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Ask Dr. David Your Own Question

Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44419
Experience:  Board Certified Physician
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Oncologist

Customer Question

Oncologist
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

do you have a question?

JACUSTOMER-63qykhuk- : Hi the surgery my dad having done is called subtotal colostomy. The tumor is right side on cevum
JACUSTOMER-63qykhuk- : But there are also 3 large polyps that cannot be taken out via colonoscopy . Does this mean too much bowel will b removed? He is worried to do that and is thinking if he should just leave the polyps in?
Dr. David :

this is not too much bowels to be removed.

Dr. David :

he needs to have a subtotal right colectomy.

Dr. David :

colectomy is removal of the colon

Dr. David :

but not the whole colon

Dr. David :

just 1/2 of it on the right side.

Dr. David :

the left side colon will be left in.

JACUSTOMER-63qykhuk- : Hi thx for your answer . They have not said right but the dr said removing more bowel - subtotal
JACUSTOMER-63qykhuk- : Colestomy as he has also three large polyps which cannot be removed via colonoscopy.
JACUSTOMER-63qykhuk- : In your experience wound it be better to ask to leave the polyps and just remove tumor? That way less bowel remove .
JACUSTOMER-63qykhuk- : Or is there other ways to remove the polyps?
JACUSTOMER-63qykhuk- : Also in letter they have not said right side , just said sus
JACUSTOMER-63qykhuk- : Just said subtotal coke tony.
JACUSTOMER-63qykhuk- : Subtotal colectomy I mean
Dr. David :

I would remove the tumors and the polyps as well.

Dr. David :

since there are large polyps would just also remove them if they are in the same area as the colon cancer.

Dr. David :

I would do the subtotal colectomy.

Dr. David :

there is really no other way to remove these large polyps if they can't be removed by colonoscopy.

JACUSTOMER-63qykhuk- : Would a stoma be required with subtotal colestomy? Does that mean whole bowel is removed ?
Dr. David :

usually with a subtotal colectomy, a colostomy or stoma or permanent bag is not needed.

Dr. David :

sometimes a temporary colostomy or stool bag is needed to allow the connection of the bowel to heal

Dr. David :

does this make sense?

JACUSTOMER-63qykhuk- : Oh ok. And the surgeon just emailed me saying from
JACUSTOMER-63qykhuk- : Ct scan it could be possibly t3. Does this mean it's invaded quite deep?
Dr. David :

T3 means it has invaded through the bowel wall

Dr. David :

do you have any other questions?

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44419
Experience: Board Certified Physician
Dr. David and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Hi I just wanted ur view, my dad seems to want to leave the polyps in as that way less bowel will be removed , he just wants the tumor cut out . He has 3 large polyps Apparantly of 3.5 cm. is he taking a risk if he does this ? We are confused .
Expert:  Dr. David replied 3 years ago.
yes, he will risk not cutting out all of the cancer if one of those polyps contain colon cancer.

it would be a shame if he had his large tumor removed, only to leave in more pre or early colon cancer in one of those polyps.
Customer: replied 3 years ago.
The colonoscopy report states the polyps are benign . Would it still be a risk
To leave them in ? His main worry is all this bowel being removed
Customer: replied 3 years ago.
If it's t3 tumor does this mean it's likely to have spread to lymphs?
Expert:  Dr. David replied 3 years ago.
without a biopsy or removal of the polyps, they could contain early canacer.

why couldn't the polyps be removed during colonoscopy?

you said these were 3 large polyps before.

yes with T3, there is a chance there is spread to lymph nodes.
Customer: replied 3 years ago.
They said too large to remove with colonoscopy . But ur right they could contain early cancer so best to
Get rid and also can turn cancerous anytime .

If he has to have chemo can he have by tablet form
?
Expert:  Dr. David replied 3 years ago.
if these polyps are really that large, they need to be removed.

tablet chemo usually is xeloda oral 5FU chemotherapy.

usually for advanced colon cancer, FOLFOX chemo regimen is given which is 5FU and oxaliplatin and leukovorin.

switching the 5FU for xeloda becomes the XELOX regimen.
Customer: replied 3 years ago.
Although no
Spread and with a poss t2 or t3, do you think
This is advanced ?
Expert:  Dr. David replied 3 years ago.
T3 is advanced.

