Now We Add Cancer To The Mix

Rocky2

DW has EOAD and is a type 1 diabetic. A few weeks ago I brought some concerns to her doctor who referred her to a an OB/GYN. A biopsy was done and resulted in a diagnosis of cervical cancer. We are scheduled for the initial appointment with the Oncologist tomorrow. I expect to have to make some difficult decisions about the cancer treatment. I don't want to subject DW to chemo since she is already dealing with early stage 6 EOAD. Do any of you have experience with AD and chemo?

Tom

Joe C.

Rocky, I am so sorry you are dealing with cancer on top of EOAD. I have no experience but I have considered what I would do if DW developed cancer or some other ailment that involved aggressive treatment because I do not believe she could tolerate chemo, radiation or major surgery. I know you will have some difficult decision ahead and I will keep you both in my thoughts & prayers.

harshedbuzz

Rocky2-

I am sorry.

Have you been able to speak with her neurologist about this? They may have suggestions or opinions worth hearing. It's always a good idea to make a list of your questions to bring with you.

She may be in a place in her dementia progression that aggressive treatment would be inappropriate given her current life expectancy-- this wouldn't be how you would want to want her to spend her remaining time in treatment and feeling poorly.

That said, often a transvaginal hysterectomy is used in this sort of situation which is not as invasive as a more traditional approach with a much easier recovery. My aunt's MIL- not a PWD- had the procedure at 94 and did really well with it-- she was in the hospital two nights and back to delivering Meals-on-Wheels with her younger son a month later.

That said, sometimes chemo is given at lower doses-- even orally at home-- that can keep the person's cancer in check for a period of time rather than going all out for remission. Perhaps something like this would be an option to balance treating and quality of life. We chose something like that for my dad's recurrence of prostate cancer. Dad had a twice yearly shot of Lupron to clear his system of testosterone which hastened the spread of the cancer. He started treatment in stage 4-5 and it bought us enough time that he never had symptoms of the cancer spreading before he died from complications of Alzheimer's.

I am assuming she's had a biopsy so far. Has she had other imaging to see if the cancer has spread? What about exams to check out her bladder and rectum which are generally done before laying out treatment options. I could see where the invasive nature of these could be scary for some women in stage 6. As always with tests, I ask what I/the medical team plan to do with that information.

The other thing, it can be appropriate at times to let the disease run its course with hospice care to support you both. If you want to consider that, ask the surgeon what you would expect to see if you make that choice.

Do you have someone that can attend the appointment with you? At any high stake's appointment, it's useful to have a second set of ears as you might not recall the details of what is said. Also, a companion could remove your wife if you feel the discussion would be upsetting to her.

Good luck to you both today.

HB

M1

Please let us know what happens. As HB said, lots of variables here--can range from easily treated to incurable. I think the suggestion about talking to her neurologist is a good one (assuming there is a neurologist in the mix). Some chemo regimens are themselves brain toxic, so it matters.

Ed1937

Tom, that's a tough one, and I'm sorry. I have nothing to add to the excellent posts above, but we are here for you whenever you need to talk about it. I hope they can find treatment that is appropriate to the situation.

Rocky2

Thank you for the feedback, Joe C, HB and M1. So far, DW has only had the biopsy done by the OB/GYN. I expect the gynecologic oncologist will map out several diagnostic tests to determine the stage before proposing a treatment plan. I will be asking many questions about treatment options either at today's appointment and/or after further diagnostic tests. Right now I want to look at options that maintain the best quality of life, not necessarily the best quantity.

DW does see a neurologist who is following a subdural hematoma incurred 2 years ago. But has not been involved with the EOAD treatment. I'm sure they would provide feedback if asked.

HB, thanks for the thought on bringing someone to the appointment. I don't have that set up for today. I may do that for the next appointment.

Thanks for all the thoughtful advice and for your prayers. We are confident that God is going to walk with us through the difficult path ahead. Whenever the time comes, DW will be free of all disease and face to face with her savior, Jesus Christ. Until then, I want to do whatever I can to improve her life.

Tom

Jo C.

I am sorry that this is happening and can understand how difficult and heart breaking this must be.

In very small, very early cervical cancers, a cone biopsy can be adequate treatment.

For cervical ca, if very early, removing just the cervix itself is treatment.

If the cancer is a bit more advanced, the treatment is usually a radical hysterectomy and is often effective for those cases.

Chemo is usually used only with advanced cervical cancer that usually has gone to other organs and is often used in conjunction with radiation therapy.

You are doing a good job of this and have reasoned things out very well. Let us know how all evolves; we will be thinking of you and your dear wife.

J.

Rocky2

We had the appointment with the Gynecological Oncologist yesterday. DW cooperated and allowed a pelvic exam. Dr. stated that the tumor was large and ruled out surgery. We will be scheduled for MRI and PET scans as well as an initial appointment with a Medical Oncologist to discuss radiation treatments.

I'm wondering if DW will need sedation in order to complete the MRI and PET scans. I'm not a fan of anesthesia, if avoidable. She does well with CT scans that follow a subdural hematoma, but I doubt she will lie still for the longer scans on her own.

