muscle mets/ more questions

Mom saw the doc yesterday. He ordered a biopsy so he can do radiation in the hopes of relieving some of her pain. He said we will discuss treatment options after a few radiation treatments. He wants  her to have 10, 1 each weekday for 2 weeks. What is the prognosis for lung cancer with muscle mets without chemo versus with and how sick does that chemo normally make elderly people in generally less than fair health?
My next question is probably selfish but my family history with cancer is Dad: Non Hodgkins Lymphoma,(deceased age 78) Sister: Melanoma (deceased age 38) and now Mom age 73: primary Lung with muscle mets and Primary colon with lymph note mets. What are my chances of getting/having cancer and what screening tests are recommended. I am 44 and get an annual PAP and Mammogram, I have had colon polyps and get a colonoscopy every 5 years. Is there anything else I should do. I try not to worry but it is pretty nerve wracking at times.

[HeinrikMD]

Hi,

The chemotherapy could improve symptoms and may extend survival. In general, the one year survival rate would be increased by about 10% or so. What is a bit crucial is what does less than healthy mean? As cancer advances, it affects daily more and more. How much the cancer is affecting daily living are among the things considered when planning the treatment. Patients who are still up and about more than half of their waking hours have a good shot at tolerating the treatment well, and in turn, extend survival. Those who may need to stay in bed for more than half of the waking hours may obtain improvement in symptoms such as cough and pain, but may have less chance of the treatment making a difference in terms of survival.

In terms of cancer screening, it seems you are doing all right. You could also check your skin, have a doctor perform inspection, or have a partner (this is because you may not be able to observe your back well). Try to keep an appropriate weight and a balanced diet (generally what works for heart disease and diabetes would do. There really isn't a well-supported cancer preventive diet) How old was mom when the colon cancer was detected? among the cancers you mentioned, this is the only one with familial patterns. The others may or may not familial.  

Stay positive.

[mommatialuv]

HI,
Less than healthy means, She had a stroke in 1994 (age 59), leaving her un-abel to work but still able to live alone. She has HTN, Diabetes, has had several TIA's, and most recently  Lung (diagnosed Nov. 06 age 71)and Colon cancer diagnosed June 07 age 72). The last month or so she has become increasingly weaker. only getting out of bet to use the bathroom, sometimes needing assistance for that. Prior to the last month, I would have said fair health, but it does appear she is becoming quite weak and frail.

[HeinrikMD]

Hi,

It seems that she is pretty weak. If this is the case, then the realistic goals may only be symptom improvement, the treatment may not change the survival picture. If however, she obtains a dramatic response (in which she becomes much more active as a result of treatment), then there would be room to re-evaluate the treatment goals.

If the colon cancer was at age  72, this is likely a sporadic case as against the familial variety. However, the fact that she has multiple cancers isn’t reassuring. At any rate, I think you are taking enough active steps to protect yourself.

[mommatialuv]

Well the biopsy shows that the muscle mass is a met from the colon. She will have 2-3 weeks if radiation for pain relief (the tumor is growing between the vertebrea, presumably hitting a nerve)then begin Chemo. 48 hours on a pump every 2 weeks. Her doc is worried about how she will tolerate the chemo as it is stronger then the preventative she had last year, she is more frail and weak already. THere is no indication yet that it has hit any vital organs, so he estimates 8-12 months without chemo and up to 28 months if she can tolerate the chemo consistently. He will re pet scan her after radiation, but says it will not change her treatment plan just longevity if they find more mets.
Please keep her an our family in your prayers.

[HeinrikMD]

Hi,

The current treatment seems reasonable. But if she is able to tolerate the current treatment, then you may consider adding more drugs to make a combination. Another option would be to shift drugs if there is minimal change after 3 or 4 cycles of treatment.

The figures I mentioned above, were for a primary lung cancer not for metastatic lung cancer with a colon primary (I thought that the muscle mets was from lung). The estimates of her doctor seem compatible with the case as it gets clearer to me also.

[mommatialuv]

Her Doc also predicted that the muscle mets were from her lung (he thought that was more common) but the biopsy connected it with the colon. She is an unusual case with 2 primary cancers. After speaking with him again today, getting more Chemo details, I found out that her Chemo will be 3 hours (2 drugs) in his office then home with the pump(1 drug, I think) for 48 hours. He will do 4 treatments then re scan to see progress and every 4 treatments or 2 months thereafter. He predicts  4-6 months then possibly a break if the tumors shrink enough, but predicts the cancer will return and she will have to begin again. He thinks Chemo will probably be a part of her life for the rest of her life now. She goes from an "oh well" attitude to" I'm going to be fine", to Call my brothers so she can see them before its to late. I have contacted my brothers and they will come, hopefully before she starts chemo and is to weak or sick to enjoy them at all.
Thanks for your listening, advice and time.