N1 if lymph nodes are involved is advanced and either of these would need chemotherapy
Customer: replied 3 years ago.
Can it be a t3 and still be a stage 2?
Expert:  Dr. David replied 3 years ago.
no.

T3N0 would be stage IIA
Customer: replied 3 years ago.
Is prognosis better for a stage IIa?
Expert:  Dr. David replied 3 years ago.
yes, better for stage II than for stage III
Customer: replied 3 years ago.

Hi u know the ct scan my dad had in nov of abdomen pelvis and chest would that look at the bladder too ? Cuz I know Colin cancer can spread to bladder .


 


Also from the biopsy via colonoscopy can they tell if it's a fast or slow growing tumor ? I am wondering why they didn't want to repeat scans or do the op sooner ?

Customer: replied 3 years ago.

In your opinion can colon cancer spread within a few months ? My only worry is in case it has and no onE knows.

Expert:  Dr. David replied 3 years ago.
yes, the CT scan would have looked at the bladder.

it is super rare for colon cancer to spread to the bladder.

we don't use a biopsy to look for fast growing or slow growing cancers.

the date of the surgery depends on the surgeons operating schedule. I wish he can do the surgery earlier as well.

I understand your worry.

no one can know if his colon cancer has spread or not.

I hope it hasn't. I hope he can get his surgery sooner.



but that depends on his schedule and the schedule of the anesthesia doctors.
Customer: replied 3 years ago.
Surgery for 26 feb so not long. But although his scans were clear in nov cud it still have spread ?
Expert:  Dr. David replied 3 years ago.
that is good.

surgery in 2 weeks.

always a small chance his colon cancer can spread.

try not to stress about this.

nothing more to do now except wait for the surgery.
Customer: replied 3 years ago.
Is bowel surgery risky ?
Expert:  Dr. David replied 3 years ago.
there are some small risks to it,

but overall it is very safe

and is needed to cut the colon cancer out.

so the risks are worth it.
Customer: replied 3 years ago.
Yea true . Thx for all your advice .
Expert:  Dr. David replied 3 years ago.
you are welcome

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here 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 3 years ago.
Hi we saw the dr again today as I was concerned re spread . He said the chances are slim as his tumor is slow growing . How can the dr know it's a flow growing tumor ?

Also we discussed surgery . Is it safe as my father did have a minor attack
In July last year and he also recently had blood clots in his lungs which he is on blood thinning injections for? Is surgery risky for him
Then or not?
Expert:  Dr. David replied 3 years ago.
there is no way to know if it is a slow growing tumor.

there is always a risks for colon surgery which is a major surgery.

hopefully his heart can take the surgery. he should be able to . no real option otherwise. he needs to have the colon surgery. when is the surgery scheduled for? next week?
Customer: replied 3 years ago.
25 feb yea. His heart fine otherwise etc . I
Dont get how dr made that comment that's it's slow growing tumor
Expert:  Dr. David replied 3 years ago.
I don't know either.

perhaps the doctor could sense you were worried and was just trying to put your mind at ease.
Customer: replied 3 years ago.
Yea possibly cuz I am worried . I hope it has not gone to the lymph nodes . Do most tumors Go to the lymphs with Colon?

How long is surgery usually ?
Expert:  Dr. David replied 3 years ago.
many colon cancers can spread to lymph nodes.

surgery is usually several hours.
Customer: replied 3 years ago.
But only a pathological examination would reveal this right ?
I think thr main worry is lymph node spread . I hope it hasn't
Expert:  Dr. David replied 3 years ago.
yes, only pathological exam would show this

I hope it hasn't spread to lymph nodes either.
Customer: replied 3 years ago.
The fact that he's had anemia for atleast 1.5 years, would this suggest it's advanced ?
Expert:  Dr. David replied 3 years ago.
I have answered this question for you before.

we don't know until he has the surgery.
Customer: replied 3 years ago.

