My 92-year-old MIL was just diagnosed with colon cancer. Because of her advanced age, general condition and other health issues, there will be no surgery, chemo or radiation therapy. Probably just palliative care. Doctor says most people in this situation survive less than a year.
My question is this: What should we expect the next year to be like? What will be the actual mechanism of her demise? How will the disease probably progress?
I’ve tried googling “colon cancer” and I get lots of pages about treatment and prevention, but we’re past that.
I don’t know much about her specific case since my retired husband is the major contact for the doctors, and he’s not real good with medical things and other stuff that’s “icky.”
I have a book on diseases, but it doesn’t say much (it’s more concerned with treatment). It mentions intestinal blockage and the possibility of anemia from rectal bleeding. Spread of the cancer to other organs is common, typically the lungs and liver (that favorite gathering point of wandering cancer cells).
In another book I find these symptoms of intestinal obstruction: nausea and vomiting; signs of hypovolemic shock (low blood pressure, rapid heart beat).
My condolences. My mother passed away from colon cancer at a much younger age and it won’t be easy, but a good hospice can make things easier for the woman. They have experience with this condition and will determine the best way to make things the least painful.
My mother was eventually given some sort of machine that diverted intestinal fluids that were essentially blocked off by the tumors inside her. But that was over 10 years ago and palliative methods might have changed. And there are differences depending upon where the tumor is located.
Thanks folks. This is the type of info that doctors don’t seem to want to talk about. I don’t know yet what kind of plan we will have for the rest of her days. The intention will be to have her at home for as long as that’s possible. Both she and my husband have a horror of “nursing homes” of any kind. There is a general attitude among her cohorts that to “put her away” would be disgraceful, an indication of her family being unwilling to care for her. Since he’s retired and her home is only a few blocks from here, if she can return home my husband will probably stay with her and care for her as much as he can.
The link provided by Szlater is especially interesting. Some of the body changes mentioned have already started, but were just attributed to old age. In particular, weakness, exhaustion and muscle wasting.
So far she does not seem to be in any pain. She’s been in the hospital for about a week already because of a TIA suffered about a week ago. Then a couple days ago she started with internal bleeding, sufficient that she needed a transfusion. That’s when they called in the gastroenterologist who diagnosed the cancer. She’s also, at least so far, not especially distressed. She’s a very religious woman, to the point of superstition, and I am sure she believes that in good time she will be reunited with friends and family who predeceased her. She has not generally been one of my favorite people, but is admirable for having had such a positive outlook on life considering the tragedies life has handed her.
We took care of my mom at home with some visits by nurses to check that we weren’t screwing anything up. It was a lot of work, but well worth it.
If you get a copy of Sherwin Nuland’s book “How We Die”, there are two chapters which deal with people dying of colon cancer. Both stories, although not identical, should give you a good idea of what’s going on also.
contact a hospice near you as soon as you can. they do provide in-home services. it is better to have things lined up now, rather than scramble about later. some hospitals have a hospice that is affiliated.
as she is in hospital now there should be a patient advocate that is assigned to her. this advocate will help you in contacting the people and agencies that can help y’all care for her at home.
There are multiple ways for this cancer to kill. Local effects include intestinal blockage and bleeding. Bleeding is messy but it is not a painful way to die. Intestinal blockage is. Try to decide while she is alert if she will want palliative surgery for intestinal blockage or just lots of drugs. It’s hard to predict without very exact knowledge of her case what her particular course will be.
Most of the other ways to die are because of where the cancer has spread, including liver, lungs and other soft tissues. These are not usually painful or uncomfortable and can be managed with drugs.
Plan now for good palliative care, and whether she wants to die with family, at home, or in hospice. No one else but family can make this decision and neither one is wrong. Decide in advance whether she wants IV fluids, a feeding tube, and a central IV line for access to give medications. Decide in advance at what point you will not do things such as blood transfusions. For myself the tipping point is when I can no longer make my own decisions–at that point I want everything stopped, including fluids. Not everyone feels that way.
Although there are a number of possibilities, succumbing to hepatic (liver) failure as a result of the cancer spreading there is a distinct possibility.
One of the features of liver failure is hepatic encephalopathy - a mode of death which should be peaceful.
BTW, from my post in this thread and repeated in others, I’ll list below the ways that cancer can kill:
Cancer, at its primary site can cause lethal problems eg. lung cancer blocking a bronchus (breathing tube) leading to pneumonia, eg. cancer of the bile ducts blocking off the liver
Cancer can spread locally and kill, eg. a lung tumor that eats it way into a blood vessel or into the heart lining
Cancer can spread far beyond its primary site and do damage there, eg. breast cancer spreading to the liver and causing liver failure, or eg. breast cancer spreading diffusely through the lungs, or eg. lung cancer spreading to the brain
Cancer weakens the body, sometimes in obvious ways such as malnutrition, and sometimes in subtler ways such as inhibiting the immune system. In either case, infections result and are much more severe than in “normal” individuals.
