End Stage Stomach Cancer
There are IV stages of stomach cancer and the disease is classified according to several factors. Stage III B, III C and IV are considered stages of advanced disease and stage IV is actually the terminal stage of this malignant disease.
Stage III B is characterized by the growth of the tumor outside the stomach lining. The tumor penetrates through all the layers of the stomach wall and affects regional lymph nodes as well as surrounding tissues. This stage is not terminal but requires prompt treatment in order to prevent further progression of the disease and quick lethal outcome.
Stage III C includes spread of the tumor to nearby organs and regional lymph nodes. For example, tumor cells can be found in the pancreas, intestine and liver. Even though the tumor has affected abdominal organs, it has not yet spread to distant organs and organs systems in the body.
And finally, stage IV is the terminal stage of stomach cancer. It involves uncontrollable growth of the tumor and its metastases. The tumor may affect many different organs and even spread to distant ones such as the brain, lungs or bones. In women stomach cancer has tendency to spread to the ovaries. The very presence of the tumor, its location and size determine symptoms and signs patients are forced to deal with. This stage is practically incurable and all doctors can do is to provide with appropriate symptomatic treatment such as pain management, feeding assistance and similar.
What Tests Will I Have
You may have tests to find out how far the cancer has spread. If you are generally not very well it may not be necessary to do extra tests. Your doctor will still be able to recommend treatment. Some of these tests can also be used to check how you are responding to treatment.
You may have some or all of the following tests:
PSA blood test
Prostate specific antigen is a protein that can rise due to disease in your prostate gland. A sample is taken from your blood and measured. A PSA test can also show how well your cancer is responding to treatment.
A biopsy is where a sample of your prostate tissue is taken and examined under a microscope. It isnt common to have a biopsy with metastatic prostate cancer, but if this is your first prostate cancer diagnosis it may be necessary. Treatment can still start without a biopsy.
Metastatic prostate cancer often spreads to the bones. Bone scans can find cancer spots before they show up on an ordinary X-ray. For this test, a tiny amount of radioactive liquid is put into a vein, usually in your arm. After the injection you will have to wait up to 3 hours. A scan is then taken of all the bones in your body. Abnormal bone takes up more radioactive liquid than normal bone. These areas will show up on the scan and are known as ‘hot spots’. The scan can also show bone changes like arthritis.
Read more about cancer tests.
These tests will help your doctor to decide on the best treatment for you.
Metastatic Spinal Cord Compression
Metastatic spinal cord compression happens when cancer cells that have spread from the prostate grow in or near to the spine, and press on the spinal cord. MSCC isnt common, but you need to be aware of the risk if your prostate cancer has spread to your bones or has a high risk of spreading to your bones. The risk of MSCC is highest if the cancer has already spread to the spine. Speak to your doctor or nurse for more information about your risk.
MSCC can cause any of the following symptoms.
- Pain or soreness in your lower, middle or upper back or neck. The pain may be severe or get worse over time. It might get worse when you cough, sneeze, lift or strain, go to the toilet, or lie down. It might get worse when you are lying down. It may wake you at night or stop you from sleeping.
- A narrow band of pain around your abdomen or chest that can move towards your lower back, buttocks or legs.
- Pain that moves down your arms or legs.
- Weakness or loss of control of your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
- Numbness or tingling in your legs, arms, fingers, toes, buttocks, stomach area or chest, that doesnt go away.
- Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.
It is very important to seek medical advice immediately if you think you might have MSCC.
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Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
Treatments To Control Advanced Prostate Cancer
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Chemotherapy with hormone therapy
Chemotherapy uses anti-cancer drugs to kill cancer cells, wherever they are in the body. It wont get rid of your prostate cancer, but it aims to shrink it and slow down its growth. You might be offered chemotherapy at the same time as, or soon after, you start having hormone therapy. This helps many men to live longer, and may help delay symptoms such as pain.
You need to be quite fit to have chemotherapy. This is because it can cause side effects that are harder to deal with if you have other health problems. Read more about chemotherapy.
