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Wednesday, December 4, 2013
Urinary Tract Cancers
96 year old female with bladder cancer
My 96 year old grandmother has been diagnosed with stage 3 or 4 invasive bladder cancer, which has went through the wall of the bladder. We are not sure yet if it has spread. There are 2 spots on the lungs, but there is no determination yet if that is associated.
We are trying to decide exactly what route to take. She is frail in that she needs assistance in some tasks, such as bathing, getting into a car, etc. She walks on her own, goes to the bathroom on her own, etc. She eats on her own.
With her advanced age, we are afraid of surgery. However, I have been reading research online which shows the possibility of treating elderly patients with radiation treatment without very harsh regiments of chemotherapy.
She was tested by doctors in the past year and has been advised to be in excellent health for her age, other than this most recent event. She is now experiencing loss of appetite and has in the past complained of some shortness of breath.
I need to know enough to convince my family that a second opinion and follow up is needed. My questions is: What are the risks of the various treatments to a patient as elderly as my grandmother? What are the possible effects on the quality of life for a 96 year old with the various treatments?
Also, could you comment on the general question: When is it time to give up on treatment? At what point do we decide when a person`s life span is not long enough anyway to continue to fight?
Thank you for your comments.
To answer your first question - you need to discuss this with your grandmother. At her age she may or may not desire intensive therapy which is likely to be required. Surgery which would likely be removal of her bladder is quite extensive and will require a urinary diversion with urine collecting in a bag. Patients do well but this obviously will impact on her quality of life. Radiation therapy which is often combined with chemotherapy is also quite intensive and is associated with significant side effects. I suggest you have your grandmother consult with a urologist or medical oncologist who has significant experience in managing complicated patients with this disease. Unfortunately there is no easy solution and any choice has significant risks that must be considered. She also will need a full evaluation to assess the stage of the disease to insure it has not spread to other parts of her body.
Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University