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Don't know what to expect 
27 Oct 2019, 4:56 AM

Hi. I had a liver resection in 2018. The doctors were able to take out most of the tumour. But learlier this year, the remaining tumours started to spread. I took a first-line targeted therapy, lenvima, but it was not effective. I started immunotherapy, nivolumab, but have had to pause the treatment because my liver toxicity markers are too high. I need to decide soon whether to embark on a second-line targeted therapy. I feel fine right now, which surprises the doctors. I'd like to know more about what I can expect to feel as the cancer spreads further. I know that each person is different. But I would just like to have a sense of what I should prepare for physicially and psychologically.
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29 Oct 2019, 3:51 PM

Hello – thanks for connecting here on the Discussion Forums. We are sorry to hear about the progression of your cancer.

You are asking some important questions here, about what you might expect as the cancer spreads. You are also correct; each person is different and will experience their illness in a unique way but across all advanced illnesses there are often some commonalities that can be seen.

Generally, advanced illness can have significant impacts on the body and it is not uncommon for palliative care patient, as illness progresses, to have a general slowing down in their function and ability, being able to physically do less and less over time. Often as illness progresses there is a general slowing down of overall function and ability and it becomes more challenging and more of a physical effort to complete usual day to day tasks. An individual may not be eating much or have much of an appetite. They will have less energy, spending more time sitting and resting and eventually more time in bed throughout the day and sleeping more through the daytime and night. Often towards the last days of someone’s life, time will only be spent in bed and they may not be awake and alert anymore.
 
It is not possible to know, how quickly or perhaps how slowly such changes may occur and sometimes unexpected changes and acute decline can happen or someone’s condition may plateau for some time. It’s hard to know exactly what may happen in your case, however the health care providers directly involved in your care are best suited to provide more specific information to you on this. As you continue to consider your options for care, it would be important to share your questions and concerns with your medical team so that they can provide answers to you based on your specific circumstances. It is not uncommon for people to have questions around whether or not to continue treatments like chemotherapy and immunotherapy. These are not always easy decisions to make. 
 
People dealing with advanced illness often experience a range of emotions, good days and bad days. Now is likely a time when you may need to lean on others for support, comfort and a listening ear. Some people find talking to a trusted friend helpful, others find more formal counselling services most beneficial. You might consider connecting with supportive services or resources linked to the health center where you received care. Often social workers are available to support patients and families dealing with illness. They can provide emotional support, counselling and connect people with further supportive resources if needed or wanted.
 
Here are some articles from our website, to help inform some of your thinking as you continue to evaluate what is best for you in this situation;
- Health Care Decisions: An Approach to Decision Making and Advance Care Planning

We hope this information is helpful to you,

Warm regards,

-Ogechi (CVH Moderator)
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