bone lesion treatment plan distress

16 years 2 months ago #12610 by mssmr
Replied by mssmr on topic bone lesion treatment plan distress
Thank you, Julie, for your helpful, detailed and compassionate reply. I understand now the past tense. After I finish with the forum, I'm going to write up questions to ask my dr. later today. As long as I get up the courage to ask, he seems to give pretty direct answers. Of course, sometimes, I don't like what I'm hearing.

I'll be thinkiong about you and your husband, too -- Susan

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16 years 2 months ago #12592 by Julie
Replied by Julie on topic bone lesion treatment plan distress

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16 years 2 months ago #12564 by wendy
Replied by wendy on topic bone lesion treatment plan distress

Dear Susan and other warriors on this thread,

There are a couple of good studies done on surgical removal of small volume mets increasing survival, both referenced in the side bar here:http://blcwebcafe.org/metatcc.asp

It's something to bring up. I think response to chemo was a pre-requisite. I have a copy of the Japanese artilce from '07, if you want it, let me know and I'll email you.

Yes, it was not nice that the forum was down!Perhaps I should start a thread= once we find out what the problem actually was. It was taking so long to fix we just switched servers instead!

Take care,
Wendy

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16 years 2 months ago #12563 by wendy
Replied by wendy on topic bone lesion treatment plan distress

Dear Holly,

I am puzzled as well. It could be that the mets are not big enough to judge which treatment might be best. Maybe radiation at this point would do collateral damage without enough benefit to outweigh the risk?

Here are some of the issues on treating mets (from the article on WebCafe);
Will further treatments improve my quality of life?
Will benefits outweigh risk and discomfort?
Will further treatments add to survival?
What feels most comfortable to me?
Do I feel I can manage the side effects of each treatment option? What kind of support will I have from family or friends? Outside agencies?

Many studies cite the addition of 2-3 months to a person's life as justification enough for aggressive chemotherapy. Ask your doctor how many patients he's treated with the same therapy and how the patients did. Palliation of symptoms alone is still a valid goal in metastatic cancer.

Because the needs of metastatic patients are highly individual and many of the treatments are still experimental, there are no standard guidelines available to either the patient or the doctor. In some cases the decision is determined by whose opinion you seek — a surgeon will recommend surgery, an oncologist chemotherapy or a radiation oncologist radiation therapy. Often, the patient and family must decide on the course of treatment. .
<snip>
Bone Metastasis
Aside from causing pain in up to 70% of people afflicted, the most serious implication of bone metastasis is that they increase the possibility of "pathological fractures", so named because they are due to problems within the bone itself rather than to external factors.

Metastatic bone lesions can be described as osteolytic, osteoblastic and mixed. The osteolytic lesions are most common where the destructive processes outstrip the laying down of new bone. Osteoblastic lesions result from new bone growth that is stimulated by the tumor. Microscopically, most lesions are mixed.

Treatment for bone metastasis is normally palliative. An assessment of the risk of pathological fracture must be made by an experienced orthopaedic surgeon. Lesions that do not represent a risk for fracture may be treated with radiation or by appropriate chemotherapy directed at the tumor.

Where a weight-bearing bone, such as the leg is involved, your doctor may suggest an operation to support the bone and prevent a break. This procedure will involve reinforcing the bone with internal splints and may help relieve pain and prevent a break. The goals of surgery are to preserve stability and function of the musculoskeletal system as well as alleviate pain.

The ribs, pelvis and spine are usually first affected. Pain, which resembles ordinary low back pain or a disease such as arthritis, is usually the first sign. Standing up on the bone may compress it, causing more pain than when lying down.

Another risk from bone metastasis is hypercalcemia (a higher concentration of calcium compounds in the bloodstreatm). This condition can cause a number of symptoms, including dehydration, loss of appetite, nausea, thirst, fatigue, muscle weakness, kidney problems, restlessness, confusion and even death.

For an article with everything you wish you never needed to know about bone metastases: www.emedicine.com/radio/topic88.htm#section~mri

Zometa for bone metastases/hypercalcemia
Bisphosphonates work by slowing down the actions of bone cells.
Bisphosphonates (clodronate, pamidronate, aredia, zometa), a family of drugs used to treat osteoporosis and the bone pain caused by some types of cancer, have been investigated in large trials for breast and prostate cancer with good results at relieving bone pain and perhaps even slowing destructive processes.

Zometa, the youngest and easiest to use of the bisphosphonates, was first approved for the treatment of hypercalecemia. In February, 2002, The FDA approved Zometa (Zoledronic Acid) for patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy. The trials that led to the approval of Zometa mark the first time any bisphosphonate has demonstrated efficacy in treating bone complications in patients with prostate cancer, lung cancer and other solid tumors (including bladder tumors). see; www.zometa.com/index.html

One potential potential side effect of Zometa included kidney damage, which can also occur with other bisphosphonates.

blcwebcafe.org/metatcc.asp

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16 years 2 months ago #12556 by mssmr
Replied by mssmr on topic bone lesion treatment plan distress
Dear Julie - When you say "had" do you mean that he no longer has the lung tumor? Was it removed surgically or otherwise treated? I ask, because of my confusion about
not giving him chemotherapy if there IS a measurable tumor....

I am so sorry he is having new pain and I hope for the best with his upcoming tests.

I have an extended appointment tomorrow with my medical oncologist and am determined to ask as many direct questions about treating metastatic bladder cancer as I can! As I believe I mentioned before on the forum, one concern I have is that none of the presumed "mets" that have shown up in imaging have been biopsied so that
there really isn't confirmation that they are, indeed, spread of my bladder cancer or even malignant. (Both of my parents had lung cnacer when they died, I wonder if I have a second primary, for one thing.) I imagine that there is a good chance that they are metastatic -- but I wonder why my team doesn't think we should investigate that. For one thing, it makes it hard to fill out questionnaires for clinical trials.

Maybe if some of you send me questions, I can ask those, too. It seems we all wonder what the "gold standard" might be for treating metastatic bladder cancer -- or at least if there is anything like consensus on high quality treatment given specific manifestations of spreading.

The message I am putting together indirectly is that oncological teams
do not want to "go for a cure" unless there is not only full removal
of the bladder tumor and either no mets or an isolated met that seems
fully to respond to treatment (surgery, radition, chemotherapy).
Given multisite spread, we are opposed in our quest for aggressive
treatment to remove/control as many mets as possible and expected to
be satisfied with supportive care in response to pain and other distress.
I wonder what would be the "cost" (penalty or punishment) to the oncological team for trying to cure someone, me for example, and failing to do so? I hope it wouldn't be just a hit to ego. I also wonder where the "standards" I think I am discerning are coming from and hoping it is not the insurance industry....I know there are government treatment tables....are there accreditation or certification penalties for trying harder then they suggest?

Incidentally, I am SO happy and relieved that the forum is back after its brief hiatus (that didn't seem brief). I missed you all -- my best, Susan (mssmr)

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16 years 2 months ago #12520 by Julie
Replied by Julie on topic bone lesion treatment plan distress
Treatment of metastatic Bladder Cancer sure is puzzling. I don't know why some people get chemo and others are told we will scan you frequently. My husband had a lung tumor that metastasized from his bladder cancer and at present there are no other sites so the oncologist said no chemo as there is no way to measure success without a tumor. Now Dick is complaining of pain in his ribs so more scans are scheduled for next week including a bone scan. What we don't know is if there is evidence of another metastasis will any treatment be recommended. I feel you and we are hanging out here to dry.


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