Dear Doctor, After analysis of pleural effusion fluid, my mother has been diagnosed with Stage 4 Cancer - CUP, poorly differentiated carcinoma. She has exhibited lower lobe fibrosis for at least three years, has normal kidney lab work at this time, previous breast carcinoma ductal in situ with removal and radiation; multiple broken bones over the last three years - however no bone density scan or Vitamin D treatment until last few months; mild anemia and leukopenia for over two years, low albumin since June 2013; degenerative arthritis, scoliosis, stenosis, spontaneous fracture of t11, numerous treatments for UTI that were positive for WBC, leukocytes, but not nitrates or positive cultures. She developed c-diff with significant pseudomembranous colitis in July 2012; MRSA infection on skin outside of spine near fracture and under armpit but resolved. CT in last few weeks did not identify mass in lungs, breast or esophagus; doctor failed to order the CT to include abdominal area despite onset of chf, weight loss, and prior squamous cell cancer of the anus. I need a diagnosis - this is unconscionable on so many levels. Could the medical community be trying to cover its failure to diagnose a cancer that has been there for some time. Bone scan revealed nothing despite her significant bone pain, broken bones and arthritis. Unfortunately - my 76 year old mother's quality of life is so poor that she is very accepting of this treatment as long as they keep her out of pain. Other sisters do not want to "upset the doctors" by asking further questions and getting copies of results. Please advise.
Hi. Thanks for the information given. To get the facts right, patient is a 74 year old female with prior history of Anal canal cancer and Breast cancer (DCIS) treated with surgery and radiation. Her co-morbidity includes osteoporosis / prior UTI / Lung fibrosis / multiple fractures ? metastatic disease ? weak bones. Is it possible to do a PET/CT scan which can give a clear idea on the extent of the disease? Your doctor would be able to give much more clear idea on it based on the need and present health status permitting it. Based on your information, I feel that it is currently a stage 4 disease with pleural effusion. If fluid is too much, she may require a drain to keep her breathing comfortable. After a complete drain, she may undergo pleurodesis to prevent re-collection again. This will help her definitely. But the doctor should decide based on her present health condition. Regarding further treatment (chemotherapy/targeted therapy), it may not be possible for me to comment without physically seeing/examining the patient. Your doctor may guide you better after discussions. She would need pain killers either oral or as replaceable patch based on the intensity of pain and requirement of pain relief. But at one point of time, I am afraid to say that all treatment have to be stopped just to continue hospice care and this is unavoidable. Hope I have answered your queries. I would be available to answer more of your questions, if any. Take care.