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ether
05-04-2012, 06:27 AM
I've gone through some of the other threads pertaining to cancer, but thought I'd start my own to give specifics and get some feedback.

I have a secondary character in my current WIP. 16-17ish and the outlook is terminal. She underwent treatment for a long while, without results, before the doctors became pretty convinced she was likely going to die anyway, at which point, she requests to stop treatment. The doctors give her about six months. (Of course, any of these details can be changed to be more realistic. ;) )

I went with ovarian cancer because it seems like one that its my above scenario. Any tips? Details I need to change? If not, then I'd love to know how she'd be feeling physically in those last few weeks? Would she likely become bedridden at some point? What kind of medication would she likely be put on?

Any help would be appreciated!

Shakesbear
05-04-2012, 11:44 AM
My mother died of ovarian cancer - I'm ok about it, if I wasn't I wouldn't be posting. It's thirteen and a half years since she died, and the medical side may have changed.

She was diagnosed in January '98 and died in the December of that year. The first symptom she had was in August '97, on her 75th birthday. She just felt ill and although she got up and got ready for her birthday treat she just was not well enough to go. In the months following she developed a cough and it took me five months to persuade/nag her into going to the doctors. The cough was caused by fluid building up between the pleura (lining between the ribs and the lungs). The doctor listened to her chest and got a taxi to take her to the emergency bit of the local hospital. He also phoned me at work so I was able to join her there. The doctor in the A and E was draining the fluid from her when I arrived. They drained nearly two litres/three and a half pints of fluid. This was sent off to be tested. A young doctor examined my mothers abdomen and said the to senior doctor that he had found a lump. He had a big grin on his face and I told him not to look so happy about it!


Draining the fluid stopped the cough and mum was able to breath properly. It also meant that she was able to do more things, despite the cancer.

Mum was in hospital for the rest of the week - I think it was the only time in her life that she was pleased not to have to cook! On the Friday evening she was told that she had ovarian cancer. There is no easy way and the doctor was not very good at his job.

The following week I took mum to Barts (St Bartholomew's Hospital, London) where she underwent some pre-treatment tests. Before she could have any chemotherapy the hospital had to ensure that she was well enough to withstand it. One of the things they had to check was that her kidneys were still functioning normally. She had her first chemo treatment about ten days after being diagnosed – which was very quick because I was very pushy! Having the treatment was, for me, a very nasty process because I am not good with ‘stuff’ like that. She had a tube inserted into her chest – I think it was into an artery – into which medication was released. This came from a bottle that she had to have with her 24/7. It fitted into a bum bag which was good as it was easy to keep it out of the way. The chemo itself she had to go into hospital for. She was very lucky as it did not make her at all ill. But she did lose most of her hair. We had a lovely day out in the West End of London buying a wig, having lunch and seeing a play.

The last day out we had together was to Portsmouth to visit the Start Trek exhibition. Mum was in no pain or physical discomfort at this point. She was thrilled to be able to sit on the Captain’s chair on the bridge of the Enterprise.

She had six chemo treatments in all – which at the time was the most that could be administered. At the end of August she was in hospital for various tests and the medics decided that surgery might help her. The surgeon who saw her was the nephew of one of her friends. He was very kind and considerate and explained what would happen and he also told her that surgery might not be of any use at all. He said that it was possible he would open her up to find that the cancer had reached a stage that made it inoperable. Which was what happened.

After the surgery she was very weak and needed a lot of care and attention, which she had in the hospital. Just over a week after the operation my brother and I took her home. She found the journey of about forty minutes very tiring and went to bed. Her cat was really pleased to see her and curled up at the end of the bed and purred.

I had to take mum to the hospital every week for a blood test as she had to take warfarin. There was very little that could be done after the surgery. The cancer caused a lot of weight loss and distension of the abdomen. The local hospice sent a nurse or doctor to visit once a week to make sure we were both alright. They were concerned about me as her principal carer. Each time they visited I was asked if I wanted mum to go into the hospice so I could have some respite from caring for her. I never used that option. Mum had many friends and they seemed to have devised a rota. One day a week one of them would come to spend the day with mum so I could go out and shop or just have time to myself.

In the last two weeks of her life mum started to feel some physical discomfort and the doctor from the hospice had a long chat with her and prescribed morphine for her. It was a very weak solution and I had to mix half a teaspoon into a small glass of water. This proved to be too strong as it knocked her out. I reduced it to a quarter of a teaspoon which killed the discomfort but made her woozy. The last week mum was not very steady on her feet and she was confused at times.

On Christmas day mum got up and got ready for the guests and for lunch. She could not eat lunch and went to bed. Later I had to phone for an ambulance as she had fallen and I could not life her. She was taken, at her own wish, into hospital, where she died the following evening. She was semi conscious until about thirty minutes before she died.