[HeinrikMD]

Hi,

Chemotherapy for as long as tolerated used to be the norm. This was at the time when there were few drugs for colon cancer. With the advent of more drugs (and along with it, more toxicities), one common practice would be to use a drug over 4 to 6 months or until there is an observed reduction in the size of the target mass, then consider a holiday with a plan to reintroduce the drugs when control of the disease starts to wan.

Best of luck to you and your loved one.

[mommatialuv]

Moms sugar spiked up this morning to 409@ 0700, upon arrival to the ER she received insulin@ 0830  with the result being sugar 416 @1030, they decided to admit her. She was given more insulin and the next 3 sugar checks over 6.5 hours were 358, 296 and 195 by about 1700. Could this be caused by a met on the pancreas. She has had diabetes for several years (non insulin dependent) she never has been over 200, and has been well controlled the last 6 months 100-120 always. I am waiting for a call from her Dr to see what testing he orders. Any and all information is greatly appreciated.

[HeinrikMD]

Hi,

Cancers of the colon tend to involve the liver. This is because of the digestive function of the liver, as most food absorbed passes initially through the liver. Involvement of the pancreas is uncommon.

Some patients who have poor appetite may receive some steroids. This is one possible cause of increasing blood sugar.

If she isn't eating much, then such a condition may lead to diabetic complications. Some patients with advanced cancers tend to lose weight due to muscle wasting - this is another potential cause of sugars going awry.

[mommatialuv]

Her doc agreed that the sugar issues was from the steroids, we are cutting them in half now, hopping to wean her off over the next few days. She is beginning to have trouble distinguishing dreams from reality, not always, sporadically. Could this be a side effect of the steroid? The only pain med she is on is darvocet, my understanding is that it should not cause confusion etc. We are  beginning to think about end of life decisions. Her home health aid is already mentioning Hospice, but mom wants to at least try Chemo. Any suggestions?

[HeinrikMD]

Hi,

The symptoms you describe about dreams and reality isn’t very clear. If you are referring to things that can happen but did not happen recently then this may only be a function of disorientation to date and time. People who are perennially in bed may suffer from this, but it doesn’t always suggest an underlying dysfunction.

If you are referring to hallucinations (things that aren’t really there), then this could be serious. The Darvocet is a mild narcotic, though it may have more to do with it rather than the steroid. IF there are headaches all the time, this may indicate cancer involvement of the brain.

If your mom wants to give chemo a shot – make sure that her expectations are realistic. It may be she is expecting the treatment will restore everything to her old healthy self. If she is pretty weak now, the treatment may afford a  reduction in pain, she may be a bit more active than before, but a reversal of symptoms is unlikely. It is possible to start the treatment with a lower dose to see how she takes it before going for higher doses. Talk it over with her doctor.

Stay positive.  

[mommatialuv]

They are hallucinations, seeing and speaking to people that are not there and havn't been around for years or in some cases ever. SHe does not say anything about headaches. sometimes she seems to understand that she will never really be "cured" but still wants to try chemo, Other times she expresses frustration over the fact that she "felt so good yesterday" and so bad today. She does sometimes have 3=4 hours of feeling good, sitting on the side of the bed having real conversations, but then back to sleep. She is still very weak, she is supposed to start physical therapy this week to strengthen her for chemo. Her doc  told her today that if she cant walk with a walker from his waiting room to the exam room (25=30 feet), she will not be strong enough for chemo, and he wont start it, now she seems determined to walk so she can have chemo, but I am afraid the chemo will still weaken her very quickly. We are thinking about putting her in a nursing home for more round the clock care, but are getting conflicting information on transporting for chemo. She lives with my 2 young adult (19 and 23) daughters, I go by daily after work to help but we are getting worn down already, emotionally and physically. none of us have any clinical training, just lots of love, but we all have to work so scheduling time is difficult, even with home health coming out 2=3 days a week for an hour or so.

[HeinrikMD]

Hi,

If the symptoms are largely cognitive, has there been an evaluation for brain metastasis?
I recall a discussion on radiation for muscle mets, but not radiation to the brain.  The radiation here may be able to restore coherence.

Caregivers do get fatigued especially if the problems seem to be endless and repetitive. The best way to avoid it is to share the load, have more people performing the task.

