Hello to all,

I'm new on this board. It has been so helpful to read these posts about your elderly mother from schues6 and the helpful comments from you all and from lam007 (hoping I'm getting the names right). You are all so brave.

My father is 83 and somewhat frail at this point. He was diagnosed 1 month ago with T2N1MO stage III squamous on right lateral tongue. They think they see something in one lymph in neck, but not sure. They are recommending 3 treatment options:

1. Standard of care is:
- remove cancer from tongue and neck dissection (Supraomohyoid Neck Dissection)
- benefit is that this can tell us more about the node/neck
- if there are adverse features- may need radiation therapy +/- chemotherapy
2. Radiation therapy only to tongue and neck, including HDR brachytherapy
3. Alternative is a modified neck dissection, no surgery to the tongue, with radiation to neck and tongue HDR boost to tongue through catheter

The post from lam007 (nurse in Australia I believe) got me thinking. My father asked the doctors at the beginning "what about doing nothing" - and they said it would be an "awful way to go." I am trying to get all the answers I can about treatments and how they would affect quality of life. At the same time, I want to honor his wishes that he may feel "his time has come." As background, one of the few things he still enjoys is "the gift of gab" and surgery and radiation I think will severely limit that - if not just the toll from all the treatments.

My father currently lives in a small board and care 2 minutes from our home with my mother and a few other elders. He has seen 3 of his housemates pass recently from cancer but they passed very calmly and there didn't seem much suffering. He thinks his passing from tongue cancer will be similar.

I am having a hard time getting an honest answer from doctors as to how much pain, disfigurement, etc. would be involved, and what we could do to alleviate it - and to what extent? I don't mean to be harsh in my questions, but would he starve to death or sufficate, or? I thought those of you who have medical and care backgrounds might have some honest answers.

thanks so much to all. We are heartbroken.

Marie-Jeanne

Marie-Jeanne, I have commented on your other post and given you a link to cancer centers. This is the very best way to get the best treatment for your father. They are more experienced and see many more cases than smaller lesser known facilities. It really does make a big difference in where your father gets treated.

Most tongue cancer patients have the options of surgery with radiation (with or without chemo) as a follow up to kill any stray cells that could have been missed. Many patients also get neck dissections. Oral cancer is very different than other cancers. It affects things which other cancers and their treatments do not such as speaking, eating, tasting food, even giving a kiss. The things people take for granted an oral cancer patient can struggle with for example going to McDonalds for a big mac, fires and Coke. Treatments for OC patients can be especially brutal as well with many patients facing life long after effects. That is NOT to say its not possible to go thru treatments successfully and go on to lead a good meaningful life even after invasive treatments. I know treatment decisions are very difficult to make.

Dying from oral cancer can be a very hard way to go. Many patients are fortunate to have hospice to help them with the pain and discomfort.

Best wishes to you and your father.

Christine:

Thank you so much for your response. I will look into the various centers asap.

MJ

Hi,
There is a website nccn.org (the National Comprehensive Cancer Network) that gives guidelines on treatments. You do have to register, which is free, & then you can look at them. On the left side you'll find NCCN guidelines, go into that, then cancer by site, head and neck, and when there go to page 17 for cancers of the oral cavity. You can see that the preferred treatment is resection (surgery) of lesion and neck dissection for this particular kind of oral cancer. Then if no adverse features, radiation is optional, adverse features, then it gives you radiation and perhaps chemo.

It would be very hard to be in your situation with a parent who is fragile. The treatment is not easy, but there are older persons who go through it. Christine provided the link to the CCCs, and I too would suggest you get a second opinion from one of them.

Best,
Anne

Marie-Jean,
on the same site that Anne references, you will a guideline for Adult Senior Oncology; it is near the bottom of the page so you will have to scroll down to find it. If you read it, you will find that they would not be recommending treatment if they did not think it would help, and that he would benefit from it. There is a section on head and neck cancer treatments and how older people handle them.
Maria

83.....this is one tough thing to have to deal with. I'm only ("only") 63 and had successful treatment last year. I was strong and healthy when I started and was pretty flattened by the experience. I'm not sure what I would have done at 83. There is length of life and quality of life. What's most important to him? If you father is mentally capable I'd have him get the best opinions he can find and make the decision that is right FOR HIM!! It's not an easy decision and nobody can advise him on what to do. But remember, Doctors almost ALWAYS want to treat.

Hi,

Marie-Jeanne,

As Christine said, treatment decisions are tough. Your dad needs to get all the information he can then make the decision that rings true for him. There will be similarities with schues6's family situation. And there will be differences. This may factor into his decision making. I'm sure you will support him with all your heart.

I'm so sorry that you are facing something that there is no easy way through. You will have to find the "least bad" option.

My thoughts are with you. Laura

Marie-Jeanne

The TX and its effects are very hard. This is a decision that only your father should make for himself, not the doctors.
How is your father's health otherwise? The Social Security Actuarial Life Table shows 6 and half years left for the average 83 year old male
ssa life tables Is it likely that the TX would give him more years than that if he is already frail? If he truly feels "his time has come", it's understandable to me that he would not want to spend a year of the time he has left in pain and speech therapy and risk losing his 'gift of gab".
I asked my doctor the same question after my cancer came back at 61 and was told the same thing. For me the math was simple: I could be dead by 62 or risk the permanent side effects of losing my "gift of gab" and ability to eat or drink but gain another 10 to 15 to 19 years. As I have a son and wife who depend on me, it wasn't a difficult choice.
Your father's math though merits exploration of palliative options with hospice at the end. With enough pain medication, even this horrible cancer can be tolerable for the patient although hell on the family.
The good news is that your father's doctors are not discriminating against him on the basis of his age. There is no age limit on these TXs working.
Charm

Marie-Jeanne, I have nothing to add to these wise opinions but my good thoughts for you and your dad.

marie-jeanne

Today's OCF news feed has a report on coping with the effects of radiation tx. Perspectives on Coping
it has a laundry list of what your father may face and why his hesitation is understandable. It also lists coping strategies if it is his decision to get TX.
Charm