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About Claes-Gustaf Nordquist, M.D.
Expertise
Questions concerning Cancer, Oncology, radiation Therapy, Tumours, Chemotherapy, Cytotoxic Drugs, Hormonal Therapy, Radiation Protection.

Experience
I'm a Doctor of Medicine. Licensed/certified physician and surgeon and specialist in Medical Oncology and Radiation therapy in Sweden, Denmark, Finland, Iceland, Norway and the European Union. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. Now in private practice in Stockholm, Sweden. I also answer questions in these other categories: General History, Military History, Brain Tumors, Breast Cancer, Colon Cancer

You are here: Experts > Health/Fitness > Medical Specialists > Oncology (General Cancer) > Dying from radiation damage?

Oncology (General Cancer) - Dying from radiation damage?

Expert: Claes-Gustaf Nordquist, M.D. - 10/28/2009

Question
QUESTION: Hello Doctor

In Oct 2008 my mother was diagnosed with a malignant peritoneal tumour in the area of her kidney. It was diagnosed during an op to remove a mass that was blocking her ureter. On further study it was found to be malignant. This was the culmination of a 3 year mystery which included oedema and chronic pain down the right leg as part of my mother's symptoms. It was said that the cancer was a regrowth of some ovarian cancer that had been removed during her hysterectomy over 6 years previous. (Why no one picked up a link to this earlier, I cannot say. It is a cause of concern for me.)
The tumour could not be removed as it was too enmeshed with the nerves and veins inn the area.

She was given a course of 25 radiation treatments in Nov 08. Since then she would have a few good days but then not be able to keep food down at all. She was told it was the treatment that made her nauseous. 8 months later she was a mere 40kgs, could only eat mild, dairy based soft food and liquids but had more frequent nausea and vomiting. Even water gave her heartburn. Only by Sept, after pushing by my father, did they do a barium meal test to find blockage in the intestine. Apparently, the radiation caused adhesions which grew together and caused further convolution and blockage. So, due to radiation damage, NOT the tumour, my mom could not stomach a decent meal and be nourished properly for a year. Her psychological state is weak, overwhelmed and I fear she won't be with us long. The leg pain and oedema have returned.
She had surgery in September but the surgeon could only correct some of the damage and said that the symptoms probably would return as surgery creates more scar tissue.
She had a few good days over Sep/Oct but is back to throwing up just stomach liquids most of the day. I don't know what nourishment is staying down.
It fills me with anger that people are not told of the damage radiation can do when pushed into immediate treatment and that I will have to say that my mom didn't die of cancer but a doctor recommended treatment, when the time comes. I feel that her suffering could have been avoided to some degree.

Is it possible to prescribe too many/too potent treatments. And is it a cause for further investigation for possible malpractice?
I realize that this may be a natural reaction to a loved one's imminent death. But too many people have wondered the same thing for me to let it go unasked.

Many thanks

ANSWER: First of all, in order to block her ureter (the duct leading urine away from her kidney to her bladder) the tumor we are discussing must have been growing BEHIND her peritoneum (retroperitoneally) because that is where both her kidneys and her ureters are. So it was NOT growing inside her peritoneal cavity = her abdominal cavity but behind it. It is very important to keep the anatomical conditions here in mind because otherwise everything becomes impossible to understand. So the tumor process was between her abdominal cavity and her back. However if it was tried to remove her tumor by surgery the normal way to enter that area behind her abdominal cavity is via her abdominal cavity. So her surgery started as any abdominal operation. Is it certain that she had an ovarian cancer at the time of her hysterectomy 6 years ago? I ask because you say that her surgery was a hysterectomy (removal of her uterus/womb) NOT that it was a surgery for an ovarian cancer which is something very different. If indeed she had an ovarian cancer then why was that not mentioned? At least it should have been mentioned when the pathologist studied the surgical material that had been removed (usually the ovaries are removed along with the womb). Also her surgeon should have seen signs of this during her operation. Another reason why I doubt that this has to do with an ovarian cancer is that surgery for that is usually followed directly by radiation therapy and chemotherapy since surgery is normally not enough for treatment. As far as I can understand from your description nothing like that was done. Furthermore if indeed an ovarian cancer had been treated 6 years ago it is remarkable that no one suspected any tumor regrowth with the symptoms you describe (edema & pain in her right leg). Yet one more thing, if indeed this started as an ovarian cancer 6 years ago it is MOST unlikely that your mother would be alive today. So I find the ovarian cancer theory most unlikely. So your mother has had several abdominal surgeries including her hysterectomy, her later cancer surgery close to her kidney and her ureter and later even more surgery. As you yourself mention surgery in the abdominal cavity area increases the risk of intestinal adhesions that can cause intestinal blockage. So her clinical situation here is quite complicated. She has been given 25 radiation doses (of probably around 200 cGy or rads per dose which is a normal dose level). That means a total dose of around 5000 cGy/rads. NO ONE dies of a local radiation dose of 5000 cGy/rads! Remember that what has been irradiated is the area BEHIND her abdominal cavity. The amount of radiation inside her abdominal cavity has been MUCH lower. I myself have received 7000 cGy/rads to my prostate just below my abdominal cavity because of a prostate cancer and I'm OK! Every radiation therapy plan strives to put as much radiation as possible in the tumor and as little as possible elsewhere to avoid injuring healthy tissues as much as possible. So honestly I do not believe at all that her problems or present condition were caused
by radiation damage! In fact I believe that a dose of 5000 cGy/rad was not enough to cure her but that it for technical reasons was impossible to give her much more and enough (my own dose was possible because in the prostate it is possible to combine 2 different radiation techniques, internal brachytherapy and external radiation, while in the case of your mother only external radiation could be given. So I think that her intestinal problems were (mainly) caused by her surgeries and what is killing her is her cancer which it unfortunately has been impossible to cure. Unfortunately it is quite common to unjustly blame things on radiation therapy even when it is impossible for it - as here - to be the cause. I do hope I have been able to explain your mother's tragic case!

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

QUESTION: Thank you Doctor.

You are correct. It was a retro-peritoneal tumour. The diagnosis was not ovarian cancer but there was tissuee in the area which was said to be malignant and removed during the hysterectomy. The adhesions were said to be as a result of the radiation as it caused scar tissue affecting the tumour and surrounding tissue. It caused convolution of the small intestine in the area just below the bottom rib on the opposite side. But the damage was not said to have been caused by the original surgery, although that does make sense. The tumour was said to be a regrowth of what was discovered during the hysterectomy though. The tumour shrunk to the size of about 1x1cm over 4 months and no pain was felt until a week ago.(No positive confirmation on its regrowth has been gotten yet).

So, from what you have told me, the radiation was possibly an indirect cause (as far as causing adhesions along with the surgery) of the intestinal blockage. Although all her radiation treatment spots were in the front of her abdomen including the upper left side. Is it correct to treat a retroperitoneal tumour from the front of the abdomen?

I will follow up on the malignancy found in her hysterectomy for more clarity. Thank you for your timeous reply. It has helped to bring clarity to the confusing mass of half-facts in my mind and clarified what I need to follow up on to get closure. At a time like this, it helps so much. Thank you.

Answer
You are welcome! I'm quite sure that her surgery was much more important in forming these adhesions than her radiation therapy. Probably she was given radiation from all sides around her, from front, back, left & right and perhaps also in between, all in order to spare healthy tissues. Markings need only to be on one side for guidance. All other measurements are in the plan. I'm rather surprised that something malignant was said to have been present at the time of her hysterectomy. Why was then not more done? VERY strange! Please do keep me posted and please rate my answers.

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