Cancer makes the blood clot more readily. Likwise, people with advanced cancer are often immobile. Immobility leads to the blood pooling and, hence, a strong tendency for blood cuts to form. Blood clots kill. (The association between cancer and clots is quite common but not generally appreciated, IMO, by lay people)
Cancer replaces the bone marrow causing fewer white blood cells and/or platelets to be produced. Infection and/or bleeding results.
Cancer can lead to bizarre, unpredictable, and sometimes mysterious effects in the body, eg. lung cancer causing “Lou Gehrig’s Disease”, eg. kidney cancer causing high blood calcium levels, eg. myeloma (a type of bone marrow cancer) causing breakdown of the nerves in the body (neuropathy), eg. lymph cancer leading to kidney failure, etc.
No, we already have the first, second, third and last opinion: She does not want any surgery, chemo or radiation. If she even survived those, the side effects would be more than she could stand. It’s not as if any of those is going to prolong her useful life for 5 years. She is 92, has a weakened heart, and cannot walk due to spinal degeneration. She’s been housebound for at least 6 months prior to this diagnosis. Most of her friends are already gone, and the few that are left are mostly too ill themselves to come and visit.
Karl Gauss, Chief Pedant, thanks for the info. That’s the kind of factual stuff I was looking for.
My 86 year old mother passed last September. She had bowel cancer and the only possible treatment of major surgery would have given her just a few months more, with lots of undesirable side-effects.
So she decided to enter a hospice and had a dignified end.
No pain, family and friends visiting frequently and a supportive staff.
MLS, I am also sorry to hear this news. And I also recommend hospice. Depending on what your MIL and the family want this can be approached in two ways. Many communities have a dedicated hospice facility where the patient is admitted and remains until the end. They must have a terminal diagnosis and a relatively short estimate of time left. There are is also home-based hospice, where the patient remains in her home and is visited there by caregivers. This is the way the last days of both my uncle (lung cancer) and my mother in law (old age) were handled. In both cases they wanted to be with family and in familiar surroundings at the end.
The main reason I emphasize hospice is because they are very concerned that the terminally ill do not suffer needlessly at the end. This is a view that is not shared by many main-line hospitals, in my opinion. When the doctors at the local (formerly Catholic*) hospital here told my family there was “nothing they could do” for my mother in law, they still refused to give her pain medication. I pitched a fit and we got her out of there. If someone I love is dying with no chance of recovery I do not want them to suffer!
Feel free to come here and vent. What your family is facing is difficult and doesn’t have a traditionally happy ending.
*this tidbit shared to differentiate this hospital from the other local hospital. I do not know the other hospital’s policies on pain medication.
While it’s not a happy event, none of us is seeing it as tragic, including my MIL. She has had a fantastic run, especially considering the trials she faced, starting with becoming a refugee in her early twenties, on the run from the Nazis with her husband, a six-year-old and a six-month-old infant (who was to become my husband). They reached America after WWII, started from absolute zero to build a nice home in the country, after which her husband died of metastasized lung cancer. She later married again, and outlived that husband too, as well as her older son, who was mentally incapacitated by what they then called shell shock, now post-traumatic stress syndrome. She considers herself blessed and lucky because she lived to the advanced age of 92, old enough to see her grandchildren grow up. We’d had some hopes that she’d get to see a great-grandchild as well, but perhaps that is not to be.
She says the care she’s received has been marvelous, (especially compared to the stories she hears from her remaining relatives in the old country). We’re also fortunate that in this day and age we can certainly find a hospice or other suitable service so that she does not have to suffer unnecessarily.
I just didn’t know what the actual mechanism of demise is for this kind of advanced cancer, and a number of posters have provided great info, which I appreciate.
We’ve known for a while that she was on limited time, as she’s become weaker especially for about the last 6 months. Now we know why. She’s also in possession of her mental faculties. I think something like Alzheimers would be much more difficult to deal with.
The hospice people are pretty amazing. My uncle was able to stay at home for most of the time leading up to his death (early, with teenaged children, of a rare brain tumor.) The hospice people will come in and are invaluable, particularly if you have just one person who has to do most of the caretaking. Contact them now and discuss your options.
The hospital she’s in now has a hospice program. We’ve found a subacute care/rehab facility nearby where she will spend some time in an attempt to help her get to a point where she can be cared for in her own home.
Fortunately, as I said earlier, her home is within walking distance of ours, and my husband is retired, so he can stay there as much as is necessary, as he’s been doing the past 6 months or so.