stage IV and progression

[michelle3305]

my 83 year old aunt was dx with stage IV Lung CA 2 months ago, it was seen on CT back in May and we have been told it has doubled in size in the past 6 months. She is not a candidate for treatment and is refusing even palliative tx such as Tarceva.  PET Scan showed no evidence of cancer in brain, liver or bone. Because she  is experiencing no symptoms she is hesistant to participate in a home hospice program.  What symptoms are generally experienced and if possible a general timeline for disease progression.  

[dbrown09]

my dad passed away three years ago from advanced ca of the lung.they said that he would only have about 6 months left.He lived for exactly one year from the date of his diagnosis. my father did not want any treatment either.He said that he didn't want to be treated like a guinea pig experiment,that he wanted things to happen naturally and to enjoy whatever time he had left with his family.My best advice to you is to respect your loved one's decision to not go through any more treatment,and respect her decision to not get hospice involved at this time .It is best to only have hospice involved in her last few months of life or when her doctor feels that she is no longer able to make her own health decisions.Then her doctor will discuss with you or whoever your aunt has decided to name as her healthcare proxy about your aunt's end of life options such as hospice care

[HeinrikMD]

Hi,
Its hard to say how rapidly things will progress even if you mentioned a doubling in size. A doubling in size of 0.5 cm to 1 cm will probably not lead to any symptoms, whereas a change from 9 to 10 cm is not a doubling but will more likely produce symptoms.
IF you meant by "she is not a candidate for treatment" meaning "not a candidate for local treatment such as surgery or radiation therapy" (which actually means current treatment options are likely to effect palliation of symptoms and modest improvement in survival but not really to effect cure) - in the absence of treatment - the percentage of survivors at 1 year is about 20-30%.
Which particular symptoms to be expected are also a little difficult to predict - there are the general symptoms of weight loss, cough, shortness of breath, generalized weakness... when located along certain areas the tumor may compress nerves and cause hoarseness, when located near blood vessels may cause bloody sputum/phlegm.
Inquire about her concerns and try to find out specific reasons why she would have chosen no treatment. She may have some misconceptions about what to expect which when discussed - she may change her decision.
Keep an open mind and lines of communication open.