Expert: Claes-Gustaf Nordquist, M.D. - 8/1/2008

Question
QUESTION: My 85 year old mother was diagnosed with cancer back in November 07. She had a small spot (small finger nail size) on her left lung. (She never smoked). She also had a small spot on her left shoulder bone and a sidewall tumor in her rectum. Radiation was given to treat the shoulder bone. She them received Chemo treatment for her lung. Based on increasing pain in her legs the doctored ordered an MRI on her brain where they found 7 lesions. She received radiation treatment for the lesions in Feb 08 and then she decided to not continue the chemo due to her failing overall health. We all agreed that she needed some time to gain some strength back before any more treatment given. She spent time in a recovery home and was finally released based on the home not being able to do any more for her. She was brought to my brothers home on April 4th where visiting nurses and hospice were brought in. She died in 10 days. Morphine was administered for pain at half the dose recommended by hospice. My question(s) - Is it normal for patients to all of a sudden have intense pain in the head from the radiation treatments? 2-4 months was how long some family  members were told that she would live - she lasted about a month. When 2-4 months is given from health professionals how accurate can they really be?

ANSWER: No survival time predictions are not very accurate. I find this case rather disturbing. Was there never any biopsy done of at least her rectal tumor?! Without any biopsy no one could know what they were dealing with! No pain should NOT have been a prominent symptom - hardly at all in fact. That makes me wonder if her cause of death may have been a cerebro-vascular accident?! Was no autopsy done? Sad if not since that would have answered ALL questions! That is why autopsies are much more important than people seem to understand. They are the only final quality control of medical diagnosis & care!


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QUESTION: No pain should NOT have been a prominent symptom - hardly at all in fact. What does this mean. She should NOT have expereienced pain or YES she should have experienced some pain intense pain at times based on her medical condition...

Answer
It means just what it says that pain is NOT a common symptom in late brain cancer cases. If this was a rectal cancer it could have spread both to her lung and her brain. It is possible that she could have had both a rectal cancer and a lung cancer (10% of those have nothing to do with smoking). Lung cancers often spread to the brain. And as I wrote advanced cancers in the brain rarely cause pain. That is why I wonder if her early death was caused by a cerebro-vascular accident like a rupture of an aneurysm in her brain. That will cause pain. However without an autopsy we will never know.