Questions about cancer.

[RobertaFirmino]

I have a few questions about cancer, if anyone could help please.

MIL collapsed on Thur eve, waited 4 hrs for ambulance and was in A&E for over 24 hrs. Had CT scan on Fri night, was told Sat am that she had multiple fractures in her hip. Unfortunately, they also discovered a mass on a lung which they believe to be metastatic cancer. They won't be certain until she's had a PET (?) scan.

She had endometrial cancer 2 yrs ago. Had a hysterectomy and radiotherapy and was given the all clear. One question I have is this: Why do they believe the mass to be metastatic? Does this mean she has cancer somewhere else? Or is it possible that there were some left over cells from last time?

She is 84 btw. Morbidly obese, has a pacemaker, oedema in her legs, pre-diabetic, could barely walk pre-collapse. They have already said that they won't replace her hip or otherwise operate due to all this. How would they treat her cancer, assuming that is what this mass is? Would they even treat it do you think, or would they go straight to palliative?

I know nothing is certain but please don't sugar coat anything. I am a practical person and would prefer to be prepared. Thanks for reading!

I'm sorry to hear about your MiL.

My understanding is that the cancerous cells will not look like lung cancer cells, but will look more like the cells of the part of the body where the cancer began. So they may be leftover cells from before, or another body part entirely. They don't always find the origin.

As for treatment - I'm not sure they will be able to offer much if they are not going to operate.

It'll be the appearance e.g. lots of small masses rather than one big one.

Thank you @mycoffeecup and @AndIKnewYouMeantIt so it's all in the appearance then.

I expect the best thing to do wrt DH is prepare him for palliative only.

So sorry to hear about MIL.
I would privately prepare for the worst. My DSis lost her best friend to metastatic endometrial cancer during the pandemic. Hers had spread before she was diagnosed with the primary. Her pelvis and hips were riddled and no treatment was possible. She had been fit and well ( age 53) and had problems just before the pandemic started. Biopsies didn’t show anything. She survived 6mnths and died “peacefully” at home six months after diagnosis.
I think you need to wait until all the results are in. It will be a shock to the family but hopefully they will accept any medical decisions. End of life care is generally good. However it depends on the patient and the family. I lost my mum to cancer, she was an HCP and planned it all with the oncology staff. We all understood that she wasn’t going to go all out for a miracle cure and we had to promise not to intervene. Not all families think this way and will insist on invasive treatments to try and extend life because they are not ready to lose the family member.
Having recently gone through the cancer journey myself I’m not ready to throw in the towel so would be open to anything going. When I get to 80, if I get to 80 I will have very different outlook.
If your MIL is able to understand and make informed decisions then you will have to roll with it, but it does sound like she has some complex medical needs. The oncology staff will be very frank with her but often elderly patients struggle understanding the whole concept. My husbands grandmother had breast cancer in her 60s and had a mastectomy. When it recurred in her 80s and had spread to her lungs she couldn’t understand why they couldn’t just remove it like they had her breast.
Be prepared for every type of reaction from your MIL and the rest of the family.

Sorry to hear that, RobertaFirmino. It might be that they think it's more likely to be metastatic given her endometrial cancer history. I don't know whether they would biopsy the lung mass to establish this for sure - perhaps something to ask. The PET wouldn't distinguish between cancer types, as I understand it, but would show cancerous tumours - or sometimes inflammation - as 'hot spots'.

Re treatment - you can still have palliative treatment, even if the cancer is metastatic. Many metastatic cancers are deemed incurable but treatable. It's just that the treatment intent is not to cure, but to control the cancer for as long as possible - shrink the tumour/delay the development of others, as well as relieving any symptoms. They may offer systemic therapies like chemotherapy, but there are other newer ones too such as immunotherapy, targeted therapy - depends on the cancer type, but also on the physical fitness of your MIL and whether she would be strong enough for them. She/you will know more after speaking to the consultant after the PET scan and any other scans/testing they need to do. I just wanted to say that 'palliative' doesn't necessarily mean 'no treatment available'; there may well be, and I hope that that is the case for her and you all.

All the best to you. It's a very worrying time, I know.

Whilst advanced cancers can be treated but usually not cured and can control cancer for a long time I’m afraid that at 84 with significant other health issues I think it would be reasonable to assume they’ll be reluctant to do too much as she may well not be strong enough to withstand treatments. Im sorry to hear the news