My wife had Crohn's disease since a teenager, and was diagnosed with metastatic gallbladder cancer aged 52. A death sentence. She chose to do aggressive chemo to prolong her life from a few weeks to a few months. She suffered a great deal before she died.

An immunotherapy treatment was discussed, and it could possibly have helped a lot, but it carried a somewhat high risk of causing a disastrous Crohn's flare that would kill her immediately. The doctor was unwilling to try this because it might kill her. So she died inevitably without it.

It was a classic medical ethics case right there in our crisis. We did a lot of interesting and intense things in those months before she died. Fuck.

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southernplaces7 4 days ago | parent | next [-]

>An immunotherapy treatment was discussed, and it could possibly have helped a lot, but it carried a somewhat high risk of causing a disastrous Crohn's flare

I'm really sorry to hear about it playing out that way man. What a horrible dilemma to have to be in. Also, want to ask because I have a few people close to me with Crohns: Obviously there's a lot of nuance and detail in this kind of combination of two illnesses and a specific, very complex medicine, but would you mind sharing a bit more detail of why the immunotherapy was so risky for such a deadly flare? I know immunotherapies are sometimes used to even treat autoimmune diseases, so I'm very curious for this reason too.

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matheweis 4 days ago | parent [-]

The problem is that the cancerous cells are themselves descended from healthy cells; other than the small differences that make them cancerous, they are in fact the same thing.

Many of the cutting edge immunotherapies for cancer essentially teach the immune system to target the cancerous cells.

However, in combination with an autoimmune disease like Chrons where the immune system has already learned to react to healthy cells, there is a much higher chance that an immunotherapy intended to target only cancerous cells also causes the immune system to target more healthy cells.

	▲	robotresearcher 4 days ago \| parent [-]
		Yes, exactly. The specific risk for Crohn's is that the amped up immune system will rapidly kill ALL the gut cells that they've been pissed about for decades. For the unfamiliar: Crohn's is to guts what eczema is to skin. They are both autoimmune diseases where the immune system attacks a specific kind of healthy cell. Unhelpful.

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m_fayer 4 days ago | parent | prev [-]

It sounds like the most vicious possible dilemma to find yourself in. Cancer treatment has a way of doing that. I’m very sorry for your loss.