The Story of Mom’s Lung-Brain-Bone Cancer

This is the story of a 66-year-old lady who had lung cancer. The cancer has spread to her lymph nodes, bones and brain.

This is what her daughter wrote about her mom.

Mom who cooked and ate meat, dairy, eggs, honey, garlic and onion as part of her diet since young, became a vegan since 3 years ago when she started to follow Master Ching Hai’s teachings.

Mom had high blood pressure for about a decade now. She used to take medicine to control her blood pressure but has since stopped taking it about 6 months now. Mom is a non-smoker.

Since June 2013, mom started to complain about being tired and she slept a lot. She felt no mood or lazy to do housework. We thought all these were due to aging. She also tended to forget things, like misplacing items.

Sometime in early August 2013, she lost her balance and fell. Mom declined to see the doctor.

Mom started to look very tired. She also had a hard time formulated her speech and stammered. She started to take vitamin B12 pills in the hope of improving her condition. We all thought she might suffer from vitamin B12 deficiency being a vegan. Mom wanted to monitor for 2 weeks before seeing a doctor.

Walking extremely slow, one step at a time, and very tired, we brought mom to see a GP. The doctor advised blood test together with a CT scan at a hospital. The doctor suspected a minor stroke.

Mom Had Cancer

We brought mom to a university hospital. Her CEA was more than 1,000. She was referred to an oncologist who suspected mom had cancer. He prescribed mom Dexamathasone, to reduce swelling of the brain and Omezole – to take care of the side effects of the steroid medication.

CT/PET scan on 3 September 2013, confirmed that mom has Stage 4 lung cancer. The cancer had spread to her brain, mediastinal nodes and bones. The next day, she did a biopsy. The tissue was positive to EGFR.

Radiotherapy and Iressa

From 11 to 23 September 2013, mom had 8 session of radiation treatment to her brain. From 21 September to 11  November 2013 (about 7 weeks) she took Iressa.

Deceptive Positive Results

A second  MRI and PET scan was done on 13 November 2013. The results were great! Mom’s brain metastases reduced tremendously. Also the lesions in her lungs shrunk.

However, liver function test taken on 11 November 2013, indicated liver damage.

Mom had to stop Iressa.

Another blood test on 9 December (i.e. 3 weeks after stopping Iressa), indicated liver got better. Mom started to take Iressa again. This time, a table on alternate days. But in January 2014, mom started to take Iressa daily.

More of Deceptive Positive Results

During the Chinese New Year (February 2014) mom started to lose her voice. A third MRI/PET/CT scan was done on done. The results were:

• The oncologist was pleased with the MRI result. The oncologist mentioned that in September 2013 MRI there were about 50 lesions in her pain. In this February 2014 MRI showed less than 10 lesions. The oncologist said when he first saw mom’s MRI, he did not think mom was going to make it.
• However, the PET scan results showed a different story. In the September 2013 PET scan it was a nice result with much reduced lesions (almost not seen). But for this February 2014 PET scan results, some lesions had recurred near her right neck (near vocal chords — therefore loss of voice?).
• The oncologist mentioned that he was very worried, “it looks like the cancer cells got smarter and tried to overcome the Iressa.” Mom was asked to continue with her Iressa.
• The oncologist, however, suggested a few options:

1. Start chemotherapy on day 1 and day 8, then rest for 3 weeks. In addition, mom take another oral drug, Tarceva or Afatinib (which was recently approved and is now available for free). We told the oncologist that we preferred not to do chemotherapy. As such the oncologists suggested the following options.

2. Start radiotherapy to the body in addition to taking another type of oral drug similar to Iressa.

3. Take only Tarceva or Afatinib without chemotherapy. But the oncologist said this was not a viable option.

• For  mom’s voice issue, we brought mom to see an ENT specialist. Endoscopy to the nose/throat showed the left vocal cord was not moving (paralysed?) but the right one was doing fine. The ENT specialist said the problem could be due to the cancer. There is no medicine that he could prescribe for mom.

March 2014 — Iressa failed, switched to Tarceva 

• Blood test on 5 March 2014, showed the tumor markers were slightly higher. The oncologist said he was worried that the cancer cells were growing and spreading. He suggested chemotherapy. He said he would give mom a lower dosage, perhaps 80 percent strength instead of the normal 100 percent strength. However there will be side effects such as low white blood cell count but the doctor said this can be countered by taking medicines. He also mentioned that patients can get better after going through the “weak” phase.
• As we were reluctant to undergo chemo, the oncologist suggested radiation treatment to the neck and the left side of the lung. This treatment cost RM 9,100. Mom received 10 sessions of radiation.
• The oncologist switched mom to Tarceva since Iressa doesn’t seem to be effective anymore. Tarceva cost RM 8,000 per month while Iressa cost RM 7,000 per month.
• On 24 March 2014, mom received her fist xGeva (denosumab)  injection to protect her bones. This cost RM1,600 per shot and mom is supposed to have it every month.
• 28 March 2014, mom started to lose her appetite.

