Expert: Claes-Gustaf Nordquist, M.D. - 11/29/2008

Question
QUESTION: My mother is 72, and had a primary CNS tumor which metastisized.  Most of the tumor was removed, and she was treated with methatrexate.  After the 2nd treatment, she contracted pneumonia and further treatment was delayed.  After the 3rd treatment, she had an MRI which showed the cancer returned and spread.  She was given the option of WBR or die in 3 weeks.  At this time she was getting around on a walker and taking care of herself.  She had 5 weeks of WBR, and was able to get around on the walker, feed herself, etc.  It has been 1 month since the end of her treatment, and in the last 2 weeks she is completely physically disabled and has severe dementia.  Her recent brain scans showed no cancer.  What is happening?

ANSWER: Even if no cancer can be seen at present it has most probably damaged her brain and is probably still there though at present so small that CT or MRI scans can not pick it up. But based on bitter experience it most probably will return. Then no more treatment will be possible. So her survival time can probably be measured in months and all what this kind of treatment can do is to extend the survival time. Unfortunately in this case in a not good condition. I'm sorry I have nothing better to tell you!


---------- FOLLOW-UP ----------

QUESTION: She is presently undergoing occupational and physical therapy.  Would you recommend a neurologist, her radiologist or oncologist to follow up with to try and find out what is going on?  She had an MRI 2 weeks ago.  Is it too soon for her to undergo any additional testing?  Also, should she have a full body scan at this stage?  Thank you.

Answer
It is not wrong to ask a neurologist to check her. The neurologist must then decide what further tests to do. With regards to a full body scan you have stated 1. That her tumor was a primary brain tumor = originating in her brain & 2. That it has metastasized. That is confusing. Primary brain tumors only very rarely metastasize outside the central nervous system, so in that case no full body scanning would probably be needed. Only if her tumor actually started somewhere else and then spread (metastasized) to her brain would such scanning really be necessary. So which is it? For your previous question it did not matter but now it does.