Hormone therapy will be a life-long treatment for most men with advanced prostate cancer.
Prostate cancer usually needs the hormone testosterone to grow. Hormone therapy works by either stopping your body from making testosterone, or stopping testosterone from reaching the cancer cells. This usually causes the cancer to shrink, wherever it is in the body. Hormone therapy can also help control symptoms of advanced prostate cancer, such as bone pain.
Hormone therapy can cause side effects speak to your doctor or nurse about ways to manage these. Read more about hormone therapy, and its side effects.
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Signs Of Approaching Death
Death from cancer usually occurs after a person has become weaker and more tired over several weeks or months. It is not always possible to predict how long someone will live. But some common signs and symptoms show that a person is entering the final weeks and days of life. Knowing what to expect helps relieve anxiety and allows better planning.
The following are signs and symptoms that suggest a person with cancer may be entering the final weeks of life:
Worsening weakness and exhaustion.
A need to sleep much of the time, often spending most of the day in bed or resting.
Weight loss and muscle thinning or loss.
Minimal or no appetite and difficulty eating or swallowing fluids.
Little interest in doing things that were previously important.
Loss of interest in the outside world, news, politics, entertainment, and local events.
Wanting to have only a few people nearby and limiting time spent with visitors.
As the last days of life approach, you may see the following signs and symptoms:
Of course, every person is different. The signs and symptoms that people experience vary. And the order in which signs and symptoms occur may differ.
Other Ways To Help Cancer Pain
With certain types of pain, doctors can do special procedures such as nerve blocks, targeted radiation treatments, or even surgical procedures to control pain. Sometimes physical therapy may help. If your pain isnt well controlled, your doctor might also refer you to an expert in pain management. The pain specialist might have some different options to help you.
Medicines and medical procedures are not the only ways to help lessen your pain. There are other things you can do. Some people find distractions like music, movies, conversation, or games help. Using heat, cold, or massage on a painful area can help. Relaxation exercises and meditation can help lessen the pain and lower anxiety for some people. Keep in mind that for most people with cancer pain these measures alone are not enough to control pain. But, they may help improve comfort when used along with pain medicines.
You can learn more in Cancer Pain.
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Supportive And Palliative Care For Adults With Cancer
The guidance on supportive and palliative care for adults with cancer was published by NICE in March 2004. It placed importance on the holistic approach to managing patients, their carers and relatives following a diagnosis of cancer. In particular, the multidisciplinary team was recognized as key in the process of providing continuity of total care. The importance of working as a multidisciplinary team cannot be stressed enough. To believe that the suffering experienced by patients with a terminal diagnosis can be solely managed by one professional body is foolish. Within the context of the Palliative Care Team, members of the MDT should include those who can deal with physical, spiritual, psychological and social needs. Rehabilitative and nutritional needs should also be recognized and addressed along with the provision of access to complementary therapies.
What Are Stage 4 Prostate Cancer Treatments
After prostate cancer has spread to other parts of your body and reached the final stage it is often incurable. Some treatments may be able to shrink tumors or slow the cancers spread.
Hormone blocking therapy
Prostate cancer needs the male hormone testosterone to grow. Blocking or preventing your body from making testosterone can potentially slow the cancers spread or even shrink tumors. Testosterone can be blocked with many different types of medications or surgery to remove your testicles.
In late-stage prostate cancer, hormone therapy is usually used alone but can also be combined with other treatments.
Radiation therapy may be recommended in stage 4 prostate cancer for men with very large tumors or cancer that has spread to the lymph nodes and other areas. It is often combined with hormone therapy or used after surgery to kill off any remaining cancer cells.
Chemotherapy might be recommended for people with stage 4 prostate cancer in combination with hormone therapy or other treatments. It can help relieve some of your prostate cancer symptoms and potentially prolong your life expectancy.
Pain relief and supportive care
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Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- having blood in your urine or semen
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
- stomach pain
Your Gp Practice Nurse And District Nurse
Your GP, practice nurse, and district or community nurse will work with other health professionals to co-ordinate your care and offer you support and advice. They can also refer you to local services. They can visit you in your home and also help support your family. They might also care for you if you go into a nursing home or hospice.
