Metastatic Poorly Differentiated Adenocarcinoma - 1266557

Fri, 10/17/2014 - 23:08

My father, who is 61 years old, was recently diagnosed with a metastatic poorly differentiated adenocarcinoma. The doctors have not been able to determine the primary site. The only biopsy was on the lymphnodes. Based on the presence of cancer cells, we were told he had lymphoma. He was sent home and given an appointment with an oncologist 2 weeks later. During this time frame, my father experienced difficulty swallowing and a feeling of fullness. Since he wasn't eating much, he lost weight. The doctor explained to us that my dad had a tumor sitting in the mesentary tissue behind his liver and this tumor was pressing on his esophagus and spine. This was the reason he had difficulty with eating and also causing him to have back discomfort. Within the past week, we have admitted him to a hospital because he was so week. A CT Scan showed that the tumor was branching out. It has since caused fluid around my dad's lung. We were then told the cancer was fast growing and aggressive and my dad was given a 2 year life span. As of Wednesday, however, the doctors ASSUMED that the primary site was the pancreas, diagnosed it at Stage IV, and gave my dad a 2 month life span. Today, the doctors say it isn't pancreatic cancer, but there are cancer cells in the stomach, esophagus and liver. They don't recommend any treatment and are pushing to send him to hospice care. They have put a catheter in his lung to drain the fluid and a port in his shoulder. This, of course, has been quite overwhelming for me and I'm not sure what options he has at this point. The doctors have made it sound hopeless, but I'm not ready to give up on the battle. I have done limited research on poorly differentiated adenocarcinoma and found that combination regimes could help. My question for you is basically where should I go from here? A second opinion? Demand more tests (he has had CT Scans and MRIs)? Give up? And is there any cancer treatment facilities that deal with this form of cancer with some success

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Welcome to GRACE. I am sorry to hear of your father's diagnosis, and the difficult symptoms he's experiencing. This sounds like a complex matter which certainly suggests the need for a second opinion, preferably at a teaching hospital affiliated with a medical school.

The time periods quoted to you (2 years, 2 months) should not be given too much credence. The GRACE doctors have often said that they are not very good at such predictions; no one is. All that can be said accurately is that each type of cancer has a corresponding median survival rate, which is based on the results of clinical trials involving large numbers of patients. Half live less than the median, half live longer, sometimes considerably longer. They don't tell you much in terms of one individual patient.

Metastatic cancer can't be cured but it can usually be treated in an effort to increase the length and quality of life. At times, a patient's overall health condition makes treatment difficult or impossible, but it would be helpful to address this issue with your father's doctors, including another set of eyes provided as a result of a second opinion.

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Dr West

I'm very sorry about your father's diagnosis and ongoing problems.

The value of chemotherapy in an aggressive lung cancer and a patient who is quite ill may be minimal or even non-existent, so I don't think it's really feasible or even necessarily best for him to demand treatment just for the sake of treatment if it has more of a chance of harming than helping. It may be most valuable to get a second opinion in such a situation in order to either clarify that the recommendation you and he have been given is really the best one or to offer a different strategy. However, I will say that I and other thoughtful oncologists sometimes make a recommendation against treatment. Focusing on symptom management with the assistance of hospice can be very meaningful and potentially the best option.

Good luck.

-Dr. West