I hope this helps you, please pm me if there is anything specific you want to know or any thing that is not clear.

monkeymum
05-04-2012, 01:06 PM
Just a thought here, but something you might want to check out to make sure the facts in your story are correct...ovarian cancer is generally more common in post menopausal women. It does occur in younger women, but I believe it tends to occur in a different cell type and therefore has a better prognosis (more women tend to survive, although they may be left infertile). Of course, survival also depends on how quickly the disease is diagnosed and whether the cancer has metasasised.

I survived
05-04-2012, 05:10 PM
There is a type of Ovarian Cancer that is almost always terminal that younger women get while they are pregnant I forget what it is called. My mom died of it when she was 23 and pregnant with my brother. I asked my OB'Gyn about it because I had heard the same thing monkey mom just said and that's what I was told.

McMich
05-04-2012, 05:59 PM
I agree with monkeymum- at 16-17 I would expect ovarian cancer would not be very common either. I’ve read a lot about it since my grandmother died from it at 49- she was considered young to be having it. At the age 16-17 I would think a pediatric cancer might be more believable.

LJD
05-04-2012, 06:17 PM
Ovarian cancer at that age is unlikely, but not impossible.

My childhood best friend's mom died of it. She was 39 I think. She hadn't known for long--ovarian cancer is often not caught in time.

My mom had a tumor in her ovary when she was 18, but it was benign.

boron
05-04-2012, 07:00 PM
One type of ovarian cancer that occurs before 20 is called dysgerminoma (http://emedicine.medscape.com/article/253701-overview#showall). It's quite curable, but when discovered lately, it may be already spread to other organs. Anyway, this type of cancer is rare, and, with early and proper treatment it's rarely fatal...Symptoms are not specific and include abdominal pain, painful urination and such...In the late stage (metastases to other organs), typical symptoms include weakness and paleness due to anemia, fatigue; eventual nausea, sleepiness and dizziness caused by morphine, loss of appetite (cancer patients typically don't like meat), profound weight loss. During the last two months, a patient may be bedridden, needs food served at bed, assistance to go to toilet. In the last days of life, the patient often becomes progressively sleepy, unresponsive and may die silently..just stop breathing at one point...

When doctors were saying the "outlook was terminal," and no additional treatment planned, six mounts would sound a bit long to me ( so, maybe 2-4 months).

I suggest you read few articles about terminal care (http://www.cancer.gov/cancertopics/factsheet/Support/end-of-life-care) to get an impression how does it feel, what the patient needs, wants...

Hip-Hop-a-potamus
05-04-2012, 07:24 PM
I had emergency surgery in 2005 (I was 38).

I'd had horrible abdominal pain the day before, and woke up Saturday morning feeling a little better. Stomach began bothering me, and husband gave me some Pepto.

When I threw up the Pepto, we knew it was something pretty serious. We went to the hospital around 9 AM, and were there all day, with me having sonograms, MRIs, pregnancy tests, and various other procedures. I also threw up a bit more. They admitted me around 4 PM, after telling me they saw irregularities with one or both ovaries. One idiot doctor who didn't know about diplomacy or premature diagnoses, told us it was cancer. I freaked the $%^& out.

Turned out it was a ruptured endometrial cyst that had bled out very nastily. At midnight, I was taken in for a laporoscopy, and while they were in, they cleaned everything up. Thank God it wasn't more serious. I see where ovarian cancer might be diagnosed late. I'd never had a single symptom of endometriosis until right then.

I always worry if I'll be more susceptible to an ovarian cancer down the road because of the endometriosis. It has now become a major problem in my life, and I'll have to stay on birth control for as long as it's safe, because of the risk of this happening again.

ether
05-04-2012, 08:14 PM
This is all fantastic. And, yeah, I knew ovarian cancer was a stretch for someone this young, so huge thanks for suggesting some others that are more realistic. ;)

And thank you for sharing your stories. I know so many people speak from experience in dealing with it, so I appreciate you being willing to do so.

shaldna
05-05-2012, 12:24 PM
As others have pointed out, ovarian cancer tends to affect older women, by that I mean, 50+.

However, have you considered cervical cancer. It affects many younger women, and, although they say it isn't genetic, my mother, both of her sisters, my grandmother and six of my female cousins on the same side have all had cervical cancer - all picked up via a routine smear test.

ether
05-06-2012, 03:50 AM
As others have pointed out, ovarian cancer tends to affect older women, by that I mean, 50+.

However, have you considered cervical cancer. It affects many younger women, and, although they say it isn't genetic, my mother, both of her sisters, my grandmother and six of my female cousins on the same side have all had cervical cancer - all picked up via a routine smear test.

I hadn't even thought of that. (Obviously.) Thanks, Shaldna! I'll look into it! :)

shaldna
05-07-2012, 06:17 PM
I hadn't even thought of that. (Obviously.) Thanks, Shaldna! I'll look into it! :)

No probs. It's one of those cancers that is highly treatable if caught early, unfortunately, according to the CDC's latest stats, about one third of people who have it will die from it - usually because it's been too late when it's been found.

