End stage rectal cancer

Last Modified: March 14, 2004

Dear OncoLink "Ask The Experts,"
I am a critical care nurse, with 17 years of nursing experience. My husband was diagnosed with recurrent rectal cancer 1 yr ago. He has undergone multiple Chemotherapy treatments, and due to growing tumors on lung, abdominal, and pelvic CT scans and the fact that his CEA is also rising. He may soon be starting treatment with Erbitux. He has multiple organ involvement. He still works full time as an electrician but I am concerned and trying to prepare myself for the coming months if he continues to fail chemotherapy. What can you tell me about what to expect physically and mentally from him as his disease progresses to termination? His doctor seems to think his survival is about 6 months from this point. How do I prepare myself? Where is his disease likely to take him from here in the next few months?

Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

I am truly sorry to hear of the situation your husband and you are going through. As a critical care nurse, you have undoubtedly seen many patients with end-stage cancers. I have long ago given up on trying to predict the future. Each patient is different and making specific statements on what might happen is usually bound to be wrong.

How your husband is affected will be determined, in part, by the tissues that are affected the most. Pain is by no means a universally expected problem in colon cancer but can occur. Fatigue, weight loss and decreased stamina and energy may occur as the amount of tumor increases. Specific problems again may occur depending on what organ the cancer is affecting. For now treatment is still directed against the cancer and Erbitux has been shown to have a potential positive effect. Treatment goals after chemotherapy are palliative and will include making sure that comfort measures are primary along with maintaining quality of life.

Your oncologist may be able to give you more information. Additionally, you may find excellent guidance from both residential and home hospice organizations. They provide care not only for the patients but also the family members who may need it just as much. Frequently spiritual counselors can be tremendously helpful.

I wish you both the best in this difficult time.