What to expect in the last stages

Hello there

My brother, age 68 who never smoked, no alcohol is diagnosed with multiple liver metastases ( two small and one big spot on his liver) covering spleen but not infected, as per CT scan report his kidneys, lungs, bladder, prostate and all other organs are free and normal, doctor requested a biopsy and waiting for the results

Someone please share their experience and show me the next step forward, all of us are shaken and traumatized

Really need help

mjones2108 said:

I have reached stage iv-a in my liver cancer as it has metastisized to my lymphs, that is as of a little over 2 mos. ago. I have multiple tumors in my liver that are unresectable, they are too large, and they are also invading my portal vein causing a tumor thrombus. I found out this information approximately 8 mos. ago and was not expected to live this long, especially without treatment. Since I have decided on my own to not take the chemo, nexavar, which is the current standard, some doctors disagree, and yet some agree with my decision. Also, I am trying not to take pain medications unless absolutely necessary, though I have them available. I can assure you that without pain control, sometimes it is very painful, but the pain medications cause constipation which increases my abdominal pain, even with stool softeners. I have intense pain in my right shoulder and the right side of my neck, as well as my abdomen. I have tried some alternative therapies to try and alleviate some of my symptoms, but I don't feel that I am winning this war. I am slowing going downhill. The pain attacks ended after a few days at first, now they last longer and come more often. Due to the tumor thrombus, it is possible that I may die suddenly due to esophogeal bleeding from portal hypertension caused by the blockage in the portal vein. I may also die suddenly if a tumor ruptures, if the thrombus ruptures, or if the capsule of the liver ruptures from internal pressure. These first methods of death would be due to loss of blood and are preferable to the others as I would probably just get tired and go to sleep. If it is esophogeal varices, I could spit-up blood. The other causes of sudden death is if part of the clot breaks loose and goes to my heart, my brain, or my lung. These could cause a heart attack, a stroke, or an embolism. If I am hospitalized at the time one of these things occurs, it is possible that I may be kept alive a while longer, but it is doubtful that I would survive even in a hospital setting. These first sudden deaths are only seen in patients with the tumor thrombus (well, except for the capsule of the liver rupturing). The other method, due to liver failure, is much slower, and less pretty. So far, I have not been affected by the hepatic encephalopathy I have heard about. I wonder if that may be more of a symptom of the treatment with chemo as the chemo is hard on the liver. Anyway, when the liver fails in its functioning, it no longer cleans impurities out of the blood. This causes a brain fog, an inability to think clearly, confusion, and possibly, coma. So far I have no apparent signs of liver failure, which include jaundice (yellow skin, yellow eyes, pale stools, etc.), ascites (a build-up of fluids in the abdomen causing the abdomen to swell to very large proportions. The longer I survive without dying from the thrombus, the more likely it will be for me to go into full liver failure. My current prognosis is about 3 mos., but there is no way to tell for sure. It is, however, fatal in most cases and I am almost certain it will be in mine. The tumors in my liver are causing me to feel excessively full due to pressure on my other internal organs, and I am only able to eat small meals currently. Larger meals cause me a great deal of pain. The only symptom of liver failure I may have is generalized pain, the doctor calls it arthralgia/myalgia, joint and tissue pain. This is caused by the build-up of toxins in my blood. It is the normal function of the liver to cleanse these toxins from the body for eimination. Since the tumor is still growing, I am losing weight, I have lost approximately 65 lbs. I have been trying to eat healthy foods such as organic fruits and vegtables in order to keep myself as healthy as possible. I expect if I advance to the final stages in the next few months I will be in a lot more pain, my stomach will swell and my mind will no longer be clear. There is nothing modern medicine can offer but a short extension of my life, while being subjected to the side-effects of chemo. I will allow more pain medicines when I need them, but so far I have been able to stand it most of the time. When I can't, I take small amounts so I don't build-up a tolerance to the pain meds. That way it will work when I truly need it. Some people think I'm brave, some people think I'm stupid. However, I choose to go out on my own terms. I don't want to be a guinea pig or be recovering from surgical procedures the last few days of my life. Some days I feel better and can actually go out and do things, though these days are becoming fewer and farther between. I choose to die of cancer, not chemo or complications from surgery. That is my decision, and I will live or die with it. Sometimes I cry-out in pain, sometime I just cry. Yes, it really hurts bad, sometimes I am doubled-over and cannot get comfortable. But, I am still functioning and I will do this as long as I can. I lost my wife of twenty-six years to ALS almost two years ago. I didn't even know while I was taking care of her that this cancer was probably already growing inside me. The doctors I went to didn't find anything, one even referred me to a psychologist. I guess he was wrong. I wish anyone affected by this terrible disease the strength to deal with all the facets of it. God bless you. m.jones

Yours is the most detailed summary I have seen regarding what to expect in the last stages. A close friend shared with me her diagnosis this spring. She chose a path different than yours. After resection and removal of a 5.5 cm tumor and gallbladder, she underwent 30 radiation treatments and committed to a chemotherapy course. Once chemotherapy began, negative side effects multiplied. First ascites, 8 liters of fluid removal in each of four successive weeks, then last week, 11 liters removed, three days ago an additional six. She continued to be ambulatory with no dietary restrictions, but limited appetite. Two days ago she collapsed at home, vomiting blood and unable to move. She was transported to the hospital by ambulance. She was in a hypovolemic shock, the fluids were not going to her cells. She had severly chapped lips and it was painful to talk. They were unable to draw blood. The source of the blood in vomit was from the esophageal varices, veins from the heart to the liver that were under pressure due to blockages in the liver. And with the buildup of toxins in the blood, the brain stopped functioning properly. My friend was placed on a ventilator earlier today and in an induced coma. This morning's plan was to do an endoscopy to see where the blood was coming from. This evening she was removed from the ventilator and she is in hospice care. The last three days her condition deteriorated very rapidly. On Sunday she was walking on her own, we had lunch together and we sat on the couch and talked for three or four hours. I think she will probably be released from suffering tonight.

There are a lot of twists and turns along the way, but in the end the body's systems are so fragile and interconnected that it's a question of which fails first. Four months ago she was told that she was "cancer free".