Q. My uncle has been diagnosed with cancer. Please give suggestion on palliative care.

Answered by
Dr. Bharat Bhushan Jain
and medically reviewed by iCliniq medical review team.
Published on Dec 06, 2019

Hello doctor,

My uncle has been diagnosed with cancer. I am looking for treatment options and advice from an oncologist. The current doctor who has been treating him has suggested we stop all treatment as he may not have much time left. I am looking for other options or opinions this is what one of the doctors said on seeing the biopsy. "It appears like rectal malignancy but a PSA value and PSA stain of the biopsy tissue would rule out prostate cancer. It is not a good prognosis if it is rectal cancer given the stage but I think a PCN will only help to improve him temporarily with improvement in creatinine and possibly avoid dialysis. I guess you need an oncology opinion to give palliative care to keep him comfortable ie.. free of pain, eating and breath easy."

I can provide you with some status, but since I am not sure how to distinguish between prostate cancer and rectum cancer. I would need help from a professional to differentiate. Additionally, he has two bags attached to his body now, one for stool another for urine. He got operated for rectal dysfunction about 18 years ago and has had been using a stool bag since. Due to his recent kidney stone issue, a urine bag has been added as well. Please help. He is really suffering, and I do not know how to help.

Dr. Bharat Bhushan Jain

Medical Oncology Radiation Oncology Radiotherapy
#

Hello,

Welcome to icliniq.com.

I have seen the reports. (attachment removed to protect patient identity).

It is quite sad that your uncle has advanced stage of cancer. As you asked me how to differentiate between prostate and rectal cancer. There are three possible ways.

1. Serum PSA (noninvasive).

2. PSMA PET scan (noninvasive).

3. TRUS guided biopsy (invasive).

Doing a PCN (percutaneous nephrostomy) is a very good option as a tumor of such kind usually obstructs the ureter. And depending upon whether it is a prostate or rectal primary. Palliative radiotherapy along with metronomic chemotherapy is a good choice at this stage. But this will improve his condition on a temporary basis only. And if it is a prostate cancer then he can be started on hormonal therapy.


Investigations to be done:

Serum PSA (prostrate specific antigen) levels,
PSMA PET (prostrate-specific membrane antigen) scan,
or TRUS (transrectal ultrasound guided) biopsy.

Differential diagnosis:

Ca rectum.
Ca prostate.

Treatment plan:

Based on histology or PSA (prostate-specific antigen) level but with palliative intent only.

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