I have a personal Q about radiation.

  1. Since I am not certified in the area of oncology I though I would ask your opinions on something that recently happened to one of my family members.

    My aunt had a hysterectomy about a month ago due to Stage II CA. She recovered fine from the surgery, and is nearly back to her normal activities. On Monday, she called my mother and told her that she has opted not to do radiation therapy because the doctor told her about the risks of bowel and bladder problems. Her doctor told her that Chemotherapy isn't really a good option for her.

    A little background on her: She lives in a rural area about an hour and a half away from the nearest hospital that does radiation therapy. (my mother and I are wondering if this might be the problem, due to the fact that the Tx would be 5 days a week for 3 months) This is her second CA - she had CA of the eye 5 years ago, and now has a prosthetic. She is 50yo. Her mother died of uterine CA in 1989.

    So, I guess my question is: What might be her outcome if she isn't going to do any radiation/chemo therapy? And is there and lab work her doctor could do to monitor her condition?

    Thank you for your help!!!!

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    About Flynurse

    Joined: May '02; Posts: 791; Likes: 2
    LPN - Med/Surg, Cardiac Monitoring, ER holding, Infectious Controlled rooms, ETC. Unit


  3. by   Flynurse
    okay, so I guess nevermind.
  4. by   caroladybelle
    Would have to have more info to hazard a guess.

    The Oncologist would be the best source for the info. He knows the source tissue (the primary is not the same necessarily the site), grade and other parameters, as well as the reason that chemo is not a good option, if the tissue is hormone positive, the grade of differentiation or dysplasia, if the tumor was invasive or aggressive, and if the ca was removed entirely with clean margins or not. Without this info or personal knowledge of the case, most of us can't hazard a guess as all of these factors affect the outcome greatly. Also, many of us do not have more than extremely general stats. As such, the Oncologist is probably a better source due to his knowledge of the case.

    Sorry that I could not be of more help.
  5. by   Flynurse
    Really, you are more help than you think. For my aunt, its become a little more difficult. She is getting a biopsy of a cyst she and her doctor found in her breast. I guess all I really can do is sit and wait like the rest of my family, instead of trying to be something I am not.

    Thanks anyway!
  6. by   ozzie sue
    i think also you should be aware of your aunts QOL issues that may have lead to her decision to have no further tx! My concern is where is/was the primary and has she have mets now.
  7. by   Flynurse
    The surgeon had her get an MRI done so he would know exactly where to biopsy the breast...which by a miracle showed nothing at all. Not a thing. As far as mets I don't know a thing about that simply due to the fact that my information is coming second hand (through my mother).
    As far as quality of life....well, I'm not sure what you mean by that. I didn't mention it above, but my aunt only turned 50 years last year. She is a very active person in general. She is an active member of her community and church. She babysits her 9yo and 2yo (twins) grandsons at least three times a week (is expecting another on the way). She and her husband plant and harvest their farmland together. I could go on and on. As far as I know she isn't in any pain other than the incision from surgery. So, I would say she has a pretty good QOL.

    I just talked to my mom a while ago and found out that my aunt is getting some blood work done every six months for a couple of years to detect any signs of CA. So, I guess this has answered my question.
    Thank you both!
  8. by   caroladybelle
    Radiation can (not always) impair bowel/ and ocassionally bladder function - perhaps causing diarrhea or urgency/frequency problems - it can also sometimes lead to needs for surgery or temp. ostomy in some scenarios. Also, frequently causes skin excoriation/edema and associated discomfort. For a 50 year old woman, working in a farm environment, this can be personally troubling and impair QOL. Radiation also can cause low blood count and some degree of pancytopenia (see below)

    Chemo almost always impairs imune system function and and generally will cause some amount of pancytopenia. During the chemo therapy regiman (generally every three weeks for X number of cycles - could be several monthes or more), there will be episodes of nadir (low blood component counts) - much of farm work regimen would need to be altered as well as care for grandkids. She would be very tired from the anemia (low hemoglobin). She could be easily injured and bleed or bruise excessively if an accident were to occur (thrombocytopenia). And as her immune system would be compromised (neutropenia), she could pick up even the smallest/benignest infections from farm/animals/kids/cuts on hands/etc. and they could proliferate easily in her system - travel back to grandkids or others as well as cause her serious illness. Thus chemo could also impair QOL. Also, during chemo/rad treatment (all however many weeks of it) she would need to drink plenty of fluids (hard to do when farming)to flush out toxins, bacteria, cellular breakdown products and void frequently. Patients sometimes take high-dose steroids and then go off abruptly (talk about volatile mood swings and energy swings - I wouldn't be safe around sharp objects), and of course generally feel icky.

    Some of the newer biotherapies are easier on the blood components, but worse as far as severe(!!!!) allergic reactions and flu-like syndromes.

    Some people, after talking to their MD, decide that the risk of further cancer is low and and the risk of problems to their life from further treatment is high, and opt to forgo adjunctive/neoadjunctive therapy. That is a personal decision based on what they know about their disease and what is important in their life (QOL). Your Aunt may change her mind later, as what her disease/nondisease state is.

    Offer support for her decision - it may change as time goes on - but she is the only one who can decide what is most important to her.
    Last edit by caroladybelle on Mar 11, '03
  9. by   Flynurse
    Thank you for that very informative post. I had realized that chemo/radtiation therapy could do these things to a person, but I guess I didn't stop to think about what it could do to her life. Maybe that's why I posted this here...to get someone to make me realize the bigger picture.
    My aunt is a very self educating woman, and I am sure her decision was a well informed one. I certianly support my family in (almost) any decision they make. I just wanted to be certian what her options were and how they could affect her life.
    Through prayers and positive support we, as a family, can make it through this.

    (Another thing I hadn't mentioned is that my family is in the Midwest, and I am here on the East coast....its frustrating to be so far detatched physically from what is going on.)

    Thanks! I feel much better now.