Expert: Claes-Gustaf Nordquist, M.D. - 5/12/2011

Question
QUESTION: July 2010 my mother In-law at the age of 70 was diagnoised with 3 brain turmors, 2 connecting in the front, and 1 at the base of her head in the back. The tumors were inoperable and chomotherapy was the chosen treatment.  In the beginning stages she was extremely confused, aggressive, anxious, and mean.  After a few months of chemo, her confusing and aggressiveness improved.  Although the brain tumors can no longer be seen in medical scans she still has 3 to 4 more months of chemo left.  As I mentioned she seemed to have improved in the beginning, but the last 2 months she has taken several steps backwards in reference to her mental health.  We were lead to believe that she would return mentally after the chemo, and have tried to keep her in her home, this is no longer going to be an option.  I don't know why she is going backwards mentally, and we don't seem to be getting answers from the doctors.  After 9 to 10 months of chemo is it common to have such a severe decline mentally?  She no longer can control her finances, she runs around the house screaming, and she is mean to just about everyone she comes in contact with. Are we not asking the right questions?  Why has she gone backwards?

ANSWER: So many brain tumors at one time probably should be regarded as an indication that these are not primary brain tumors but cancers that have spread to her brain from elsewhere. Is any previous cancer illness known? Regardless of if they are primary brain tumors or cancers that have spread to her brain her prognosis must be regarded as very bad regardless of treatment. These tumors must be regarded as incurable and eventually fatal at present. Treatment can at best so far only prolong survival. I estimate her remaining survival time to be at most measured in months but could be much shorter. Her condition is getting worse because her brain is injured by her tumors and they or other tumors in her brain are probably growing again - even if nothing yet can be seen on any scans. Radiation therapy may be yet one more option but can at best only prolong survival somewhat more and even that is uncertain. I'm sorry I have nothing better to tell you!




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

QUESTION: Dear Dr. Nordquist,

Thank you for answering my questions and concerns so quickly.  In your response you had a question for me “Is any previous cancer illness known?”  The answer to that is yes.  Along with the 3 brain tumors, she was also diagnosed with Lymphoma.  I guess the question now is what came first the chicken or the egg?  As a layman, I am going to say that the Lymphoma came first, and that she probably had it for quite some time.  Prior to her being diagnosed 9-10 months ago, I had noticed, at least a year prior, that her gait was not quite right.  Her steps were shuffled, and her balance was slightly off.  I had mentioned it, but never pushed the issued.  If only we could go back in time.   I’m guessing that she had the lymphoma for a few years and the brains tumors at least 2, maybe longer?  I now believe that her altered gait was because of the tumors dating back a couple years.  Can I be right?  How long can these types of illness continue without being detected?

The tumors were apparently extremely large, wide, and deep, and that is why they were inoperable.  The biopsy came back showing the tumors to be benign.  Did the size of the tumors have any bearing on how long she had them?

My understanding of your answer is that even though she is still having chemotherapy and will continue for the next 3 to 4 months, the tumors or new ones are probably growing, even though they can’t be seen, and that she may only have months left to be with us.  When the doctor did the biopsy and before he received the results, he did at that time, give her 9 to 18 months, but when the results came back showing the tumors were not cancerous he reneged on that statement, or so I thought.  I was not there at the time and got the information from my husband.  I think we need to ask again.

My mother In-Law has good days and bad days, and although I do understand that her brain is damaged I am still having a hard time understanding her behavior.  She seems to have her intelligence, as she does understand explanations, and hold very intelligent conversations; however she has no control of her emotions, or rationality.  She screams, and cusses; she is extremely compulsive, and very anxious.  When she eats, she is like a chipmunk and will put so much in her mouth that is begins to fall out.  She is rude and does not see it, but with all that said, when we take her somewhere or if we have our 4 year old grandson around her, we tell her that she can’t behave like this.  Sure enough the screaming stops and she is rather well behaved.  Does she have control or does she not?

What can we expect?  She is beginning to have a hard time getting up from the couch from a sitting position.  I am assuming that she will get to a point where she can’t get up.  With all her anxiety, her mind seems to be going all the time.  She is tired all the time, but goes constantly.  The only down time, for her mind, is when she sleeps and she has to take pills to help with that.  I just don’t see her being bed ridden, although not being able to get up from the couch may be a sign that it is getting closer than what I realized.  It was just a few months ago that she had to stop taking baths because she couldn’t get out of the tub.  Paramedics had to be called the first time, but Ron was there the second time she couldn’t get out.  So not being able to get out of the tub, to having trouble getting up off the couch, for me are signs of her health declining. Again, what should we expect?  Is she just going to just get physically weaker?  Is her mind going to worst?

Answer
Her tumors can NOT be benign! You do not treat benign tumors with chemotherapy! For me to be able to answer your questions I DO need to read the pathology report of her biopsy and also her MRI brain scan reports - if possible! You can copy them here!



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