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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54162
Experience:  GP in the United States
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My husband has three melanoma mets in parietal lobe of brain

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My husband has three melanoma mets in parietal lobe of brain and bone cancer of arm . The hospital are vague about prognosis but he is on 90 mst bd now and I would like an idea how long he will be suffering this way
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Phil, MD replied 1 year ago.
This is a very poor prognosis. I'm very sorryHe will not likely live more than a monthI'm so sorry
Expert:  Dr. David replied 1 year ago.
This is Dr. DavidI am a cancer doctor.patients who have melanoma brain metastasis can actually live for many monthssome melanoma mets to the brain can be slow growing.with treatment such as gamma knife radiation or steriotactic radiosurgery to the brain, the brain metastasis can be controlled in some patients.
Expert:  Dr. Phil, MD replied 1 year ago.
Very unlikely to live much longer than that. I'm sorry
Customer: replied 1 year ago.
Thank you for th information. He is slightly confused and sleepy could this be the tumours or their morphine ? Is 90 bd a lot and will this in itself affect the prognosis? He won't discuss anything not even last wishes so I feel very much in the dark about everything
Expert:  Dr. Phil, MD replied 1 year ago.
It is probably a combination of the drugs and tumors Overall some people live a while but it is usually very fast. Honestly sometimes prolonging life is worse and more painfulHospice is appropriate
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54162
Experience: GP in the United States
Dr. Phil, MD and other Medical Specialists are ready to help you
Customer: replied 1 year ago.
No gamma or treatment advised but has had palliative radiotherapy to arm just once. The right pareatal tumours are 12mm 9mm and 6mm but no seizures as yet. Are they considered large at this size and are fits likely soon please?
Expert:  Dr. Phil, MD replied 1 year ago.
Those are moderate sized. Yes seizures are likely at some point
Expert:  Dr. David replied 1 year ago.
This is Dr. DavidI am a cancer doctor.those are considered small brain metastasis in the brain.I don't know your husband and how aggressive he would have wanted to be at the end stage of his lifein the USA, some patients get gamma knife or focused radiation or stereiotactic radiosurgery to small brain metastasis from melanoma to control brain mets for months and years.there are also new PD-1 inhibitor immune modulator Iv systemic therapy which can slow down melanoma growth and shrink metastasis.some melanomas have BRAF mutation which can be tested for and treated with targeted therapy.these treatments are expensive, some the NHS in the UK sometimes doesn't want to pay for them.but at age 90 for him, he may not want to be aggressive and he may only want comfort care at this point. dexamethasone steroid medications can help decrease brain swelling and headaches.
Customer: replied 1 year ago.
He is 60 not 90 by the way! 90 msg morphine bd is what he is taking. No braf or gamma treatment recommended because melanoma in lungs, liver and bone. Lungs and liver are static though but arm needed a rod two weeks ago to hold it. I just wondered how long he might have if left untreated but do know you can only say an estimate based on averages. The pain is bad even on morphine so don't want this suffering to continue for months for his sake
Customer: replied 1 year ago.
And those measurements were six weeks ago on the last scan. I am very grateful for your help by the way
Expert:  Dr. David replied 1 year ago.
This is Dr. Davidyou are welcomeyou didn't answer my question about how aggressive you and he want to be with treatments.you should ask his doctors about PD-1 immune modulators which could slow down his melanoma cancer.every patient is different. some patients with untreated brain metastasis can live for 1-6 months, some patients can live longer with melanoma untreated in the brain. some melanomas can be very slow growing.a repeat brain MRI scan can see how fast his brain mets are growing and if there is T2 edema swelling changes around his metastasis.if his pain is bad in his arm, he might benefit from a repeat 8Gy x 1 radiation palliation of the bonelidocaine patches on the area could help decrease pain.let me know if you have other questions.if done for now, please leave positive rating above the chat box so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me with "a question for Dr. David" in the medicine or oncology categories if you have any other questionshere is my website if you need to reach me again:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
Customer: replied 1 year ago.
I have rated you 5 stars. Some oedema reported on that scan too but no further scans booked. He doesn't see the pint of aggressive treatment because it is systemic.
Expert:  Dr. David replied 1 year ago.
This is Dr. David,I am the cancer doctor.you rated the other expert, not me.systemic therapy like new PD-1 immune modulators nivolumab by itself or incombination with ipilimumab (anti-CTLA-4) have been shown to melt way metastatic melanoma.these are expensive therapy, the NHS may or may not want to pay for them.
Expert:  Dr. Phil, MD replied 1 year ago.
There is some evidence that some of the newer agents can treat it.Even when it is systemicIt is a worth it getting a second opinion

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