What actually precipitates death from liver cancer? - Dad Tx
My Father was diagnosed with primary liver cancer HCC stage 4 with a tumor 11 x 9 cm (4 inches) in his liver. He had a CT scan done the first week of May 2008 and was informed of the cancer May 8th, 2008.
He had been losing weight, especially in his upper body, shoulders, neck, face, and chest. Muscle wasting of a sort. Yet his abdomin is still a bit bulbous but I wouldn't call it ascites. His mental state has deteriorated significantly and he is dizzy and often confused. His doctors have said he may have or is developing alzhiemers. I don't understand why they would say this as I believe it is connected to the cancer. Researching this I have found alot of information regarding hepatic enchephalogy which is one of liver cancers manifestations. Why don't the doctors first suspect this when dealing with Liver cancer with patients who have mental/cognitive changes arising along with the cancer?
He also has been complaining about his lower neck (pain, discomfort). Doctors haven't really looked into this as of yet and my father probably didn't know of its relationship to the disease. Researching online, they explain portal hypertension. My fathers tumor involves his portal vein. If the pressure of the vascular system changes as a result of portal vein occlusion, this can cause esophageal varicies, which I suspect is causing the discomfort in his neck. I asked him just yesterday if he ever coughed up blood and he said he has just recently, although just minute amounts - nothing substantial.
I find it odd that I can not ascertain, how he will actually pass. I have concluded two different scenerios on what I can expect and would appreciate folks being honest and forth coming. The first scenerio is that poisons are not filtered through the liver, affect the brain, and the patient sleeps more and more each day until they slip into a coma and pass. The other option is that with blood clotting compromised, and the vascular pressures out of control, uncontrolled bleeding could result.
Dad seems to want to fight this - yet it has almost been a month and he hasn't yet made a decision. They offered TACE as the most promising option but only as a possibility of adding additional time (and only a few months at that). I believe that I would rather advise my father against the TACE as I believe that as soon as they start poking around and attacking his liver (killing off a large chunk of it with chemo drugs and blocking off arterial flow essentially starving it). That this could also lead to him having even more adverse affects sooner and possibly shortening his time or causing quality of life issues. But yet, I don't want to obscund all hope but I don't want to lie or hide truth from him.
More facts about my fathers cancer - mets to a rib and to soft tissue by his prostrate. Cancer is said to be in the lymph nodes around the liver. My father was a rot gut scotch drinker (cheap scotch). I recently advised him to get milk thistle as it is supposed to help with the cognitive functions by helping the body to rid itself from ammonia poisons. My father has an appointment with a Dr. Geller at UPMC in Pittsburgh. I have read many posts from that area that establish him as one of the best in the area for treatment of Liver cancer. His appointment is not until June 8th which will mean that we have done nothing about this cancer now for a month. My Dad had blood work done last week and all of his liver enzymes were normal range which I really didn't understand.
My father had liver cancer so I understand your question completely. Ironically he shared your fathers love of scotch as well. He ended up having a 10 cm tumor and he died of hepatic enchephalogy as his final cause of death. I was taking care of him and it went like this, he would come in and out of what I call sleep but it was likely the result of his liver not functioning well and the resulting high ammonia levels.
More and more he would be awake and then out. His legs - one day swelled badly and I brought him in to the Hospital, as this was to me a quite severe symptom as it affects his ability to walk safely. Up to this point he was fine, he had had a biopsy which caused him some pain afterwards but other then that he was basically sleeping and then awake and completely present. He also lost some weight but nothing bad. He was very careful what he would eat because I think certain things would cause him discomfort . For us it was very quick, he was admitted to the hospital that day for his legs, and died two days later. They seemed to make attempts to get his blood chemistry better, lower the ammonia levels, but I think in the end they knew that he was going to die, and that they would try to make him comfortable. Because it all went very quickly after that. I know at this point there was little they could do for him. I think the less the better in my view. They gave him morphine, haldol, something to try to get the ammonia out of his system, did many many test. I guess in end my feeling is to limit what doctors do, there is at this time no cure for liver cancer, and there are many experimental drugs out there which he I am glad to say never had to go down that path, although the possible option of it gave him and I great hope. But there is always reason for hope, because just as a tumor forms it can also die out and no one really knows why. I hope this helpful to you. I know what you are going through and I know it is not easy. I look back and feel some relief in knowing that his death could have been so much worse. I find comfort in knowing that he did not suffer in a physical sense. My best wishes and prayers are with you all.
I am very sorry about your father's liver cancer. If I understand your question correctly, you want to know what to expect when your father is nearing the end. He will most likely die of complications secondary to liver failure. As his liver function becomes more and more affected by the cancer, it will no longer be able to filter the toxins from his blood. You will see this by a change in his color... skin and whites of his eyes.
It is usually a "painless" death since the person just slowly goes into a coma.
Joe, you and your father are in my thoughts and prayers.
Just an update on my father's condition;
He was hospitalized yesterday June 15th because of blood test results which were all out of whack. Bilirubin 1.7, Direct Bilirubin .6, alkaline phosphate 181 and AST 42. His creatinine levels are elevated and they did an ultrasound on his abdomen Friday june 12th but I have not yet seen or heard of the results of that test. Chest xray confirms a bony lesion on the rib, right side, thought to be a met.
Dad has not turned yellow as of yet and I have been looking for a Bilirubin reading that jaundice might occur. If anyone knows what that level might be I'd like to know. I reside in CT and Dad is in Pittsburgh, PA and I have driven there 3 times in the past 6 weeks to spend extended weekends. Dad's encephalopathy has gotten pretty bad. I can't hardly talk to him on the phone and I was just there this past weekend - came home Sunday, and he wasn't to bad, compared to now. He told me he would have to have my mother come get him, but my mother died 2003 - (the way I want to go - she just dropped dead!.) Besides that, my father and she were divorced for 25 years now. I need to know when I will need to go over there, whats about to happen does not bode well by me. I want to be there while I can still tell him things and he can understand.
This has happened really quick, the encephalopathy is like a natural sedative for the cancer. The slow accumulation of toxins in the brain may actually provide a cushion for him if theres anything positive to say about it. I still want to talk to him a few more times.
Thank you all for prayers and responses, and all the different posts. I will try to keep you all informed as to whats up next. - Joe