Doc: No treatment valid treatment option for some cases
Dear Dr. Roach: My mother has Alzheimer’s disease and had some tests due to abnormal liver enzyme levels in the blood. Her ultrasound says: “There are multiple masses throughout the liver. Underlying malignancy and metastatic disease cannot be excluded.” A CT scan was done, and it says, “Innumerable low-density liver lesions are identified in both right and left lobes, also eccentric wall thickening involving the stomach.”
A liver biopsy was done two days ago. We won’t have results till next week.
I have been advised by her primary physician that he is sure it is cancer and, due to her age, I should do nothing, just keep her as comfortable as possible. I don’t want my mom to go through chemo and radiation. I don’t know, at her age and with dementia, if she could survive that treatment. But I also can’t stand the idea of watching her waste away and knowing I did nothing to help.
If I do nothing and let the disease take its course, what is in store for Mama? Will she be in pain? The doctor who did the biopsy sat with me and told me he was sure it was cancer that started elsewhere and spread to her liver, stage 4, but he would know more after the biopsy. He said, “You have a hard decision to make.” I need to know what to expect. What will she go through, and what kind of time does she have?
Dear R.D.: I am very sorry to hear about your mother. I agree, from the report, that it is likely to be metastatic cancer — cancer that has spread from another site in the body, probably originating in the stomach. After the biopsy results come back, you can make a more informed choice about treatment. Surgery or chemotherapy would be a bad idea for most people in her situation, having advanced dementia, and you should realize that a choice not to treat, made with her best interests in mind and with the support of her physician, is not something you should feel guilty about.
Many people with a new diagnosis of metastatic cancer can be helped, if not cured, by treatment. However, for the majority of people with stage 4 metastatic cancer whose normal level of function is poor, treating the cancer helps neither their quality nor their length of life.
Even though we are unlikely to be able to affect the course of the disease, we are usually well able to manage the symptoms of cancer, when treated by an expert, such as a palliative care physician (some oncologists and even some general doctors are very good at this, too). Treatment includes proper nutritional care and treating and preventing pain, nausea and shortness of breath, any of which might happen.
Physicians are not very good at predicting how much time people have left, as there is a large range, even in people with advanced disease. I suspect you are looking at months, but possibly only weeks, and not likely more than a year.
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