3 years 8 months ago - 3 years 8 months ago#52607by Cynthia
I am sorry you have to be here but welcome to our community. Dealing with blc in the elderly should almost be a specialty of its own, adding the complications with age in your Mother'sgt case seems to be the start of memory problems. A honest conversation with her doctors about the options and thier ramifications are in order here. Some of the questions I would ask if I were in your situations would be.
If she does not wish to have surgery or chemotheropy are there other treatment options?
Would surgery without chemotheropy be of benefit? What are probability that a Radical Cystectomy without chemotheropy could be curative?
Would a schedule of surveillance with tumor removal and BCG if needed benefit her potentially?
If she chooses not to have further treatment what is the prognosis and possible timeline?
If she has a Radical Cystectomy and her memory problems increase would she need full time help?
If she decides to not pursue further treatment what steps can be taken to give her the best quality of life?
If she decides to not pursue further treatment would she be a good candidate for hospice care and if she what would the time table be to start.
The truth of the matter is there are no good answers some times we can only do the best we can while keeping in mind what her wishes are. If she is able to have the conversation after you have looked at all your options talking about what she wants would be of the most compfort to both of you. If you have to make the decisions you may already know what her wishes are. The bottom line is that the right answer is the one that is made with her best interest made in a holistic way.
I know this is probably things you have already thought of and of little help. We have seen families in singular situations over the year and it has not been easy for any of them no matter what the choices they make are. All I can offer is the fact we will be here to support your family if you need us.
T2 g3 CIS 8/04
Chemotherapy & Radiation 10/04-12/04
RC w/umbilical Indiana pouch 5/06
Left Nephrectomy 1/09
President American Bladder Cancer Society
My Mom awoke one early morning (the day after Thanksgiving 2016) to use the restroom to urinate with no pain but looked into the toilet and say all blood! She had a stone and UTI a year and a half ago before that went sepsis. She was very sick but came through. At that time the bladder was scanned and no tumors.
This recent event had another scan and a large tumor was found. Before Christmas, she had surgery to remove the tumor. We were told "we had to dig deep into the muscle to get it out - the size of her fist!). The Pathology report came back that said it was "Muscle Invasive Bladder cancer T2B". Her Urologist suggested we see a surgeon and have the bladder removed. The surgeon did a scope (I saw the screen) and it showed on the right side yellow and white cotton like tumor that he said is what was left from surgery. He said "Ideally, we would do chemo/radiation, then remove the bladder and Uterus. 5 hr operation, two week stay in Hospital then Rehab for a few more weeks." He said "You look pretty good for an 85 year old, I think you could do well through the surgery". "Could"??
Well my Mom survived breast cancer (Mastectomy) 15 years ago and vowed NEVER to do chemo again as she had a VERY difficult time with it. She was only 69 then. When the Dr suggested this, she said NO CHEMO for me. That evening we had dinner and she couldn't recall what the doctor said and when I explained, she said no chemo, "I rather just die".
Everything I read basically says with Muscle invasive bladder cancer, you must do the chemo if you are considering the cystectomy.
Her mind is beginning to go as she asks me a lot what is wrong with her. "Is it my breast that has a problem?".
My dilemma is this - Currently she has no signs of cancer from a pain point of view and clear urine. She said to the Surgeon "How could I have cancer if I feel this good?". Do I want to take a chance w/o chemo? Do I put her through a 5 hr operation of MAJOR surgery? Do I confine her to the hospitals for months? What if she gets an infection? and finally, can she really manage caring for the bag? I hear that it is very difficult at late age to care for that bag and stoma without getting infections.
As her son and health advocate, I am leaning toward taking her to Florida for a week to enjoy the weather and then have her Geriatric Physician manage her Palliative care. I talk to her every day and see her at least 3 days a week. I am also financially able to provide nursing when needed. I was curious if anyone had a similar situation? Any honest comments are appreciated.