are from the state of Georgia, and she's getting treated in a local
> hospital.  She is still doing fine, and other than having to take Procrit,
[quoted text clipped - 9 lines]
> appreciative.  My doctor says not to have them removed, even though he knows
> I have problems with them, but it's my body.

Hello Sharon,
I wonder if you and Ruth know that there's a (potential) connection between
genetic risks breast/ovarian and colon cancer?
http://www.cancerbacup.org.uk/Cancertype/Ovary/Causesdiagnosis/Causes
You could perhaps calculate your risk by using that as a guideline.
However, since your mother had her ovaries removed, we've now got some missing
info as to "close relatives".

There's a more complex explanation here
http://www.nci.nih.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofes
sional


There's no "patient version" as best that I can see
http://www.nci.nih.gov/cancertopics/prevention-genetics-causes/ovarian

alt.support.pco (less current discussions (Febriary) /problems with spam)
alt.support.childfree a person that I know posts there and they discuss PCO .
(March discussions)
I think I saw that she takes or took Depo-provara

http://groups-beta.google.com/advanced_search?q=& (to search the archives)
type in the newsgroup name, sort by date, and PCOS, read a few threads
repeat but type in "phrase" - ovarian cysts, read a few threads
Reading some of their posts first, gets your "feet wet" and gives you some
information first, before posting.

http://www.4woman.gov/faq/ovarian_cysts.htm (discusses various types of ovarian
cysts - also has a list of organizations)
When are women most likely to have ovarian cysts?
Functional ovarian cysts usually occur during the childbearing years. Most
often, cysts in women of this age group are not cancerous. Women who are past
menopause (ages 50-70) with ovarian cysts have a higher risk of ovarian cancer.
At any age, if you think you have a cyst, it’s important to tell your doctor
<end quoted text>

I had a friend who had one cyst. It was asymptomatic; no pain; so her doctor and
she decided to just monitor.
After 12 - 15 years, her belly was getting bigger, so they scanned and realized
it was grapefruit size. That's when they decided to remove it. I don't know if
they removed both ovaries at the time. At the time, she already had 2 kids and
did not want more. Her surgery just happened to also be in the same date range
as discussed above. That's all I can pull from personal knowledge about.

It is your body. Have you asked your doctor the reasons why? One might think
"she might want children later" (ie not believe you that you don't and/or think
that later you might change your mind). Or might have very good reasons for
discouraging same.  Future osteoporosis risk?  Surgery/anesthetic risk? Costs
(what's covered or not)?  Scars?  Whether they tend to recur?  Hormone
replacements therapy; risks, costs. "Surgical menopause" symptoms, if any such
as hot flashes, depression etc   One gauge might be to discuss with your mother
as to the pros and cons.  However, there's no guarantee that how things go/went
with her, would be the same for you. We're all different and I believe that some
of us "take after" more one parent than the other.

There's pros and cons of having one ovaries removed. I want you to have the best
information about.
If you go to a surgeon, a surgeon finds a surgical solution.
If you went to a psychologist, she/he'd probably analyze you for 5 years
<smile>  .  See what I mean?
If you go to a women's health clinic (if there is one nearby), perhaps they
would be more prepared to discuss the pros and cons? Or know of a local support
group, where the experiences of others can be shared and discussed.
I don't know your age, but if you're going to college, they sometimes have
health/women's clinics.

I cannot give advice.  Not because I'm fence-sitting about the not wanting
children. I respect your decision. You sound like an intelligent person who has
thought it all through.  It's really because these issues are very complex.
Years ago, they gave women too strong or wrong medicines and there was fallout
later on that..thinking some birth contol pills, or example: thalidomide.
There's more known now, but i still see controversy about hormone replacement:
risks for heart, for various cancers (breast, I think, because there's more than
one type of breast cancer). It's enough to give a person a chronic headache.
<grin> So I hope that you will read up and discuss it with as many knowledgable
persons as possible, then make your decision because you'll have to live with
the decision.

As a sidenote and perhaps relevant, I note that those on Medicaid are refused
certain procedures
Even if this does not apply to you, it might give you some idea about screenings
that you should have and "State views" and possibly (some) doctor views.
<http://www.statehealthfacts.kff.org/cgi-bin/healthfacts.cgi?action=profile&area=
Georgia&category=Women's+Health&subcategory=&topic
=>

If that link does not work, try http://www.statehealthfacts.kff.org/ Then click
on your State.
I don't know a lot about US coverage but sometimes such facts are "telling" of
the state's views about women and women's issues.  For instance, I note that
there's a right of refusal for sterilization services.
So as an example; if a person in such coverages requested such surgery on the
basis of pain, but the doctor was not sympathetic to the amount of pain, could
perhaps refuse to refer for surgery (and perhaps think that a person was trying
to get sterilized at the cost of the State/medicaid and is faking the pain). Do
you see what I mean?

I hope that the information and my thoughts and/or questions help you.
I wish you the best.
J
Jeff - 17 Mar 2005 16:25 GMT
>I am new here, but thought maybe someone could answer a question.
>
[quoted text clipped - 10 lines]
> life for over a year, worked full time, and wasn't bothered by anything
> much but some back pain, which was the cancer.

