Oncology (General Cancer)/Father, age 86

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Question
Hello,

My father is 86 years old and suffers from dementia. He recognizes his family members, but is in a state of constant condusion about where he is, what is happeneing, etc.  His quality of life is very low because of the dementia.  

He was recently hospitalized for pneumonia.  While there, they found kidney trouble, weakened heart with an irregular heart beat, and colon cancer.  After 9 days, he has recovered from the non-cancer issues and is being discharged to a rehabilitation facility today for physical therapy and to rebuild muscle strength.

While in the hospital, he became very depressed, agitated, and desperately wanted to leave.  It was heart breaking to see him like this.  He kept trying to remove tubes and get out of bed, so he had to be watched 24/7.

The oncologist and internist are recommending surgery to remove the 4cm by 3 cm tumor in the colon.  An alternative would be a combination of chemo and radiation.   The mass is not obstructing anything.  The cancer has not spread to other organs or areas.  They completed a colonoscopy, a CT scan, and a biopsy.

Considering his overall condition, my siblings and I are considering whether he should have any cancer treatment at all, because our concern is the treatment may kill him, or make him so miserable it is not worthwhile.  

We asked the doctors what would happen if we chose to NOT treat the cancer, and how long he might live, and what his quality of life would be.  They refused to provide an estimate, and said they would not know until they removed the tumor.  I am wondering if the doctors' response is reasonable?  When I have heard of others diagnosed with cancer, it seems the doctors are usually able to provide a life expectancy estimate.

Thanks for your help!

Answer
If your father's dementia is not too far advanced, he may live for a few more years.  The problem with the colon cancer is that it could bleed (in which case he might die from blood loss) or it may grow and obstruct (causing pain, inability to eat, etc).  It may also metastasize to liver or abdomen, in which case further disabling in irreversible problems could occur.  Removal of a small tumor via laparoscopic surgery would probably not be too serious, and might prevent a lot of complications in the future.  If the doctors are talking about major surgery and possible colostomy, that would be a much harder thing for him to undergo.  I don't favor chemo and radiation alone.  First of all, it won't solve the problem, just postpone things; second, it would be harder on him that a single surgical procedure.  If your doctors aren't willing to consider laparoscopic surgery, ask them why, and if they don't want to do it because they haven't got the training, maybe your dad should get an opinion from somebody who does that kind of thing.  
All in all, of the possible choices that face you, I would favor getting rid of the tumor surgically, and soon, if the procedure would not be too extensive.  I owuldn't worry about staging; I would be doing the procedure not to cure him, but to keep him from having massive blood loss or obstruction, and if "cure" took place, that would be ok too.  
I agree with you that at this point in his life and with his other conditions, quality of life is the most important thing.  
Parenthetically, my own mother who was probably about as demented as your father is, broke her hip.  My sisters and I had a lot of debate about what to do, and ultimately agreed to have the hip surgically fixed.  She did ok, and got back to being able to ambulate for the next four years before she died.  I think we made the right decision, even though she put up a terrible fuss throughout the post op period and the rehabilitation.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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