Dear All,
My sister of 50 years of age was diagnosed with lung cancer about 6 months ago. She lives in Sri Lanka and is being treated in Sri Lanka. I live in the U.S. and trying to do anything/everything possible to make her feel better.
Initial CT scan report said lobulated soft tissue mass of 6cm in left mid and lower zones involving the area of lingular segment of upper lobe. no evidence of limphnode enlargement, no pleural effusion. Other organs in the abdomen were fine.
Diagnosis was "poorly differentiated carcinoma."
She started chemo right away: medicines names were Panataxel/Paclitaxel and Carbosin.
After 5 rounds another CT scan was done and it showed that the tumor has not responded to chemo. It has not grown in size or spread to other areas either.
Her doctor started her on radiation therapy: x-rays after the radiation therapy regimen showed her lungs are clear. But during the therapy she developed an acute back pain on the left side (sounds like in the rib cage area).
Doctor has ordered x-rays for the area and said they don't show any cancer.She was given some pain medicine and sent home.
Pain became severe after few days and doctor has given an injection called zodone (I cannot find any information on this on the web: must be an Indian drug). On top of that she is taking something called tramadol.
In the meantime she started throwing up also. Doctor did a CT scan on brain and said it is clear. She is going to do another CT scan on abdomen next Monday.
On top of everything she has been having a very poor appetite throughout the treatment.
I am sorry this message is too long but hoping that someone might be able to give me an idea about what is going on with her.
She is in severe pain and it is not going away for the pain medicine that is given to her. We are desperate at least to reduce the pain and get her appetite back.
Thank you in advance for any replies.
Anil Rupasingha
Lung cancer and severe and constant pain in the left rib cage - 1267018
anilr
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Reply # - November 7, 2014, 02:45 PM
Hello Anil,
Hello Anil,
Welcome to GRACE. I am sorry to hear of your sister's diagnosis and all the pain she is experiencing.
It's good that the cancer in the lung has responded to therapy. As far as the back pain, it certainly sounds suspicious for a bone metastasis, possibly in a rib. That might or might not show up on an x-ray; is there any chance of getting an MRI (which is much more likely to reveal any bone mets that are present) or even a bone scan?
It's likely that the injection was zoledronic acid (also known as Zometa) which is in a class of drugs called bisphosphonates. These drugs are prescribed for cancer patients with bone mets in an effort to prevent fractures and diminish pain.
If a bone met is identified, if it is causing great pain the typical treatment is radiation directed at the bone lesion. Such treatments tend to be quite effective in relieving pain.
Both radiation and pain can reduce appetite, so if the pain can be better addressed (possibly even with a dose adjustment of the tramadol or a switch to a different pain medication) and the radiation concludes, perhaps her appetite will come back.
Good luck with addressing those issues.
JimC
Forum moderator
Reply # - November 7, 2014, 03:09 PM
Hello Anil,
Hello Anil,
Welcome to Grace I'm so sorry to meet this way. I hope we can be of help.
Tramadol is a very mild narcotic pain reliever for moderate pain. I too wasn't able to find zodone online. It sounds like codone so may be related or spelled wrong.
You are right to question your sister's pain management. All but a few instances of pain can be managed.
Often for severe pain there the use of 2 drugs are warranted. An extended release med to bring and keep pain under control is taken on a regular schedule then an immediate release pain med is taken for "break through" pain is taken as needed if pain returns before the scheduled drug time. Your sister should be able to get these drugs from her oncologist or possibly a pain management doctor or palliative care doctor. My husband's onc has prescribed all his drugs, it varies depending on the care center not just country to country. The only place I've heard of a doctor not wanting to help with pain was in a small town in the U.S. so the person had to see another doc at a different center. Here are links to what your sister should be able to use.
I wonder if she has had mutation testing for EGFR orALK mutation for which there are drugs that may have efficacy.
http://cancergrace.org/cancer-treatments/tag/pain-management/
http://cancergrace.org/cancer-treatments/2012/07/28/dr-harman-on-cancer…
http://cancergrace.org/cancer-treatments/2009/07/26/bone-pain-in-cancer/
Reply # - November 7, 2014, 08:57 PM
I'm sorry she's having these
I'm sorry she's having these problems. I do think perhaps the most helpful thing for her would be getting opioid pain medication. A steroid medication may also help with pain and appetite. Her doctors would need to consider the value of these medications.
Good luck.
-Dr. West
Reply # - November 9, 2014, 05:34 PM
Thank you so much for all the
Thank you so much for all the replies. I wish I had found this forum few months back.
I have conveyed this important information to my sister.
Update: her doctor has changed her pain medicine to gabapentin and she is doing much better with that. Her appetite has improved as a result also.
Thanks again,
Anil
Reply # - November 9, 2014, 06:59 PM
That's great to hear.
That's great to hear.
-Dr. West
Reply # - December 2, 2014, 08:34 AM
Dear All,
Dear All,
This is a follow up of my sister's case. Since the back pain is not going away, she did a PET scan and got very bad news. The cancer has spread to bones and one of the kidneys. It has also spread in the lung where it was originally and they also find some FDG avid met in lower lobe of right lung . I do not know how the lungs were shown clear in x-rays after the radiation regimen 4 weeks before these results.
Her Dr. has started her on Gemzar and Cisplatin combo (she was on taxel/Carbosin before but there was no response). She was given both drugs the first day and after 8 days one of the two I think. She was asked to come for second dose in 8 days. That was yesterday but they found the blood count was low.
In the mean time her overall health has deteriorated fast. She is very very weak. Needs help in getting up and down and moving about. Cannot even be in sitting position. Has very poor appetite, especially for solids. She is taking liquid.
I will be travelling to see her soon and was wondering what kind of food items I can take from the U.S. that will help her to gain some strength while she is going through this round of chemo.
I really appreciate any information.
Best wishes,
Anil
Reply # - December 2, 2014, 09:24 AM
Hi Anil,
Hi Anil,
I am very sorry to hear the news about your sister. Unfortunately x-rays are much lower resolution than PET or CT, and it is certainly possible not to see smaller lesions on them. In addition, after radiation it can be very difficult to get a clear picture because of the damage caused by the radiation.
When appetite is very low, any foods that she finds appealing (including items that may seem strange) are good choices; you're just trying to provide calories. If you are limited to liquids, products such as Boost or Ensure can provide some nutrients in a liquid form, and can be made more palatable by adding crushed ice.
It may help to read Dr. West post on Loss of Appetite and Weight Loss.
I hope your sister's new chemo regiment will help turn things around.
Safe travels.
JimC
Forum moderator
Reply # - December 2, 2014, 07:41 PM
Jim's exactly right. I don't
Jim's exactly right. I don't really have anything to add except to say that I'm also very sorry to hear about her recent decline.
I hope you have a good visit with her soon.
-Dr. West