96 year old father just diagnosed with lung mass - 1261768

popsy
Posts:4

My 96 year old father had a CT scan which showed a large upper lobe mass, approximately 5.6 cm. He has not had a biopsy but they are fairly certain it is cancer as it almost doubled in size in a month. He first refused a biopsy and said he does not want treatment. He now says he wants a biopsy but still does not want treatment. If he isn't going to have treatment is there a need for the biopsy? His doctor is somewhat concerned about mets to the brain as he has had moments of confusion and double vision. Would a brain MRI be appropriate if he was willing to have radiation? Also, at his age, would treatment be advised in most cases? Thank you.

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Reply # - January 27, 2014, 06:02 AM

catdander
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Hi Popsy, Comfort care is always an option at any point. I'm very sorry your father probably has lung cancer. I understand your and his reluctance to move forward with invasive procedures. I'll leave you with some thoughts already written on the subject of treating elderly. Your father must fit into the frail category simply because of his age. There are quite a few to sift through, http://cancergrace.org/lung/category/lung-cancer/special-populations-in…

I'll ask a doctor to comment.

I hope your father finds the perfect balance of care,
Janine

Reply # - January 27, 2014, 01:01 PM

popsy
Posts: 4

Thank you Janine. I will await a doctor's response. My husband was diagnosed with lung cancer 3 years ago and has been NED for the past 2 years. So, unfortunately, lung cancer is not new to our family.

My father is in fairly good health for his age, but has been dropping weight for the past several months. He smoked as a young man, but not for at least 50 years. I am mostly concerned about his mental health during this, as he seems very depressed since we found out about the mass.

Reply # - January 27, 2014, 01:15 PM

JimC
Posts: 2753

Popsy,

I'm sorry to hear of your father's scan results. Treatment can certainly be challenging for elderly patients, so if it were to be considered a thorough discussion with his doctors would be necessary. Due to the frequent presence of other health issues, difficult treatments are often not recommended.

As far as a brain MRI, you can make a good argument for it since it is possible that if there is one or just a few brain mets focused radiation could be used, which his doctors might feel he could tolerate better than chemo, surgery or chest radiation. The symptoms from progressing brain mets can be debilitating relatively quickly, so that might something to discuss and consider.

JimC
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Reply # - January 27, 2014, 07:55 PM

Dr West
Posts: 4735

The first thing I'd say is that there is no "usual" approach for 96 year olds. There are no studies of patients over 90. I've had a few patients in their early 90s, but I'm not sure I've had a 96 year old. First, there aren't that many people in that age range anyway, and I think quite a few opt against treatment that might add a few months, so they never find their way to an oncologist. That very limited prognosis, however, assumes advanced disease, which may not be the case here.

We'd often do a biopsy. If it happens to be an infection, that'd be good to know. If it's cancer and it's localized, perhaps radiation alone could treat it effectively and maybe even cure it with relatively modest side effects. If metastatic, radiation to the brain could very possibly help with symptoms. And at any time the focus could shift to exclusively one on comfort and symptom management.

Good luck.

-Dr. West

Reply # - January 27, 2014, 08:32 PM

Dr Laskin
Posts: 34

I agree with Dr West, there is not even a consensus for how to treat people over 80, so there is no data to go on here.
however, there may be a few things to think about.
1. if he has signs of confusion it certainly could be his brain and a CT scan (especially with contrast dye) is faster and easier for a patient so if he didn't want to have an MRI a CT is perfectly reasonable and may give a faster answer.
2. confusion can sometimes be explained by blood results for example a calcium or sodium abnormality, so i would make sure some basic blood tests have been done because those things are relatively easy to correct.
3. not all lumps in the lung are lung cancer. though it may be highly likely, a biopsy would be nice, especially if there was some thought about treatment. because, for example, if this were a small cell cancer, instead of a non-small cell cancer, he might be able to get a small dose of radiation or a bit of chemo and have a good, maybe short-term but still possible, response. in Canada i sometimes use oral etoposide, which is very easy to take and i have actually given this to a 93 year old and it worked well - but only for small cell cancer. and i'm not sure if it's available in the USA, i would assume it is.
4. what he wants and his comfort is definitely the most important, so if he's sure he doesn't want any tests or treatment then we should all respect that (assuming his blood tests are normal), but sometimes people are just scared and they need more information and more discussion.
best of luck
- Dr Laskin

Reply # - January 28, 2014, 08:45 PM

popsy
Posts: 4

Thank you Dr. West and Dr Laskin for your quick responses. Both were very helpful. I think my dad has decided to have the biopsy, so we will have a better idea of what we are dealing with. He has no symptoms and the mass was actually found when he was having a CT for abdominal pain. His only symptom is lack of appetite. His doctor prescribed an appetite stimulant, but it hasn't helped yet. I will post again once we get the results of the biopsy. Thank you again.

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