I sometimes get asked various versions of this question: “My father has advanced cancer, but they don’t seem to be treating him very aggressively. Why aren’t they doing surgery to remove the metastases in his liver and in his brain?”
This is always a difficult question because the news is sometimes hard to absorb. When cancer spreads – or metastasizes – from its original location, the focus generally shifts from curing the cancer to controlling the cancer.
There are some exceptions to this. Relatively advanced testicular cancer is sometimes cured by aggressive chemotherapy and surgery. In other cancers, a few small metastatic tumors may be removed by surgery or radiation in the hopes of a cure.
In general, though, once the cancer spreads elsewhere in the body, surgery is not a viable option. Even if the surgeons remove all visible tumors, microscopic cancer cells are still present. The analogy of trying to close the barn door after the horses have escaped is unfortunately apt.
The primary treatment for metastatic cancer is chemotherapy because it affects cells throughout the body. Stopping the progression of the disease is often the goal.
Treatment generally goes on for as long as the benefits of the treatment (extending one’s life and/or reducing symptoms) outweigh the harm caused by the treatment (generally, the side effects of chemotherapy).
When someone asks me why the doctors aren’t doing more to aggressively treating their father’s cancer, I gently ask them what their father wants. More often than not, the father is more interested in the quality of his life than in extending his life.
The most aggressive cancer treatment is not always the best cancer treatment. The person with cancer ultimately decides how much treatment is enough. The most fortunate patients make these decisions with the understanding and support of their loved ones.
It’s ok to say, “Dad, I’m here for you if you want to continue treatment and I’m here for you if you want to stop treatment. Just know that I’m here for you.”
Reprinted with permission of the Ithaca Journal.
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