91 yo, 7.6 cm mass, L2 vertebra fracture…How much staging is sufficient

Portal Forums Cancer Basics General Cancer Basics 91 yo, 7.6 cm mass, L2 vertebra fracture…How much staging is sufficient

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November 16, 2016 at 8:26 am  #1289199    
agent99
agent99

Hello my cancergrace friends.

I am in need of your unconditional support again. My 70 yo sweetie (neurological illness but celebrating NSCLC rt pneumonectomy, 2 years post robotic) passed away in January. My 86 yo dad in August (non cancer) and now my 91 yo stepdad who fell at home this weekend and broke his L2 vertebra has a mass in the upper right lung with lymph node involvement as determined by CT scan last night. He has a pacemaker, on Coumadin. He doesn’t want invasive tests, treatments but he is also suffering with mild dementia that has escalated over the past few days. The family is trying to dtermine how far we should go with staging with contrast CT scans for the purposes of developing his end of life care plan.

We understand that he will not be going home anymore. We are meeting with oncology and palliative team soon. Our goal is quality of life. He is a WWII pilot and his personality is strong willed and thinks we are killing him.

Is there any value to his care of knowing if there are mets to brain, bone, liver, etc. given the no treatment desire?

Will knowing help with pain management since he is not always communicative about where he has pain?

Do ct scans with contrast provide sufficient info for staging?

Thank you so much for being here.

November 16, 2016 at 3:38 pm  #1289203    
JimC Forum Moderator
JimC Forum Moderator

Hello agent99,

I am so sorry to hear of all of the heartbreaking losses you have suffered so recently, and your need to deal with yet another cancer diagnosis.

Scans can reveal suspicious masses or nodules, although such scans can’t determine beyond a doubt that those findings represent cancer. The main reason you might want to know about the presence of metastases, especially to brain and bone, would be the possibility of pain reduction and/or neurological effects through the use of palliative radiation. That would depend on your stepdad’s willingness to undergo the testing and possible treatment, and his doctors’ assessment of his ability to handle them.

I hope that you can find a good plan through consultations with his medical team and hospice staff.

My heart goes out to you at this difficult time.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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