Question about lung cancer

[Robr]

My dad is in very poor health and has been smoking 2 packs a day for 60+ years.  He was recently in the hospital because he fell and hurt himself.  While there they did a lot of tests including a cat scan an x-rays.  They told him he has a mass in one of his lungs and they wanted to test it.  He told them no.  My mom passed 6 years ago and he's been waiting for his turn. 

 

Today he called me and said his PCP called him, told him he has lung cancer and that it's metastisized. That he should make final arrangements and that he can stop taking his long term meds like cholesterol. She estimated he'd have no more than 6 months left.

 

While it doesn't surprise me that he'd have lung cancer, he is prone to drama, hearing what he wants to hear from the doc and often when he tells me what's docs have told him, it's his own version.  He swears he's not doing that this time.

 

I guess my question is, based on only an x-ray and cat scan, can docs know all of the info he was told?  He's not coughing, his breathing sounds normal.  I guess I pictured symptoms being evident if you're given 6 months or less.  

[LexieCat]

Hi there,

They can probably make a good guess if he has a large mass and other evident metastases, though lung cancer can't be definitively diagnosed that way. It wouldn't surprise me if the doctor said something like, "This is what we think is going on--you need to come in for more tests," your dad said thanks but no thanks, and the doctor said assuming it is cancer, here's what's likely to happen.

I don't know, though--I've heard of other patients being told they had lung cancer with only scans to go on. That shouldn't happen but it isn't unheard of.

I think the bottom line is that unless your dad is incompetent (and it doesn't sound like he is), he doesn't have to accept treatment, nor does he have to share his medical info--even with family. 

It's a tough situation for you to be in. A lot of people have this vision of lung cancer as a swiftly lethal disease, where the treatments are almost as bad. You might tell him that treatments have come a long way and he might feel better and have more good time ahead if he proceeds with diagnosis and treatment. But if he's truly ready to check out, there probably isn't a lot you can do. Good luck.

[Robr]

Thanks for sharing your thoughts.  Treatment is his decision and given that his quality of life has been non-existent for years due to all of his other physical problems, I don't blame him at all.  There's just a lot that needs to be handled that is easier done while he is still here and I didn't want to start those balls rolling if he's potentially being dramatic.  I have a healthcare proxy for him so I intend to reach out to his doctor next week and hopefully she will talk to me and share what she told him.  It makes absolute sense that the conversation unfolded in the way you're theorizing.

[LexieCat]

Gotcha. It will be interesting to hear what the doctor has to say. Again--good luck. I'm sure that, regardless of his decisions and attitude toward treatment, you want him to live out whatever time he has left peacefully.

[LouT]

This sure is an upsetting situation for you to deal with.  But I agree with Lexie, there is not much you can do if your father refuses all medical treatment.  As she stated, there have been many medical advances in cancer and lung cancer and a diagnosis today is not the automatic death sentence that it once was.  This board and the forums are full of survivors (myself included) who are demonstration to the wonderful advancements.  Much more than a single CAT Scan needs to be done to nail down a diagnosis and a realistic prognosis.  Try to learn what his objections (a.k.a. Fears) are against getting a clearer picture of the situation and explain that it does not mean you would push him into treatment.  If after a full diagnosis the doctors explain potential treatments and expected outcomes and he still refuses, then at least he is doing it with the full knowledge of what he is facing and what the outcome would be.

I pray for your peace at this time.

Lou

[Lisa Haines]

I am very sorry about your Dad and wish there were some easy answers, but sadly there are not any. 

I do believe that is PCP is giving his best possible diagnosis, based on what they have seen.   However to say it has metastasized. confuses me a bit, unless it's clearly in both lung, which would automatically made it Stage IV metastatic lung cancer. 

Sounds like your Dad deeply misses your Mom, and there are those who "pass" from broken hearts and no longer have a great desire to live without their most cherished spouse.  I agree with the others don't think there is much you can do to push him into treatment if he doesn't want it.  Since you are named as his health care proxy I think it's great that you plan to have a conversation with his doctor.  

That being said, I have always said (I'm a Stage IV Survivor) that there may come a time in life, when I may no longer want to pursue treatment and to me that would all be based on my quality of life.  To me quality is far better than quantity.  Fighting through cancer is a tough road and it takes a lot of strength, courage and determination.   If your Dad does not want to put in that effort, I hope you will try to understand and respect his wishes.  That is what I would want from my family if that is how I was feeling.  SOunds like his is not living a good quality of life, so this makes it more understandable.

I'm sorry, because clearly this is tough and you've already lost your Mom - my heart goes out to you!   Take Care!