Actually, the back pain could have been something else, like sore muscles.

It sounds like she has stage IV ovarian cancer (not liver cancer).

Ovarian cancer is hard to diagnose. Because the ovaries are so deep and the
cancer can spread so easily, women often go a long time without knowing
something is really wrong.

http://patient.cancerconsultants.com/ovarian_cancer_treatment.aspx?id=883

or find more info here: http://www.nci.nih.gov/ (click on women's cancers
for a link to ovarian cancer).

It sounds like she has a 1 in 10 chance of being around in 10 years.

http://www.cancerhelp.org.uk/help/default.asp?page=5449

To be around in ten years, she needs the best treatment. I would highly
recommend that she goes to one of the best cancer hospitals in the country
for a second opinion. She should also consider taking part in a clinical
trial.

Here is a list of 18 excellent hospitals:
http://www.aarpmagazine.org/health/Articles/a2003-01-17-cancerhospitals.html
or click on treatment here: http://www.nci.nih.gov/. It has great info.

Jeff
J - 17 Mar 2005 17:33 GMT
> "Sharon and Mike" <registered2705@netlimit.com> wrote in message
> >I am new here, but thought maybe someone could answer a question.
[quoted text clipped - 13 lines]
>
> Actually, the back pain could have been something else, like sore muscles.

http://www.oncologychannel.com/ovariancancer/symptoms.shtml
Signs and Symptoms

Despite an increased awareness of ovarian cancer in the news and other media,
the ability to detect this disease is poor, and many women are not diagnosed
until the disease is advanced. Ovarian cancer ordinarily produces no distinctive
symptoms, and most tumors metastasize, or spread, to other abdominal organs
before being diagnosed. Metastasis can give rise to ascites, a build-up of fluid
in the abdomen that usually causes abdominal swelling. Such swelling may be the
only indication that something is wrong, and it is the most common reason most
patient visit their doctor.

Other vague, but sometimes lingering symptoms of ovarian cancer include the
following:

   * Abdominal/pelvic discomfort or pressure
   * Back or leg pain
   * Bloating
   * Changes in bowel function or urinary frequency
   * Fatigue
   * Gastrointestinal symptoms (e.g., gas, long-term stomach pain, indigestion)

   * Malnourished or wasted appearance
   * Nausea or loss of appetite
   * Unusual vaginal bleeding

> It sounds like she has stage IV ovarian cancer (not liver cancer).

She already posted that.

> Ovarian cancer is hard to diagnose. Because the ovaries are so deep and the
> cancer can spread so easily, women often go a long time without knowing
> something is really wrong.
>
> It sounds like she has a 1 in 10 chance of being around in 10 years.

http://www.oncologychannel.com/ovariancancer/types.shtml
Germ cell type is curable.

http://www.cancerhelp.org.uk/help/default.asp?page=5449
Stage 3

As you might expect, the survival statistics fall with these more advanced
stages of ovarian cancer. Between 3 and 7 out of every 20 women diagnosed with
stage 3 ovarian cancer (15 - 35%) will live at least 5 years after their
diagnosis. There is a wide range because the figures vary depending on how far
the cancer has spread into the upper abdomen.

Stage 4

Understandably, the survival statistics are lower for stage 4 ovarian cancers
than they are for stage 3. The statistics for stage 4 vary quite a bit between
reports. This is because this stage covers a lot of different situations. It
means the cancer has spread, but it will have different effects depending on
where it has spread. Between 1 in 20 (5%) and 1 in 7 (14%) women with stage 4
ovarian cancer will live for at least 5 years. Doctors generally think a patient
is doing well if they are alive 2 years after being diagnosed with ovarian
cancer that has spread.

Other factors affecting prognosis

There are 2 other factors that can affect your prognosis, apart from the stage
of your cancer

   * The grade
   * How well you are overall

The cells are graded according to how like or unlike normal cells they are when
looked at under a microscope. There are 4 groups according to the size and
appearance of the control centre (nucleus) of the cancer cells.  These 4 groups
are called grades 1 to 4.  Grade 1 cancer cells are the most similar to normal
cells.  Grade 4 are most unlike normal cells. Generally speaking, the higher the
grade, the more quickly the cancer is likely to grow.

Doctors also have a way of grading how well you are. They call this your
‘performance status’. You may see this written PS. A score of 0 means you are
completely able to look after yourself. A score of 1 means you can do most
things for yourself, but need some help. The scores continue to go up, depending
on how much help you need. This is relevant to survival because overall, the
fitter people are, the better able they are to withstand their cancer and
treatment.

> Here is a list of 18 excellent hospitals:
> http://www.aarpmagazine.org/health/Articles/a2003-01-17-cancerhospitals.html

Geography and finances matter
http://my.webmd.com/content/article/99/105323.htm
Some, if not all, the hospitals listed there, treat cancer. Many times the best
treatment is right in the person's same neighborhood.
If she wants a second opinion, she could send out her biopsy sample to another
(one of your) hospital to make sure they've typed and graded it properly.
J
 
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