Expert: Claes-Gustaf Nordquist, M.D. - 8/1/2011

Question
Hi,

My mother who is currently suffering from Anaplastic Oligoastrocytoma has developed weakness on the right side of her body though she is trying her best.

To let you know about the case my mother is 56 years old, last year around 22-23rd May'2010 she had a blackout post watching a movie in a theatre and could not recall anything about the movie. She was a thyroid patient suffering from Hypertension, Diabetes and also Protein Urea. However before her brain tumor got detected she was doing well in terms of balancing her sugar, BP and kidney function.

Within 2 days she started loosing her memory and fell weak to the extent she had to be lifted by 2 people atleast. Intially the family doctore felt it was vertigo and gave a convulsion control medicine.

However with my little knowledge of epilepsy, parkison's etc I felt we should get a CT done .On 24th May'2010 the CT reflected there was a mass and MRI with contrast was suggested.On 25th May'2010 MRI with Contrast reflected there were 2 tumour like masses on the left frontal lobe of the brain. Basis the MRI a neurosurgeon whom we consulted suggested that she needed to be operated immediately within 7 days else her life would be at risk.

Within 2 days we flew her to Bangalore as we found a good neurosurgeon suggested by my mother's Nephrologist. On visiting the Neurosurgeon he saw my mother and on seeing the MRI he said the tumour measuring 58*55*44 mm was huge however could be resected to a certain extent and the one 14*16*16 mm they would try that too. He did mention that we had no other choice than surgery and that if things work well within 7 days she should be doing better than the current situation.

Doctor performed the surger on 30th May'2010 and post surgery he informed that he has been able to remove certain part of the tumour however the tumour looks to be highly malignant. Post biopsy it revealed my mother was suffering from Anaplastic Oligoastrocytoma. The next course of action the doctore suggested was radiotheraphy and oral chemotheraphy.

With 1 month from my mothers surgery she regained her senses, she could walk again and was recovering. With God's grace she completed 1 month of Radiotheraphy without much complications except platet count reduction and also WBC count reduction which is expected. She was given a steroid to take care of her edema owing to radiation. While being in radiation she was put to TMZ and underwent 9 cycles split in variation in doses(between 180 - 300) owing to low blood counts.

I would say she has also gone through ups and downs during the last 1 yr and 2 months however she travelled to my hometown Kolkata twice by flight. We even took her to Dubai for a short trip and she was doing OK. Post completing 1 year in the month doctor suggested we another MRI to see the current condition of the tumour. The MRI which was done in June'2011 suggested growth/edema/necrosis.

Her medicine oncologist suggested we stop the chemotheraphy and the neurosurgeon should decide what needs to be done. The neurosureon suggested we wait for a month and do a PET scan to understand the current situation. During this time my mother started feeling very weak and drowsy and also started to show symptoms that we had seen when he was diagnosed with the tumour a year back. Her right side has become very weak and she is unable to lift her hand to eat or do daily life things . We can visibly see she is using her left hand . Also she started to fall down as she could not keep her body balance and also started loosing memory. During conversations she stays quite . Her speech has become disoriented again.

The PET scan was done in July'2011 and mass size now is 4*5.7 cm. There is some amount of necrosis and edema however the nueurosurgeon feels the tumour has grown back to a certain extent. As on date her chemotheraphy has been stopped since the last 1 month . The neurosurgeon wants to see her condition without medication within this month and accordingly he would take a call whther he would perform a second surgery or not.

At this point in time we are absolutely confused as my mother has not been able to control her body movements. We need to accompany her to the rest room sometimes she is not able to control her bladder and bowel and does things the wrong way. However she can relate that she has done or said something wrong. She has been forgetting our names and past quite often. However if we help her with the first alphabet or syllable she is able to spell them. Somedays she is in a good condition somedays she degrades. She has been drowsy also and does not want to move much. She has been under physiotheraphy and we try to make her talk normally and do regular things but we are not able to understand what is actually happening?

Could you help me understand or throw light on what could be the next possible course of treatment ? What is it that we could do to help her improve her quality of life ?

My myther is a strong fighter and she has been fighting this with a lot of guts and courage. Till date she never disturbs anyone or make anyone feel obligated. She tries to do as much as she can by herself.

If you could help and share some experience and way by which we can improve the situation it would be of great help to my mother and family. We do note want to lose hope and give up as beyond every medicine and situation GOD is the bigest healer and we believe in him.

Looking forward to your response.

Best Regards,
Sarmistha

Answer
Unfortunately this is not a good situation. All malignant brain tumours have a very bad prognosis regardless of treatment. The best any treatment can do is temporarily decrease symptoms and to some extent extend survival time. If her tumour was highly malignant this situation will be even more apparent. The only available treatments with any proved effects are surgery, radiation therapy and chemotherapy. There is an upper limit to how much radiation therapy that can be given. Even if her neurosurgeon is able to try some more surgery her prognosis remains bad and her remaining life span may well be measured in months or even less. As her illness advances her mental and neurological problems will increase. She will also sleep more and more. When she sleeps all the time her end will be near. She will then drift into a coma and then pass away. There will be little pain - if any at all. I'm sorry I have nothing better to tell you!


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