Hi,

My grandad was diagnosed with lung cancer a couple of years ago. He didn't want treatment so haven't had any scans since and have just been having 4 monthly meetings with oncologist with the aim of managing symptoms (the calls have been over the phone for the last year due to covid). 

He had some pain in his shoulders, some weight loss and has been coughing up more blood but no other changes until August 2020.

In August, we noticed problems with memory so took him to gp who did the dementia test and referred him to the memory team. They did a phone assessment and said mild to moderate dementia. He didn't have any scans for this either, his choice.

Since then, he has deteriorated significantly mentally to the point now where he needs 24 hour care. He talks a little but it doesn't make sense, he can't complete basic tasks, he's incontinent, has lost coordination and mobility is really poor. Since December he has lost a stone in weight, he doesn't eat anymore, hardly drinks, has been coughing up thick sticky phlegm and spits up most time he tries to swallow anything. 

I spoke to oncologist for routine appointment in Oct and mentioned his cognitive decline but nothing was mentioned about possible brain tumour and we continued investigation of this by the memory team as possible dementia made worse possibly by infections that were never confirmed. Antibiotics were prescribed but didn't improve the situation.

In the last month his decline has been very bad, especially in the past two weeks. He is becoming agitated and aggressive and hallucinating.

I spoke to the memory team on Wednesday and they said we should rule out his cancer as the cause. 

I spoke to oncologist the next day who said symptoms sound like a brain mets and his prognosis is very poor and to arrange hospice care.

He has been seen by district nurses and palliative care team who have said he looks stable and like death is not imminent so he should remain at home and also, they don't think it's a brain mets as he doesn't have headaches. Aside from the care issue which is very difficult to cope with (we are in discussions with social services as we speak)  we are extremely confused. The memory team say it's the cancer, the oncologist said he is about to die so get him to a hospice, the gp has prescribed end of life medication just in case but the palliative care nurse who is the only one who has seen him face to face has said he is stable and it's likely dementia rather than a brain mets.

Can anyone please help me to understand what's going on?

Has anyone experienced a similar pattern of decline/time frame.

Anyone with experience of brain mets that can give some insight?

If it is a brain tumour, should there be headache, seizures, one sided weakness etc?  

Thanks in advance for reading this far, any help would be massively appreciated