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Forum Name: Brain Tumors

Question: Inoperable Brain Tumor


 lalabks - Sun Dec 21, 2008 5:25 pm

My father in law has just been diagnosed with an occipital lobe brain tumor. Due to his current prior health conditions (severe heart problems) the doctors feel that he would not survive surgery nor would he survive any sort of chemo or radiation. We do not know yet if the tumor contains cancerous cells, or if it a mass.

What we do know is that he is already showing signs of increased intracranial pressure, and the hospital is going to send him home. He has no loss of vision on anything like that yet, just saying strange things and making odd hand gestures at this point, upon doing reasearch, we learned that his vision may be the next thing to go.

What I am asking is, if no treatment is the only option, how much longer does he have to live and how much suffering will he have to go through? What's the time length prognosis?
 Dr. Tamer Fouad - Wed Dec 24, 2008 8:04 am

User avatar Hello,

I am sorry to hear about your father in law's condition.

Your question would be impossible to answer without a diagnosis. Not only is it important to determine whether this mass is benign or malignant but many other things go into play:
Is it a primary or a metastasis from another tumor?
Assuming it is a primary malignant tumor, the most common brain tumors are astrocytomas and with these it's important to determine the pathological grade. Grades I, II behave more less favorably while grades III and IV have a poor prognosis. Some reports indicate that patients who have Grade IV and do not receive therapy have an average survival of 3 months.

In many cases most of the symptoms can be caused by the edema that accumulates around the brain mass. This can be treated with medicines such as steroids and diuretics.

His doctors don't think it's even worth it to get a biopsy? Of course that could be the case, I am in no position to judge. You can always ask for a second opinion.

Please keep us updated.
 lalabks - Wed Dec 24, 2008 11:00 am

I do have a little more information. He had come down with a case of pneumonia and was planning on going to the hospital anyway. So, day of, his wife noticed him making the odd hand gestures and he was talking nonsense, etc. Upon going to the hospital, the gave him a CT and found a mass in his lung and one on his occipital lobe, like I said. There was a biopsy done, results not in yet. Although the doctors are already telling him that it is most definitely cancer.

Yesterday we spoke to dad and he said at this point he is feeling better than he has ever felt in his life. According to my mother in law, he has been in great spirits. I think he will be in the hospital through Christmas atleast.

The reason I wrote in the first place was to get a round about idea of what we can expect, my husband in obviously very upset and didn't want to think of his father's last months as dementia and losing sensory and motor skills one at a time.

If it is cancer, my father in law has had heart issues to the point of having his sternum removed and doctor's say that, for one, the brain portion is inoperable and even if it was, he wouldn't survive the surgery. The same is the case with the amount of chemo or radiation he would need.

I don't know if any of that helps or not but as soon as I have more information, I'll post it.

Thanks so much for all your help!
 Dr. Tamer Fouad - Mon Dec 29, 2008 4:23 am

User avatar Hi again,

It all depends on the results of the biopsy. Apparently, doctors are suspecting a lung cancer with brain secondaries. I am not saying it is, I do not have access to all the details.

If this is the case and without therapy then we are talking about months. Then again, I think doctors may change their mind based upon the result of the biopsy. One option that you should discuss with your doctor is the possibility of palliative radiotherapy to the brain. The intent of this form of therapy is not cure but to prevent progression of symptoms as you mention.

Please keep this thread updated.
 lalabks - Mon Jan 05, 2009 11:05 am

We got an update from the visit with the oncologist. He has been diagnosed with stage 3 lung cancer, and the brain as a secondary. They are discussing options at this point, but he has been told that there are few. He has been told that radiation can be pinpointed with minimal exposure to his heart, so I think that will be the direction that they go. As far as the tumor in the brain, we are awaiting results of the PET scan. His doctors say, based on the CT, that it is inoperable anyway so they are going to try and manage the pressure on his brain the best that they can.
 Dr. Tamer Fouad - Tue Jan 06, 2009 12:23 am

User avatar Hello,

If the mass in the brain is a metastasis then one option could be brain irradiation as well as managing the edema. This is just a suggestion, it will of course depend on the details of his condition and you are best to discuss this option with his doctor. Do you know what the histologic (pathology) type is?

Again, the use of radiotherapy would aim at palliating his symptoms, of course taking into consideration how much of these symptoms are attributed to his cardiac condition and how much is due to the cancer. As his doctor has suggested the radiation would have to take into consideration shielding the heart.

