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Cancer Causing Pain in Tailbone |
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Question:
My wife was diagnosed with lung cancer, non-small-cell
adenocarcinoma. It was a relatively large (I think about 7CM) tumor in
the upper left lobe. Lots of CT scans, PET scan, MRIs showed no known
metastasis, so they did a lobectomy, followed by six weeks of daily
radiation
(M-F) and weekly chemo (carboplatin (I think) and taxol.
Well, she started having pain in her butt area that was so bad we had to
go back in to MD Anderson before her six-week post rad/chemo
follow-up appointment.
Turns out she has a 4CM or larger secondary tumor in the tailbone
area. The location, close to or intertwined with nerves and bone,
made surgery not an option. Later MRI showed another 1CM
tumor near her kidney. She had ten radiation treatments to try
to shrink the larger tumor (before small one was discovered),
ending 11 days ago; her pain level is still quite high, though.
On to the questions:
1) based on your experience (Steph and Michael and anyone
else with experience) is the nine months in line with what you've
seen?
2) I'm concerned about this tailbone tumor having grown so
fast (from undetectable to 4 or 5CM; 2+ doublings?) in five
months, with chemo during a chunk of that time. Are there
going to be chemotherapy drugs that have the ability to slow
down growth of her cancer, or are we sacrificing quality of
life for no gain? I've heard that taxotere is similar to taxol,
and that it might be a poor choice -- true? Any other
considerations?
Answer:
1. Check acor.org, and their specific non-small cell lung cancer group.
2. No can predict survival. One can estimate knowing there is a fair gap each
way.
3. Follow the work with epidermal growth factor inhibitors, Iressa, etc. though
it is not clear that they are better than the current treatment you are
receiving.
4. Celebrex and similar drugs can relieve pain and there is good evidence that
cox-2 inhibitors can play a role in frustrating the cancer process.
Although the doctors could see no evidence of the cancer in other parts of
your wife's body at the time of diagnosis a 7cm tumour is very large and
must have been there for some considerable time so the chances of matastasis
would have been great. The fact that it has spread makes the chance of cure
very unlikely and any treatment given would likely be for symptom control
only. At this stage you need the help of a palliative care team who will
have wide experience in symptom control.
I am no oncologist but I would
imagine treatment options other than palliation are very
limited.Radiotherapy to shrink localised tumours are probably the best bet
for her immediate pain control together with steroids, NSAIDs (naprosyn,
indocid, voltaren etc are probably more effective for pain control than the
newer celebrex type anti-inflammatories) and morphine type drugs until the
pain level is reduced. Referral for palliative care would be my most
important recommendation right now; this does not compromise treatment
options by the oncologist.
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