Expert: Claes-Gustaf Nordquist, M.D. - 10/21/2006

Question
I'm an RN and have a question about a patient.  She is 43 years old (I'm 42) and in February she was taken into the OR to have her gallbladder out.  When they opened her up, they discovered she had cancer everywhere and found the source to be colon.  In August she returned for further treatment/surgery for an obstruction and is now near death.  She was actually going to go back to work part time the following Monday and the doctor decided to do one last test with contrast.  Well the contrast could not be excreted, she ended up with an obstruction and needed surgery.  The doctor is making many of the nurses upset.  He told her she was clear of ca when she wasn't.  She became obstructed AGAIN after the last surgery and went in again for surgery 10 days ago only to find the cancer everywhere, worse than in February.  I'm only a nurse and could tell back in February this was more than a gallbladder issue.  Basically she has mets to the liver and probably the brain.  She is on so many pain meds, it is not 100% clear if it is the meds or mets causing her to act as she does so mets to the brain is in question.  She is on TPN, has a vac dressing, an ileostomy which has been messed up and it seems to drain into the vac dressing at times needing frequent changes.  She is so jaundiced and sick looking.  I asked the doctor yesterday how long he thought she had and he in his typical sarcastic way said he didn't know.  Well, obviously we never know for sure, but there should be an idea.  This patient is in major pain 100% of the time even though she has so many pain meds.  She was on a dilaudid PCA for nearly two months and that no longer is helping her at all.  Instead she sits there crying in misery.  She is positive for MRSA in her sputum and blood.  I don't doubt she is getting an infection with the ileostomy drainage leaking into the vac dressing.  When she gets out of control, she pulls all the tubings and that doesn't help things.  What is your idea on life expectancy with mets to the liver and brain?  I hate the fact this patient received such poor care and feel guilty myself.  I've tried the best I could, but never get anywhere with the docs.  Thanks.  

Answer
I'm sorry to read about her problems! Lisa, if indeed she has brain mets - but at the moment we do not KNOW that - her survival time can be "at best" measured in months, more probably in weeks if even that. I'm sorry I can not be more precise than that! If her major met area is her liver and not her brain her survival time may be somewhat longer but probably not much - but this is somewhat uncertain. No one can be exact and precise when predicting survival times. Her infection makes it even harder. Infections can break her at any time. I'm sorry she is in such a mess! No one can promise a cancer patient after surgery that everything is out! However it is very probable that the cancer she does have is of an exceptionally aggressive kind. I doubt from what you have written that any better care could have changed this outcome. Her cancer was most probably widely spread already at the time of diagnosis and I doubt very much that any chemo therapy could have changed her situation much given all what you have told me. Most colon cancers (cancers in the rectum are exceptions) are not very sensitive to radiation so that possibility is also out. Please do keep me posted!