Tom

Ed1937

Tom, I'm just putting this out there with the off chance that it could be workable for her. My wife needed an MRI, but was claustrophobic. She went into the tube, and immediately had to be removed. They wanted to try again in another week or so. I told her to close her eyes, and keep them shut until it was over. It worked!

Jo C.

Tom, I am sorry for how this evolved, you are right on top of things and managing as best can be done. It appears treatment is going to be palliative to shrink the tumor so as not to have it causing impingement on other organs/tissue, thereby causing difficult pain so there can be adequate pain management.

As for anesthesia, the patient must remain completely still for those scans, so medication may well be provided that will induce sleep. It usually would not be a general anesthesia, it will be something perhaps IV if not oral. It takes a bit of time to get the tests done, so having her reasonably sedated would benefit both the tech for being able to get adequate scans as well as for your dear wife's comfort.

We will be waiting to hear how things are going and also; how are you are doing yourself. Best of thoughts being sent your way.

J.

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harshedbuzz

@Rocky2

I would imagine she would need to be perfectly still for radiation or risk damaging healthy tissue related to elimination. Dad had a course of radiation for prostate cancer when he was probably in the earliest stages of dementia. I'm sure he cooperated, but he had issues going forward with moving his bowels after. It was not good.

HB

Rocky2

Thank you all for your thoughts and experiences. It was a Gynecological Oncologist who ruled out surgery based on the pelvic exam. The Dr and I also talked about quality of life vs quantity. Of course the test results will inform the treatment recommendations. That said, it's my impression that the current thought of radiation, with or without low dose chemo, is understood by all as palliative care.

I'm waiting to talk with the clinicians about possible sedation for scans. I also plan to talk with the Radiological Oncologist about sedation for treatments. IMHO this will be the only option. Still, since I'm not a medical professional, I'll listen to other thoughts.

I'm doing okay. I have my God to lean on and feel supported by family, church, friends and, of course, all of you walking similar paths. Thank you for asking.

Tom

M1

Rocky, I'm so sorry. She would likely have to be sedated not only for the scans but for any radiation treatments also. Which may be a real problem, because these treatments are usually given daily, meaning sedating medication daily. And radiation to the pelvis has lots of side effects, including bowel and bladder as mentioned above.

I would personally ask about meeting with palliative/hospice providers sooner rather than later as plans are made. No treatment may be an option to consider. I know that sounds harsh, but I face the same dilemma. My partner has an incurable lymphoma of her oropharynx that if/when it recurs, will likely choke her to death (assuming it it most likely to recur where it first appeared). Not a pleasant prospect, but I'm pretty sure that if that day comes and she doesn't die of something else first, we will opt for morphine only.

Please do keep posting, will be thinking about you.

Rocky2

M1, Your feedback is much appreciated. Although I have not posted much until recently, I have followed this forum for some time. You are one of the caregivers from whom I have greatly benefited.

As difficult as it is, PMO (pain management only) care may be the best option.

I'm so sorry to learn the details of your partner's medical situation. I will pray for both of you as you walk this path together.

Tom

Rocky2

Update: After much input and thoughtful consideration, I decided to not subject DW to lengthy MRI or PET normally done for staging of the cervical cancer. We enrolled DW in a palliative care program. When the time comes, the same group will also provide hospice care. The Radiological Oncologist suggested, and I agreed, trying external radiation treatment with Lorazepam to help her lie still. The aim is not remission, but, rather, to reduce bleeding and delay pain. The initial external radiation treatment with Lorazepam was completed successfully. So, we have schedule the full 30 treatments beginning this Tuesday.

I am also dealing with some personal medical concerns. In part due my medical issue and also based on her increasing care needs, I moved DW into a memory care facility a few days ago. I will pick her up every week day (starting on Tuesday), take her for her treatment, and return her to her new home. I plan to stay with her for several hour afterwards to avoid any falls until to the Lorazepam metabolizes.

Its only been a few days. But I can already relate to the mixed feelings of placing DW in memory care. I know it is the best place for her and that she is being well cared for. Yet DW breaks my heart when I visit her and she insists the I take her to the car because she wants to "go home".

Tom

M1

Tom, it sounds like you have an excellent plan in place. I know the grief and the sadness of the quiet house that will never be the same. Each time I leave my dear partner, she still wants to come with me, and it's so hard to tell her she can't, even with excuses. You're smart to stay with her until the lorazepam wears off--if it's just one dose a day, it shouldn't accumulate excessively. Sending you all the cybersupport I can muster. Please keep us posted how she does.

Ed1937

Tom, I'm sorry it has come to this. But I think you are handling it in the best way possible. You will probably have various emotions as the days roll by, and we'll be here to support you in the best way we can. I hope everything works out well for both of you.

Jeff86

Tom, I have nothing but admiration for how you are handling this extraordinarily challenging situation. I imagine I would have responded similarly.

we are here to support you any way we can.

Kat63

So sorry to hear everything you are going through. Sending prayers and we are here to listen.