 

PS:  I can say that it would NOT be unusual a metastatic cancer patient with a short term life expectancy to be told they not longer need to take other meds.   When my prognosis was very grim (which it once was, I remember asking my PCP about doing some labs to check my cholesterol, and he happily agreed, but did say depending on that they found, he would leave it up to me "if I wanted to treat them".   For a time I stopped having routine labs, mammograms and other scans, because my outlook was so grim, but I never gave up on trying to beat the cancer and have done well.  However, I knew at one point that I someone had then told me I also had breast cancer or colon cancer from a routine screening, it probably would have been very overwhelming and more than I could have dealt with at that time.  NOW I am back on track, but I am also younger than your Dad and wanted to fight the Lung Cancer

 

 

 

[Judy M2]

My lung cancer was diagnosed by my PCP via a CT scan 2 years ago, but a tissue biopsy confirmed metastatic NCSLC, and biomarker testing revealed a gene mutation. I went through a lot with chemo and radiation but made it through the other side. 

Many people are told in no uncertain terms that without treatment, they have months to live and to get their affairs in order (that's a good idea regardless). I expect that's what your father heard. 

I can also speak from experience as a caregiver to my father, who died this year at age 99 (not from cancer). He was in poor health and depressed over my mother's death 6. 5 years earlier. His health care proxy made very clear what he did and did not want, and I did my best to follow his wishes. Knowing your dad's wishes is vitally important to give him the care he wants and also for your peace of mind. 

It would be a good idea for you to get the story from his doctor. And having been through a nightmare with my parents' affairs when my mother died suddenly, I recommend getting as much done with your dad's cooperation as possible. 

[Robr]

Thanks everyone for helping.  I have no issue with him not wanting treatment, that's his choice and I'm fine with it.  His QoL sucks.    He's been in massive pain for years from spine issues, 24/7 morphine barely takes the edge off any longer.  He's started falling and breaking bones.  He's in a wheelchair for any distance over 50 feet.  He lives in his recliner and his muscles have atrophied to nothing.  He barely eats and when he was admitted to the hospital last week from another fall, they found his potassium level so low, they put him in the cardiac ward for three days.  He's been depressed my whole life and after my mom passed in 2015, he only had their 2 cats for company.  The last of the two cats, unable to eat, was put to sleep about 6 months ago due to jaw/gum cancer.  I mostly feel bad that he won't be a part of all the great things my two teenagers will go on to do.  

My questions for the group here were more around the diagnosis he told me he was given (and if that kind of diagnosis is possible with the limited info his PCP has that came from his hospital stay last week) and the lack of symptoms I would expect to be present if he has less than 6 months.  I will hopefully learn more from his PCP next week.  

[Tom Galli]

Robr,

Welcome here.

Is it possible, given an x-ray and a CT scan, that a definitive diagnosis of lung cancer can be made? No, not definitive. A tissue biopsy is needed for a definitive diagnosis. But can a high probability diagnosis be made from these tests. Yes. If tumors are large and extensive, they can easily be seen in organs and bones. Radiologists who read scans can therefore surmise with high probability the presence of metastatic cancer. Even with extensive tumors, symptoms may not be present. I had a tumor 3.5" long and 1.5" in diameter, completely blocking the right main stem bronchus of my right lung. It was there for a long time with no symptoms. 

Your dad may indeed be experiencing symptoms. For example, when tumors invade the bones, this can result in extensive pain. But your dad is on morphine therapy for spinal pain and that therapy may be masking bone metastasis, if he has them. Moreover, you dad is not very mobile and therefore may not notice shortness of breath that may happen with extensive tumors in the lungs.

I understand your dad's reluctance to seek treatment given his current medical conditions and quality of life. You can help, however by asking his PCP about hospice arrangements for your father. Hospice care is designed to minimize pain and suffering as the cancer progresses. As for the projection for remaining live, remember it is a projection and it may not be accurate. What it tells me, however, is that your dad has extensive tumors, perhaps in multiple organs and perhaps in several bones.

I've very sorry to learn about your father and his latest medical problem. Don't hesitate to ask if you have further questions.

Stay the course.

Tom

 

[Rower Michelle]

I can also relate to what you are going through... earlier this year my mother passed away.  My parents were married for almost 55 years and at the age of 80 my Dad isn't really interested in spending the rest of his life in and out of doctor's offices.  So when a routine urology visit stumbled into something potentially going on in the liver my Dad declined any further diagnostic work up.  He does take all of his cardiac meds and will see his team of cardiologists, but he does so out of habit for the last six years. My sister and I didn't give my Dad any grief or raise a fuss because we recognized it was a losing argument and we did not want to alienate my Dad at this stage of his life.  It's a hard spot for adult children to be in, my dad refers calls us the "helicopter kids" and has no problem telling us to back off and we do but that doesn't make it any easier.    

This is a good place to share your thoughts, feelings and ask any questions.  We know the drill and can walk with you so that you don't have to do this alone. 

Michelle