Expert: Claes-Gustaf Nordquist, M.D. - 5/26/2009

Question
My wife was diagnosed with brain metastases from breast cancer 13 months ago after exhibiting the clinical symptoms of imbalance, headaches, nausea and a little forgetfulness. An MRI showed 12 to 15 lesions. We thought she would have very little time, however we embraced all the treatment options - dexamethasone to control swelling and stopping clinical symptoms, whole brain radiotherapy, stereotactic radiotherapy, Herceptin, Tykerb and Xeloda. We have managed to knock the lesions back to about only 5 visible lesions. We were considering Cyberknife treatment in Turkey (at the Anadolu Medical Center) to buy more time but I think my wife would rather have a holiday instead. I know my wife has been very lucky surviving this long with so many brain lesions. However, we recognise that realistically she is likely to have only a matter of weeks or months left, especially once the clinical symptoms come back.

My wife doesn't want to be continue to live once she is in an incapacitated state and doesn't want to go into a hospice. She wants to die with dignity. So my question is - once the lesions progress and clinical symptoms come back how quickly will she deteriorate? How is it most likely that she will die? And I guess I'm asking - is she going to suffer?

Thank you.

Answer
Once the process does start it will take only at most a couple of months or even a few weeks for it to run into conclusion. There may be local neurological symptoms due to the locations in her brain of her lesions. Of those locations I know nothing and it is better to ask a neurologist about that. There will also be general symptoms. She will become more and more confused. She may show stroke like symptoms and even epileptic fits. She will sleep more and more. When she sleeps all the time her end is near. She will then drift into a coma and then pass away. There will be little pain - if any. I agree that she has lived far longer than expected. If that in any way will influence what I have tried to describe here I do not know. I'm sorry I have nothing better to tell you!