What Is The Treatment For Advanced Prostate Cancer
No matter where prostate cancer spreads, its still treated as prostate cancer. Its harder to treat when it reaches an advanced stage.
Treatment for advanced prostate cancer involves targeted and systemic therapies. Most men need a combination of treatments and they may have to be adjusted from time to time.
Patients And Their Families May Have Cultural Or Religious Beliefs And Customs That Are Important At The Time Of Death
After the patient dies, family members and caregivers may wish to stay with the patient a while. There may be certain customs or rituals that are important to the patient and family at this time. These might include rituals for coping with death, handling the patient’s body, making final arrangements for the body, and honoring the death. The patient and family members should let the healthcare team know about any customs or rituals they want performed after the patient’s death.
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Treatment For Prostate Cancer In Dogs
If caught very early in the disease process, before metastasis has occurred, surgical removal of the diseased portion of the prostate may be considered. Surgery is often followed by radiation therapy or chemotherapy.
If metastasis has already occurred, then palliative care should be considered. The goal of palliative care is to relieve pain and any clinical symptoms that may be present, while also trying to improve your dogs quality of life for as long as possible.
If a urinary obstruction is present, a small tube called a stent may be placed within the urethra to keep it open so the dog can urinate. Surgery of the prostate is not often performed when advanced disease is present because of the high risk of complications. Radiation therapy may be considered in certain cases.
Your veterinarian may also recommend a nonsteroidal anti-inflammatory drug to relieve pain. Any urinary tract infection that may be present will be treated with appropriate antibiotics. Chemotherapy may be considered, but long-term efficacy has not been established.
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Loss Of Bladder And Bowel Control
The dying person might lose control of their bladder and bowel. This happens because the muscles in these areas relax and dont work as they did. This can be distressing to see and you might worry that they may feel embarrassed. The nursing staff will do all they can to protect the bed and keep your relative or friend as clean and comfortable as possible.
If you are caring for the person at home, the district nurses and specialist nurses can arrange for you to have protective sheets or pads for the bed. They might also be able to arrange a laundry service for you, if necessary. As people become very close to death and are not eating or drinking, the amount of urine and stools they produce gets less and less.
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Improvements In Life Expectancy
A decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years. In the UK the survival rate for men with stage 4 prostate cancer is approximately 50%, meaning that 50 out of every 100 men will survive their cancer for 5 years or more after they are diagnosed with stage 4 prostate cancer*. There is now a much broader range of chemotherapy drugs available for men with advanced disease with greater efficacy . We also have better treatments to control the symptoms of advanced prostate cancer, such as pain from metastases. In this section, we consider in more detail the different treatments that are available and evidence for their effectiveness.
What Should I Expect As My Cancer Progresses
How does prostate cancer spread?
Prostate cancer cells can move from the prostate to other parts of the body through the blood stream. Or they can spread to the lymph nodes near the prostate and then travel through the lymph vessels to other parts of your body. Lymph nodes and lymph vessels are part of your lymphatic system and are found throughout your body.
Prostate cancer most commonly spreads to the bones and lymph nodes. It can also spread to, or press on, the tube you urinate through , the bladder, the tubes that carry urine from the kidneys to the bladder and part of the bowel . Prostate cancer may spread to other parts of the body, including the lungs and liver. But this is less common.
If tests and scans show that your cancer is spreading, ask your doctor what will happen next. This can help you and your family prepare for what to expect. Find out more about advanced prostate cancer and treatments.
Watch our video about advanced prostate cancer.
How does prostate cancer cause problems?
Prostate cancer can cause problems if it is pressing on your bones or nerves. It can also cause problems by stopping your normal cells from working properly.
What problems can advanced prostate cancer cause?
The symptoms and problems you have will depend on where the cancer has spread to. Even though your cancer is still growing, you will still be able to have treatment to help manage these problems.
Advanced prostate cancer problems may include:
What should I look out for?
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