[mommatialuv]

Mom completed her radiation last Friday, she is currently pain free. She will have her Pet scan on Friday to see if there are any other mets. SHe is still very weak but over all in good spirits. SHe has been walking with her walker a little and her sugar is still running high, we have started insulin on a sliding scale. She stopped her steroids about a week ago now. My brothers have been visiting for the last 10 days and she had a sudden burst of energy when they arrived but is back to her "normal" weakened state now.

[HeinrikMD]

Hi,

It is good to hear that she will be getting a sort of treatment holiday. I say sort of because the insulin would still be there. The use of steroids during the radiaiton may be contributory to the blood sugar running awry, so perhaps the blood sugar may have less fluctutations making handling it easier.
It is also good that there are more people seeing her, this would also help give caregivers like you some rest.
Stay positive.

[mommatialuv]

Hi,
Moms PET CT scan showed; evidence of a new metastatic lung cancer to an enlarging subcarinal lymph node, also a new metastasis to the right lung apex where there is a new mass effect seen on the CAT scan today.There is an enlarged lymph node in the lower right neck. THere is a new metastasis to the lower sternum. The abdomen is normal with no evidence of metatstatic disease to the liver or mesentery, both kidneys and urinary bladder remain normal. This is compared to her Pet scan in Sept 07. There is an unchanged small metastases in the lower right neck and a metastasis to the right hilum shows less enhancement today than 9 months ago. The radiologist looked at the scan as a lung ca restaging and made no specific mention of the colon ca. Can you tell by a PET CT if the mets are from the lung or colon. Either way, I am assuming that the prognosis is worse based on the multiple metastatic locations. How big of a difference does it make that the liver and kidneys are not affected and weather the mets are from the lung or colon. Am I correct in thinking that the only way to know for sure would to be to biopsy each met. I'm pretty sure that is not a feasible treatment plan. What do you think?
Again I want to thank you for taking the time to communicate with me, It really helps.

[mommatialuv]

Hi Dr's,
Sorry to post again without a response, I just say my last post going farther down the page and was afraid it had been missed.
As always i appreciate any information/advice.

[HeinrikMD]

Hi,

The PET scan shows metabolic activity by the intensity of the signal that any given site would accumulate. While it is plausible to think of a unique signal for each cancer, at the present time cancers may have overlapping values, and so this precludes the capability of saying this comes from this.

You are correct that the only true way of finding out where each site came from is to sample each but this is not likely doable. Also, there are overlaps in the varieties of lung and colon which would require specialized tests. On a practical approach, the distribution of the cancer is considered as some cancers tend to go to specific organs, the odds of recurrence of the initial diagnosis of cancer, the rapidity of growth, the response to treatment.

There is a difference in terms of prognosis with lung cancer having shorter survival times. The choice of medications would of course also vary.

[mommatialuv]

I had to take mom to the ER last night for SOB. The admitted he with that diagnosis. in the middle of the night her heart rate jumped to 182, she was sweating profusely. They called in the rapid response team, and she settled down. All morning her Heart rate would jump as high as 200 stay briefly then drop down. She was asymptomatic always stating she feels fine. They gave her some meds and the jumps have stopped. Her cardiac enzymes were normal, they did an echocardiogram,we are waiting for results. They have mentioned possibly CHF. They are trying to determine if the erratic heart beat is actually heart related or cancer relater. That is where I got confused. Can Cancer cause the heart to act erratically like that. The admitting doc says the Cardiologist and the Oncologist will talk and decide what route to take with the heart based on the cancer prognosis. Effectively stating that if the cancer is to bad, we wont try and fix the heart if  it is in deed bad. what are your thoughts on all of this

[Miri775]

praying for you and your Mom.....

[mommatialuv]

I spoke with the Doc today, her heart is working at about 25% capacity. The Cardiologist believes she could cath her an possibly stent her, but it would not prolong her life. The Oncologist now thinks that she will never be strong enough for Chemo as her condition worsens. He suggested we start thinking about "comfort care". Its strange, I have been thinking about it for a while now, but when the Doc confirms that it is actually time, it becomes different. It is always so much easier to "think" about something then it is to "do" it. I know that I will be able to when the time comes, most likely within the next couple of weeks, but it is harder then I thought it would be.
I will be getting more specifics on DNR's and/versus Do not treat over the next few days.

[mommatialuv]

Mom was discharged from the hospital to a nursing home under hospice care on Saturday, on Tuesday she was certified for continious care and this morning 6/26 at 0250 she made her final journey home to the hands of our Lord.
I want to thank you all for your time, information and advice.
Remember to tell your loved ones that you love them as often as possible, hug them if they are in reach.
God Bless you.