83 yr old friend with anal cancer and deposit in lung

Hi Pembroke welcome to the group and I am so sorry to hear of your friend's diagnosis. To provide you with more information do you know what the staging of the anal cancer is? You say that the original plan was to be  offered chemoradiation. Has this  plan changed? Usually the gold standard of treatment for anal cancer is  a one off short infusion of mitomycin administered intravenously on day one of treatment, followed by 8 tablets of capecitabine a day for 5.5 weeks, Monday to Friday. Radiotherapy is also administered daily Monday-Friday Monday-Friday. As you have said there is a secondary in his lungs, so has the treatment plan altered? Bev 

Yes, he was due to start chemoradiation but when the result of lung biopsy came through it showed a metastasis.

Now being offered only 5 fractions of radiotherapy to treat ‘symptoms.

He was a stage 3 on initial diagnosis.

Would appreciate your thoughts. He will see our local oncologist at the end of April and wonder if he would be offered chemo

Thank you

Hi Pembroke  as I understand matters, if there are secondaries to the lung a different form of chemo would be offered (maybe in addition to the usual chemoradiation treatment for anal cancer). Have you accompanied him to any appointments? I'm just wondering what explanation has been provided for the change in plan. Bev 

Hi Bev  He has a small secondary from the anal cancer in his lung.

We live in the islands and had a call from U.K. oncologist saying this was the change of plan. The Dr had only just got the results so I suspect not yet discussed at MDT. To be honest we were both shocked at the time at diagnosis and prognosis.

My feeling is could he not have original treatment which is ‘only’ 6 weeks and later chemo for the lung,; but perhaps it’s age related and they feel he would find the treatment hard to tolerate.

Thanks, Pembroke

Hi Pembroke  I'm assuming that you mean one week of radiotherapy to the pelvic area. If so, then I suspect this will be for the purposes of obtaining some reduction in size of the primary  tumour, whilst treatment begins for the  secondary cancer in the lung. As I understand matters, the types of drugs used in the chemotherapy offered for anal cancer and for a metastasis of the A/C to the lung are entirely different.   I'm not sure why, as you say, he would potentially have the secondary in the lung treated first.  I also think you may be right in that a final decision as to your friend's treatment plan at the MDT has not yet been made.    After the conversation with regard to diagnosis and prognosis have occurred, there all sorts of questions that pop up, it's not possible to digest what you have just been told and think of everything you want to ask all during that conversation. I wonder if your friend or yourself with his permission could contact the UK Oncologist's secretary and ask if you could have a further T/C to address these issues? Alternatively, if your friend has been assigned a colorectal nurse he/she could be contacted to provide an explanation. Bev. 

Thank you Bev... I’m sure you are right and decisions will be made at Tues’s MDT meeting. For now all we were told was a short course of radiation to treat symptoms of which he has few and then ‘let him draw breath’. The next appt with the local oncologist is in 5 weeks time so I feel that a conversation needs to be had sooner as to what the future might hold. My friend is still ‘shell shocked’ as a ‘cure’ had been mentioned at one stage.

Your idea of composing a list of questions is what I had thought we might do but I hadn’t thought of speaking to the specialist colorectal nurse in Southampton so I will contact her on my friends behalf tomorrow ( as agreed with him).

This is such a difficult time for him and it’s already been 3 months since diagnosis and a long period of anxiety not helped by mixed messages.

Very grateful for your advice... Thankyou!

Pembroke

Hi Pembroke your friend is very fortunate to have you looking out for him. Most people find the time before you have a definite treatment plan in place the most difficult and anxious time of all. I hope you get some answers tomorrow. Please do come back on with any other queries or concerns. Bev