Routine smear, or pap, tests can detect it, and usually it's fairly straightforward to treat, with good results. After getting the all clear, women will have to have more frequent smears for a couple of years, but they then move onto their normal smear cycle.

My mum's treatment was a day procedure and highly effective. She was about 35 then, and has never had problems since.

Cervical cancer is often caused by HPV - which is a very common virus and is what the cervical cancer vaccination immunizes you against.

In the UK there was always a reluctance among women when it came to smears - because they are embarrassing and quite invasive, and that puts people off. But in recent years the number of young women having smears has actually increased - the Jade Goody effect. http://en.wikipedia.org/wiki/Jade_Goody

ether
05-07-2012, 07:28 PM
You're wonderful, Shaldna, thank you! And I'm glad your mom came out okay from it. :)

Amber Nae
05-15-2012, 08:42 AM
If they decided to stop treatment, and this is usually from any type of cancer, they eventually do become bed bound. This isn't the case with all, I've learned that there are always exceptions. Typically, we just make the patient as comfortable as we can. Pain medication may be ordered (Morphine and Dilaudid are two very strong one that are administered IV, but also come in oral forms), and then some sort of anti-anxiety medication if its needed (Ativan, Xanax). They would be in a lot of pain and very tired.

ether
05-15-2012, 06:34 PM
If they decided to stop treatment, and this is usually from any type of cancer, they eventually do become bed bound. This isn't the case with all, I've learned that there are always exceptions. Typically, we just make the patient as comfortable as we can. Pain medication may be ordered (Morphine and Dilaudid are two very strong one that are administered IV, but also come in oral forms), and then some sort of anti-anxiety medication if its needed (Ativan, Xanax). They would be in a lot of pain and very tired.

This is very helpful, thank you! I'd wondered specifically is they could be given Morphine in pill-form, so this answers that question.

Skyraven
05-23-2012, 06:26 AM
Hi there. My mom also died of Ovarian Cancer. She was diagnosed in April 2002 and died September of that year. Since then, I've gone faithfully to my gyn appointments yearly. However, I was told by my doctor that OC occurs more in younger women and have heard of several stories of young patients from various people. My gyn stated that as someone who was over 50 and had four pregnancies, my mother was an outlier - a rare case of OC. So, I was surprised to read some of the earlier responses.
Anyway, some other issues associated with OC - bloating & irregularity. My mother's pcp gave her fiber thinking that it was a stomach issue like IBS rather than OC. After that didn't help, Mom went to get xrays done. A grapefruit-sized lump was found and exploratory surgery was done to see what the lump was. It was a malignant tumor above her ovary and it spread to her liver. She had two small spots on her liver for which mom was given one treatment of radiation and three of chemotherapy. She also became distended in the belly area and lost her hair & a lot of weight. She went into hospice for six days at the end. She also had morphine for the pain and was conscious up until two days before she died. She woke up when her church friends came to sing to her and then fell into the coma again the next day. Her breathing was very labored and sounded like rails. My son, his godmother and I were in the room with Mom when she died. Her breathing simply stopped and her heart raced until it stopped, too.
Hope this helps. :)

Chekurtab
05-24-2012, 08:08 PM
One type of ovarian cancer that occurs before 20 is called dysgerminoma (http://emedicine.medscape.com/article/253701-overview#showall). It's quite curable, but when discovered lately, it may be already spread to other organs. Anyway, this type of cancer is rare, and, with early and proper treatment it's rarely fatal...

I'll second it. The epithelial ovarian cancer - the most common type around 90% of the cases - is unheard of at the age of 17. The stromal and germ-cell tumors like dysgerminoma are possible, but rare, especially as a terminal case at such a young age.
I'm afraid you are going for a weird, one in the millions case.

Hope it helps.

GeorgeK
05-26-2012, 05:41 PM
Population statistics are meaningless with regard to the individual.

They way that I used to express that to patients was, "It doesn't matter what the odds are. Whatever happens to you is 100% for you. It's perfectly plausible for a fictional character to have a cancer that is a statistical outlier. Also the outliers tend to be more aggressive as well. So, it is a plausible scenario.

Death from cervical cancer is a torture born out of Hell. Bowel obstruction is common and narcotics slow down the gut so using narcotics for the pain of a bowel obstruction just makes things worse. They end up in the hospital on either an elemental diet or TPN and often with decompressive diverting enerostomies. Eventually the cancer eats through a blood vessel and they bleed to death.

Death from Ovarian cancer is more energy sapping but generally less painful. The tumors seed the peritoneum and can spread to the pleura and tend to make an exudate (a proteinaceous liquid) that can compress surrounding organs as the exudate accumulates so they end up having to get that tapped and go in periodically to drain the fluid. There's a lot of protein in that fluid and so those patients get nutritionally depleted very quickly. That makes them essentially starve to death despite having often what looks like adequate fat reserves. They tend to get weaker and weaker and then die of infections or from congestive heart failure.