My dad is 76, a lung cancer survivor with one lobe removed back in 1994, diagnosed with COPD in 1989, now has late/end stage COPD (on 02 24/7), tires easily, dsypnea, hypercalcemia. He was diagnosed with oral cancer - tumor on the right mandibular posterior. The tumor was surgically removed on August 12, at Loyola University MC in Maywood (Chicago), IL. Long story short, he's now in RML speciality hospital in Hinsdale being weaned off the ventilator. He's progressing okay - off the vent for several days now, still has the trach tube in, and an NG feeding tube, which will be changed to a stomach tube in the next few days. He really is having trouble breathing - Goes to PT, walks 12-20 feet "with guided assistance" and has to rest for 1 to 1-1/2 hours, which is actually interfering with his speech therapy.

Okay - took me a while to get to the point - I finally got his path report today. (I live in S.E. Georgia) The tumor was 2.6 cm with moderately differentiated squamous cell carcinoma; 2 of the 32 lymph nodes removed contain metastatic carcinoma with extranodal extension - salivary gland tissue with no specific pathologic changes; and margin base of tongue, posterior, shows focal high-grade dysplasia with no evidence of invasive carcinoma. The stage shows T2, N2B ... My mother, who is, at this point, incapable of recalling about 90% of what she is told and what she has said, said the pulmonologist told her that the surgeon is talking about radiation and/or chemotherapy.

From what I have read, my dad's prognosis is not good, based on his age, his general health, and the fact that the lymph nodes show extranodal extension. My mother said when my father had the lung cancer surgery 10 years ago his doctor said he was not a candidate for radiation or chemo because of the state of his lungs. Even if he IS ... in all honesty, is it worth it for him to go through that? Will it give him a chance at buying enough time to make it worth while? More importantly, assuming it WOULD buy him a significant period of time (a big assumption, I think), would it be doing him a favor to extend his time but reduce his quality of life even further? It's not my decision to make by any means, but I would like to be sure that my dad makes an informed decision, no matter what it may be.

I watched my husband die of cirrhosis/liver cancer, and I'm an endometrial cancer survivor and a survivor of vaginal cancer (luckily all I've needed so far is surgery), so I'm somewhat familiar with the terms of the disease and treatments available, and their effects on the body. I'm just trying to find out more so I can be helpful and supportive for my dad, my mom, my brother, and so I can prepare myself for what's ahead. Thanks.

Sallie, Welcome to OCF.
Your father may indeed be a candidate for radiation and It may be a permanent solution for his oral cancer. His cancer may be more advanced than some but that is not a reason to give up yet. There are many people here at OCF that had a similar advanced stage of cancer and are still here. Please don't give up yet.

Thanks, Mark. I'm not trying to be the queen of gloom and doom, but on the other hand, I don't want to be an ostrich and bury my head in the sand. I enfouraged my husband to fight and to put endure an NG tube even when he didn't want to because he was on the liver transplant list, and he had a chance as long as he was on it, but when he was taken off and declared terminal, I did everything I could to make sure he was comfortable and as happy as I could make him.

I think my dad's COPD affects his quality of life much more seriously than the cancer does. I just hate to see him go through a lot fighting the cancer and have him win the battle only to lose the war to COPD. If it weren't for that, I'd be leading the cheering section to do all he can to fight this.

Sallie,

You didn't really say when your husband passed away but I am sure it will always be painful. Thank you for sharing that and I am sorry you have had to endure that and all that is going on with your father. You are certainly a strong person. Your dad is pretty fortunate to have you by his side.

You are perhaps asking the single most important question we as humans can ever ask. There is no magic formula, unfortunately. The debate has raged on for centuries when a person has the right to fight or end life. There is no question your father is facing things that people worse off than him have faced and conquered. Yet, there are others much healthier that have chosen to not fight the battle. The treatment will be gruesome and all of us going through it have wondered at least once if the treatment was going to take us out. We are here to testify that it did not.

My recommendation is to get with a professional with your dad and talk through all the issues surrounding the treatment and candidly let your dad know what he is up against. There are people that are very good at this and do it for a living, full-time. I know ultimately that your dad has to make that decision and someone better equipped than me could guide him through a sound process of reaching the best decision for him.

My mother was diagnosed terminal with ovarian cancer and because of the brain mets they told her she probably only had 4 weeks or so left. She swore she would never have radiation. Two weeks later they told her if she didn't have radiation within days she would not make it. She looked up at me and then the doctor and asked us what we were waiting for. Ten treatments later she never got out of bed for more than a few minutes a day. She then decided to keep going with chemo for 7 more months. When she finally decided the 3 weeks of intense vomitting and feeling terrible between the chemo treatments was all she could handle, she stopped and lived almost exactly 4 weeks. I often asked her if she was content with the quality of her life. She spent all day watching the Food Network, primarily Emeril and the Iron Chef. Cooking was her life and she told me what else could you ask for.

The important thing to remember is once the decision is made to just sit back and let the disease take it's course, that decision often can not be reversed. Treating the intense pain or further progression of the disease may be all that is needed for a person to feel they are doing everything they can during the final stages of life.

Again, I am not a trained professional but I personally have already discussed this with my wife and we both know when I tell her enough is enough, exactly what that means.

I am really sorry I don't have an answer for you and even feel worse that any family has to go through this process. There is nothing in life that can ever prepare us to watch a loved one succumb to this dreaded disease or anything that ends life before nature intended it.

God Bless,

Ed

Thanks, Ed. I don't know what decision I'D make in my dad's shoes, but I'd want to know what my options are and what I would be facing in each case, as best as I could be told. His surgeon was awesome, but was VERY positive that my dad was going to be operated on on Thursday and be at home, doing great, the following Monday. Three weeks later, he's still on a trach, unable to talk, can barely walk, can't eat, sleeps most of the time, can't read, can't watch television ... just lays in the bed staring at space when he's awake. At least he used to be able to read the newspaper from cover to cover every day and watch the news. What really bothered me is that the surgeon never even acted as though my dad had any choice in the matter, just told him "This is what we're going to do." I told my dad repeatedly - it was HIS decision; NOT the doctor's, not my mother's, not mine. It's his body, it's his life. He has the right and the obligation to decide what treatment he does or does not want. He did get the surgeon to explain his options eventually, and he opted for the surgery. I have no argument with his decision, because I think he had been given the options and the likely outcomes on which to make an informed decision. I just don't want to see him get bulldozed into a decision that someone else thinks is right, and then if it doesn't turn out the way it "should", they say, oh, man, I'm sorry, I hate to admit when I was wrong, but I was, while he is left to live with it.

As for my husband, he passed away in Hospice one week after being declared terminal, a little over two years after being hospitalized for the first of many times with acute liver failure. He fought the good fight, and I was the one who forced HIM to go to the hospital that first time, or he would have died that night. I often wondered if he resented the fact that he suffered so much over the next two years and would have preferred having gone quickly. I was lucky enough to be able to ask him and he told me no, that he had no regrets, nor do I. It's one thing to watch someone you love suffer when you know that they are fighting for their life because they WANT to, and a whole different story when they are forced into a position they never wantedand never would have chosen IF they had been given a choice... and that's all I'm asking for my dad. He may live for another 10 years without treatment, he may die in a year or less with treatment ... None of us know what will happen, I'd just like him to feel he has some control over what decisions are made with his life.