Hello! My name is Maria and I'm writing to consult about my mother, who is 84 years old. In November 2010 she was diagnosed with oral squamous cell carcinoma after a biopsy of her upper gum on the left side. She had noticed a swelling that didn't go away for some time (a month or a little longer) and after being diagnosed, she underwent surgery on January 5th and the left part of her upper jaw was removed. She recovered incredibly fast after the surgery although she's still very tired, sometimes exhausted by the end of the day, which is no surprise after such a surgery at her age. The thing is, we got the results from the material they removed in the surgery yesterday. Cancer had got to the bone but everything was removed successfully. Now, the surgeon is not happy with the margins left, he says they're too narrow and he wants her to undergo six weeks of daily rads. This may sound silly but it came as a real shock as the surgeon had not mentioned rads before. Mom will have an interview with the oncologist who would be in charge and her GP to make a decision but today she said she doesn't want to do it. She's undergone a lot of surgeries in these past 20 years (hip replacement, both hips, a mastectomy due to adenocarcinoma)
My question is, what would you do? Would it be ok not to undergo rads and see what happens? She says that as the cancer has been removed, it's likely that she'll be OK anyway. Is that so? Are the side effects of rads as bad as I read? Would an 84 year old person be able to put up with them?
I would definitely welcome any opinion or piece of advice!
Thanks a lot!
Maria, I am sorry to read of your mothers struggles with oral cancer. Ive had my lower jaw removed so I do know how difficult it is to recover from a big surgery like what your mam has had.
Without getting clear margins it is possible that a teeny-tiny cell was missed which could bring back the cancer. Radiation is not easy to go thru but it can be done. Ive seen several older patients get thru radiation and go on to lead productive lives. Im sure your mom is worn out from what she has gone thru. If she chooses to not go thru with radiation then she has a much higher risk of having a recurrence. Oral cancer is a fast moving cancer. If it returns and is not found right away, it could be fatal to your mother. The best advice I can give you is if you are not comfortable with the doctors options that he suggested, get another opinion. This is a very difficult decision to make but ultimately it is up to your mother weather she wants any further treatment or not.
Hope this info has been at least a little helpful to you. Best wishes with this decision.
Thanks Christine!!! What you say IS helpful. Her doctor has suggested she go through half of the radiation treatment and then he will see how she's doing but I think that if she decides to do it, she should go through the whole treatment. On the one hand, some doctors say the older you are, the more slowly cancer spreads but honestly, I don't know if this true when it comes to oral cancer. Judging by what I've read, it spreads pretty fast!
These days are a real mess, we're seven children and we feel we aren't of much help with her decision.
Thank you for your answer and I really wish you all the best with your recovery.
Maria - I would like to echo what Christine has said about getting a second opinion. Radiation can be really difficult for some, even those much younger than your mother. My son, at age 33, had such a hard time, that the doctors gave him a 3-day break during the Rad treatment two times so that he could recuperate a little before continuing on. The closer he got to the end of Tx, the more he wanted to finish it. Everyone reacts differently of course. Many have a much easier time than others. I think all you can do is to help your Mom with all the information that you can gather and then leave the decision up to her. She will feel more in control of her own life if she can be the one to decide, knowing that you will support her whatever her decision is.
If you can get another opinion from a QUALIFIED oral cancer team then I would. Otherwise and I assume that your Mom would test negative for HPV in those cancer cells collected, I would do the radiation and not just 1/2 as I would do the entire 6 weeks, 84 or not.
Thank you Ann-Marie and David!
We have just made an appointment with an excellent oncologist and we're having a meeting with him on Feb 23rd.
We've also been talking to mom about it and she has agreed to listen to her GP and this oncologist to see what advice they give (her GP is excellent and he is already looking for a second opinion among oncologists he knows and trusts). Yet, she says she has practically made up her mind about it and she won't have rads. It has to be her decision independently from whether she's advised to or not. Her being 84 and too weak, with all the surgeries she's been through plus some other things she's been through in these past few years has taken its toll on her. It's a very delicate thing, of course we want her to be OK and she wants to be OK too but her perspective is different from that of someone younger. Her GP's fear is that she won't be able to take it.
Thanks for your answers, I'll let you know what she's decided.
David, yes, she tested negative for HPV!!
Patterns of care in elderly head-and-neck cancer radiation oncology patients: a single-center cohort study.
http://www.ncbi.nlm.nih.gov/pubmed/20395066CONCLUSION: Elderly head-and-neck cancer patients (=>75yo) exhibited different clinical characteristics and experienced different patterns of care from younger patients. Although age itself was an adverse predictor of cause-specific survival, its effect was modest. Elderly patients selected for definitive RT or intensified RT showed no evidence of impaired treatment tolerance.
Thank you all for your help, each opinion is taken into account!
Hello people
I'm writing to let you know that finally mom won't have rads. Her GP had a meeting with two oncologists and they analysed her case, taking her history and present health condition into account and they decided it would not be convenient for her to do it. She had already decided not to anyway and we agreed to respect her decision. Of course the doctor's decision helped her.
We'll try to do do our best to give her a good quality of life as long as we can and she knows perfectly well what she might be facing if cancer came back but she just can't take anymore, neither physically nor emotionally.
Thank you all very much for your help.
How very sad - it is something no one wants to hear, let alone go through. All your friends on the Forum will be wishing you the most peaceful time with each other and know that God is with you. Please keep in touch with us.
julieann
Thank you for updating us on your mother's condition. will keep her in my prayers that she remains cancer free.
Thank you Julieann and Christine! I wish you all the best too!
Sorry but I don't understand her doc's choice of words when you said they said "it would not be convenient for her"...to do radiation? Can't think of anytime that would be convenient.
My Grandmother lived until she was 98 and my Grandfather until 97. I personally don't understand why someone knowingly wants to not try and prevent their death and a pretty horrible one at that. JMO