April 2014 — 9 months Later 

• Blood test on 7 April 2014 showed mom’s calcium level had gone down a little due the previous xGeva injection. She was prescribed medicine to bring up mom’s calcium level.
• Mom was having frequent bowel movements. The oncologist said this might be due to the side effect of Tarceva, which causes minor diarrhoea.
• Mom still had coughs and still choked when drinking fluid. The throat was dry and her voice hoarse. Her appetite was poor.
• At this point, we discussed chemotherapy with the oncologist.

1. What after one session, we decided to stop the treatment. Any side effect / problem?

Oncologist: Of course we can stop at anytime, no problem.

2. How does the treatment work in terms of session, timing and rest period?

Oncologist: Do chemo on day 1 and 8 and this is considered as one cycle. Do 3 cycles first.

3. Drugs to use?

Oncologist: Two options. One, Carboplatin + Alimta which is more expensive, costing around RM 8,000 per cycle. Two, Carboplatin + Gemcitabine which cost about RM 1,000 per cycle. This option is much easier on patients but may be less effective (?). It it would be Carboplatin + Gemcintabine, the oncologist suggested that mom go for 4 to 6 cycles.

May 2014 — Tarceva Failed 

• 5 May 2014, we told the oncologist about mom’s side effects. The oncologist recommended to stop Tarceva for 4 days and we were asked to come and see him again after that. He prescribed medications for insomnia, itchiness, and inflammation.
• 9 May 2014, after 4 days not taking Tarceva, mom got much better. Acnes on scalp were drying up and there were not more rashes. But there seemed to be a new growth at mom’s neck. Oncologist asked mom to take Tarceva again but on alternate day.
• MRI on 19 May 2014, showed disease progression. There were about 7 tumours.
• PET/CT scan on 21 May 2014, showed disease progression:

1. Lymph node at the neck has enlarged.

2. Few new lesions at T9. 

The Final War Plan 

The oncologist laid out the following options.

1. Tackle the brain first – and fast! He recommended that mom go for Cyberknife and then followed up with chemotherapy. After that mom continue taking the oral drug again after 4 months. If mom’s backache persist then we need to give radiation to that location.
2. The oncologist also explained that giving mom whole brain radiation again would cause more side effects (e.g. sleepy, headaches) and only low radiation dosage could be give. If mom’s goes for Cyberknife she shouldn’t have such side effects because Cyberknife is more targeted.
3. Cyberknife cost RM 67,000.
4. Another option is to go for chemotherapy first. Do MRI after 1 or 2 months and if the tumour is shown to be growing very fast then go for Cyberknife.
5. The oncologist assured us the mom would be able to tolerate chemotherapy. The only thing we need to really watch out is the white blood cell count.
6. Mom will have to continue with her monthly xGeva injection to strengthen her bone.

One Final but Most Important Question

Can all these treatment cure mom?

The answer is: No cure. There is no guarantee that the cancer will not recur even after Cyberknife. 

CA Care – the Last Resort, 23 May 2014 

Patient came to seek our help and was prescribed herbs. On 8 June 2014, patient and her husband and daughter came to CA Care Penang and underwent the e-Therapy for her pains.

Comments

As I was about to upload this story, I received an email from Singapore. This is what it says.

Dear Mr Teo, 

My husband, age 61 was diagnosed with lung cancer 2 years ago. He was on Iressa since last year September 2013. Two months ago the oncology asked him to start chemo as he has developed tightness in the chest. We decline. So we just have to carry on with Iressa. Two weeks ago he developed bloatedness  in the stomach with  wind and fluid. Again oncologist scheduled him for chemo this coming Monday. Currently he feels  very fatigue and is too weak to go for chemo cause he lose a lot a weight. 

We are not in favour of chemo because in year 2012 he had gone through that already and we find it is too damaging to the lung and show no result because 10 months later lung had fluid. 

It is indeed sad.

Don’t those who are supposed to know, know that Iressa does not cure any cancer? And chemo does not cure lung cancer either? Click this link: https://cancercaremalaysia.com/category/lung-cancer/ and you will see that I have written no less than 70 stories about lung cancer and chemotherapy / Iressa / Tarceva, etc.

Can we not learn something from these stories? 

More stories about this patient:

Lung-Bone-Brain Cancer: Pain Gone After 4 Days of e-Therapy

Pain Recurred After Eating Rojak