Dad has Stage 4 Sigmoid Colon T4b N0 M1 Cancer

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It's been a bit of a rollercoaster.

My parents live half-way across the world, in a lovely sunny, warm place and a carefree lifestyle. Until it comes to medical support - the protocols, in theory, are the same as the UK. In practice, they are anything but and it's slow and painful going with the medical expert considered (by themselves!) God and the individual having no voice or say in their assessments or treatments. 

So, a month ago, my Dad non-chalantly says to me 'I have a problem passing stools'. He's 81 y.o. So, I say, get yourself to a GI specialist and get a scan ASAP. So, off he goes to do so, and my Mother says to me 'I've been telling him to do it for over 6 months!'. Yikes. 

The Gastroenterologist (GE) says that there 's a set protocol for assessment emetic+enema to clear the gut, then a colonscopy, then a biopsy (in vivo) and then advice on treatment. The problem is that the first sets of emetics (PEG) do not work. So, he repeats it. Nope, not working. Then he prescribes Milk of Magnesia in increased dosage and frequency of use. My Dad starts throwing up violently and cannot walk or talk with weakness. My brother refuses to send him to the GE again. And my Dad, when he can speak after 24 hours, says 'I'll wait for you'.
Which does it! I'm on the next available flight out (this being before Christmas, it's very difficult). 

I get half-way across the world... and it seems every medical professional repeats the protocol. I've done a bit of research on recommended surgeons and there's one who used to work in the NHS (albeit a while ago) and who seems to be a renegade. So, I chose him. And things move so quickly that I accompany Dad on his first consult on 16 Dec and he goes in to surgery (colectomy and anastomosis, with ablation of the liver metastasis) on the 19 Dec. The tumour has been sent for a biopsy (Results due: 27 Dec) and my Dad has just come out of the ICU today!

We're hoping for good news overall. Crossing fingers and toes, and praying for the best news possible. 
Appreciate your thoughts and messages. 

  • Hi  

    I get the sense your dad is a robust man in many ways .! 
    A big welcome to the forum and well done to your dad . He has done incredibly well . However I am very impressed with how you navigated that to get your dad to the correct surgeon in a timely manner . That is a game changer in so many ways and very impressive how you went about that .

    Great they were able to ablate the liver met too and resect the tumour . That has put your dad in a great position going forward .

    My mum is 14 years into a stage 4 diagnosis and just completed 10 months on a targeted treatment. She is the same age as your dad and made of strong stuff .

    Look forward to hearing how he is getting on .

    Take care of yourself too . Warm weather sounds wonderful though !

    Court 

    Helpline Number 0808 808 0000

  • Thanks so much Court. 

    You're right - Daddy is a very active and positive individual. He always has been - he says he's in the hands of the Doctors' and, ultimately, God. He is the best Dad and everyone I know loves him for being gentle, non-judgemental, respectful of everyone he meets and happy to help those in need. I'm not saying this because he's my Dad. He has his flaws - for not taking care of himself and not speaking up for himself. So, I have used my Tiger Mum mode with him Stuck out tongue. And it seems he actually wants me to lead the situation. Bless him. 

    Your Mum and her stage 4 diagnosis gives me hope. 'Stage 4 Cancer' sounds scary as a term. I know the biopsy results are key and the waiting is never easy, is it? It's always the unknown and us wanting to have some bit of control on this. 

    I am in a place that is a beach holiday destination - I'm unlikely to see the sand, sea, sangria, etc. I just about see the sun when I leave the room where Dad and I are staying in the hospital. 
    My Mum has Parkinson's and TIAs - I witnessed one just before Daddy was admitted. She's on her own at home ATM. So there the inevitable worry that she's okay. We need to get full-time, in-home care/help... as I have to fly back before the school break ends. My husband is holding fort at home, with his parents visiting us as always over the 2/3 week Christmas break.

  • Just asked you how you were doing on the other thread but that’s a lot you have on your plate . Hope you get home safely when the time comes . 

    Your dad has a great attitude and sounds as though he has more to give .

    It did take me years to get over the term “stage4 “ to be honest but now we don’t give it a second thought . My mum describes it as a “ wee bit cancer “ with a shake of her hand .

    Certainly the cancer growth has slowed down considerably as she has aged .

    It is not easy getting care packages together . We only had a few weeks of it before my dad passed but although the ladies were lovely they would come at random times as their schedule allowed . Still he enjoyed them and gave us and mum some help .

    Hope you are not too busy with your visitors . I have a full house on Christmas Eve and Christmas Day . Think I will need to get some energy drinks in . 
    take care ,

    Court 

    Helpline Number 0808 808 0000

  • I've got this image of your Mum being a no nonsense Scottish woman who paves her own way! Go Mam!

    Yes, post-op support is always a bit challenging. I'm not au fait with the way things work here, so that another barrier. Then again, it seems it might work to my advantage, as I can continue to look outside the box and not be restricted by local / cultural set thinking. Off to see the Doctor (First Day out of ICU) for the daily check ...

  • .. and just like that we were called to see the Doctors yesterday. We were unsuspecting as we'd been told the biopsy results were due on the 27 December.

    Well, they've come in. I have the report here with me, but the Lead Doctor basically said he recommends that for a quality of life my Dad just goes home and enjoys life. i.e.: best NOT to consider further treatment as on balance it will affect the quality of life. I asked what progression will look like and he said the metastases will cover the liver, likely over the next 5 years, leading to jaundice, then a coma. Death was gentle.

    Daddy and I both were prepared for the worst, but hoping for the best. I'm not sure the information has actually sunk in / been processed. As all I can think of is how we will break the news to Mummy.

    The Report says: 

    Specimen:...

    1. 'Sigmoid colectomy.. of large ulceroproliferative growth ..in lumen... infiltrating pericolic fat 

    2. Liver Met deposit - single, friable whitish tan tissue 1.2 cms

    Microscopic:

    1. tumour.. moderately differntiated invassive adenocarcinoma. Dense lymphocytic inflammatory response to tumour is seen.

    The tumour is seen infliltrating muscularis propia and pericolorectal fibrofatty tissue.

    Lymphovascular invasion is seen.

    Perineural invasion not seen.

    Tumor budding - intermediate score = 5-6 tumour buds/hot spot.

    No tumor deposits seen. Mild serositis is seen. Mesocolon shows congestion. 

    Proximal, distal, and radial margins of resection are free of tumor.

    No polyps / additional features such as dysplasia / IBD / ulcertaion seen in the rest of colon.

    Regional lymph nodes dissected show tumor metastases in 3 out of 6 nodes dissected.

    2. Liver deposit biopsy - shows necrosed hepatic tissue infiltrated by metastatic moderately differentiated adenocarcinoma.

    Impression:

    1. Moderately Differentiated Invasive Adenocarcinoma

    Pathological Stage Classificiation: pT3N1bL1V1

    2. Liver Biopsy - Metastatic moderately differentiared adenocarcinoma, primary colon.

    So, my question is has anyone been here? We're happy to NOT have further treatment (after all we all have to go some day) BUT we'd like to assess viable options that provide a quality of life and longevity of life.

    (I'll share this on the diagnosis forum as well)

  • That would be a similar presentation of my mum’s cell type and spread .

    I think they work on the bases that microdisease might be present in the liver but to be honest some people have only one solitary met and walk away from it at this stage . You just never know . 

    Hope you get a flight home soon . The wind has picked up now here . A rather dreary day here .

    Take care ,

    Court 

    Helpline Number 0808 808 0000