Best regards and keep us updated!
 paulous - Fri Apr 24, 2009 8:18 am

Hi


My father has similarly just been told his Lung cancer and brain mets and is untreatable rendering him with weeks/maybe months to live. I am hoping if this is entirely accurate and exploring possible solutions to this.
Not really much information to go on but here is what i know:
Dads Medical and work history:
Worked in Merchant Navy for 30 Years, Worked in Monde division at Astra Zenica (Formerly ICI), for almost a year in Manchester and Has been a taxi Driver For the remainder, he Is 61 two weeks ago and has never smoked, drinks once ever two months at most, is relatively physically fit and full of energy usually.
Never has had a cold since i have known him thats 24 years, no stomach ache or headache either. In this respect he is extremely lucky.
He did however develop a couch 3 years ago with phlegm which turned into bloody browny phlegm about 9 months ago.
He had a pacemaker fitted in May 2008 as his heart rate was 30bpm at rest. I beleive one of his valves(bicuspid or tricuspid) was not functioning correctly allowing blood to seep in after contraction of the heart.
In December 2008 He was rushed to hospital with really bad chest pain and told it was just pnuemonia even though there was a huge grey area in his lower left lung on X-ray.
He told doctor he was losing weight and throwing up on the medication they had gve him to which he said thats a good thing because slim is better.
After pleading with the nurse to change his medication he was sent home vomiting on taking it and still in pain and coughing.
We got a new set of anti-biotics from the doctor and eventually the pain dissipated but my father become increasingly tired and doctors were unsure what the lung mass was.
During April 6th my dad got a nasty headache in his right side and 2 days later began collapsing losing all feeling in his left side.
CT scan two days later showed two 4.5cm masses in the right front and right mid brain and the primary being in the lung.
A biopsy was taken of the lung but only showed inflammatory cells so the doctors are not going to try and grade of diagnose the cancers and have said he has a few weeks to live.
Thye said Chemo and radio therapy may aggravate the cancer and kill him. they haven't mentioned any trials or natural methods of fighting the disease just kept him on lose dose of atorvastin and aspirin.
Should i just accept this or keep plodding on trying to find someone who can treat my father?
Any advice welcomed, thanks and sorry for drooling on and posting here but unsure how else to post.

Kind Regards

Paul
 Dr. Tamer Fouad - Wed Apr 29, 2009 9:29 am

User avatar Hello,
I am sorry to hear about your father's condition.
Chemotherapy and radiotherapy can be effective in palliating metastatic lung cancer depending on its type. There are several types and which each require very different chemotherapy. That is why the pathology was important. Where in the lung is the tumor situated? Does it say it's peripheral or central?

However, for a patient to be able to receive chemotherapy or radiotherapy he must be fit. This is what oncologist's refer to as functional status. Is your father able to carry on with his normal chores during the day or is he bed ridden? It would be impossible to tell whether or not your father is fit to receive chemotherapy/radiotherapy without a direct medical assessment.

Small cell lung cancer is very responsive to chemotherapy. Brain mets are mostly responsive to local radiotherapy.

You are justified in wanting to seek a second opinion. It's just that here isn't the place for it. Please seek the opinion of another oncologist and let us know what your doctor thinks. An alternative would be to have a long discussion with his current physician and have him explain in details why he thinks your father won't be able to tolerate therapy.

Please keep us updated.
 paulous - Thu Apr 30, 2009 5:33 am

Thank you for the reply.

i regret to say that my father passed away on sunday morning, he spent one night with us on the saturday and we awoke to blannk eyes and gargling.

I will ask the physician about palliative radiotherapy and chemo in detail but my father was bed ridden. i'll also ask if the tumour was central or peripheral. There will be post mortem results next week not sure what they will show however but i will keep you informed.

thanks again

Paul
 Dr. Tamer Fouad - Fri May 01, 2009 10:48 am

User avatar Please accept my sincere condolences.
Apparently your doctor's assessment of his general condition was correct. I will wait for your update.

Best regards,
 paulous - Sat Nov 14, 2009 3:36 am

Hello, here is an update from the above:

My father was recently found to have been misdiagnosed with two brain tumour mets from a lung primary, in fact he had no cancer at all and a brain abscess rupturing is what killed him.

Now while i realise i cannot bring my father back, my mother and i are just so upset by this finding on top of him dying that we are looking for answers as to how doctors could make such a mistake.

He had a stroke april 6th and could not move his left side. With a slightly raised temperature, irregular heart stats(although apparently normal for someone with a pacemaker) and slow speech he went to the hospital. Since january the previous year he had been coughing up blood and sputum, had a persistant terrible cough and at times extreme difficulty breathing. Following a pacemaker fitted in May due to an admision to the hospital because of a faulty valve in his heart, he became like an athlete. I beleive he was given a course of anti biotics aswell which he completed.

slowly the sputum cae back and the cough and then the blood and In NOvember 2008 he was admitted again with incredible chest pains.
They injected around 5 or 6 injections of morphine into his system which had little effect as he went moaning in pain to sleep.

After spending 5 days in hospital he was released with a diagnosis of lower left basal pnuemonia and given numerous pills,he was vomiting still and could barely walk. still in pain and showed all the signs of fatigue.

After getting slighlty better he was diagnosed with cancer on april 8th. The doctor said he was definite it was brain cancer and that it would be months he has left. He told us this on the 22nd of April, and my did died on the 4th.

we have read some literature and come to the conclusion the abscess although apparently deep in his brain and quite large was treatable. survival rates vary but are very high above 80% in difficult cases.

Can you help me understand how a doctor could miss such symptoms and not look into them given his history of bacterial infections?

Additionally he had two lung punctures to get a biopsy of the cancerous tissue which came back negative just inflammatory cells before diagnosis was given.

This baffles me as to how someone can say it is lung cancer when the biopsy comes back negative.

please any advice is or questions welcome.

Regards

Paul

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