Hi . We have a face to face meeting with consultant today . Op


For 26 march as he wants a particular urologithere be there.


 


He said the urologist seems to think partial or total removal of kidney most likely will be required . But will know more on the day .


 


The ct scan states T4.


 


They think tumor encroaching on the kidney . What does this mean ?

Expert:  Dr. David replied 3 years ago.
I have explained this to you before.

that means the colon cancer is right up against the kidney.
Customer: replied 3 years ago.
Would this be a stage 4 then ?
Expert:  Dr. David replied 3 years ago.
no, T4N0M0 is stage IIC
Customer: replied 3 years ago.
The December ct scan also states n1. ?
Expert:  Dr. David replied 3 years ago.
I'm not sure where they saw the lymph node.
Customer: replied 3 years ago.
On the december scan they quoted n1.

Expert:  Dr. David replied 3 years ago.
I don't remember that on the CT report which didn't say much.
Customer: replied 3 years ago.
It was on old ct report of December .

Would it be stage 4 then ?

Also if tumor up against kidney is cutting kidney necessary ?
Expert:  Dr. David replied 3 years ago.
T4N1 would be stage III

only at the time of surgery will cutting of the right kidney be determined.
Customer: replied 3 years ago.
Does this mean cancer is in the kidney too ?
Expert:  Dr. David replied 3 years ago.
no, N1 means there is though that the cancer could have spread to lymph nodes.

the surgery will be able to confirm if this is true or not.
Customer: replied 3 years ago.
As lymph nodes can be enlarged due to other reasons right ?

So invasion of kidney does not mean cancer cells in kidney right ? Sorry just checking cuz its really got us worried now .
Expert:  Dr. David replied 3 years ago.
it depends on where the lymph nodes are and how large they are

but if they are in the mesentary close to the colon cancer, and if they are larger than 2cm in size, then this can be very suspicious of colon cancer spread to lymph nodes.

hopefully the colon cancer has not grown into the kidney.

the surgeon will find this out at the time of the surgery.

if it has, then part or the whole right kidney might have to be removed for a clean surgery.
Customer: replied 3 years ago.
ok. Would he be fine then do long as part/ whole kidney removed in terms of cure?

But the fact the fat plane not there strongly suggests kidney invasion right ?Have u seen cases where Its like this but kidney
Not invaded?
Expert:  Dr. David replied 3 years ago.
he will be fine if he has part of his whole kidney removed.

I have not seen cases like that.

his surgeons are worried enough about kidney invasion to ask a urology doctor to be there for potential kidney surgery.
Customer: replied 3 years ago.
ok one thing I wanted your advice . He has 2 polyps . The scan n biopsy suggest they are benign . My dad does not want to remove them as this will
Mean a sun total collectomy. If tumor only removed, only right part will be removed.

With so much going on and with him being high risk
Due to heart problems , he wants it kept less complicated.

But surgeon saying remove them or other option is just removing the polyps from the top and this will then create 3 joins which more risky due to leaks .If he leaves them
As they are is it a big risk?
Customer: replied 3 years ago.
Fat stranding and small
Volume lymph nodes keeping in line with tumor ur says in ct scan I sent u. Does this mean cancerous ones?
Expert:  Dr. David replied 3 years ago.
he should get a larger colon surgery and a subtotal colectomy.

better to get out the polyps and the lymph nodes at the time of surgery.

do not limit what the surgeons want to cut out.

this is a big part of trying to cure him of his colon cancer.

small volume lymph nodes are unclear if they contain cancer or not. only the surgery will be able to tell for sure.
Customer: replied 3 years ago.
they will remove tumor n the lymph nodes but he wants to keep
Polyps in. Is there a chance they may be already cancerous of ct and biopsy have shown benign ?
Expert:  Dr. David replied 3 years ago.
there is a chance there could be cancer in those polyps.

you don't know until they are removed.

usually polyps are easily removed during colonoscopy.

if they were snar loop biopsied during colonoscopy, then they are removed with colonoscopy.
Customer: replied 3 years ago.
They are 2.7cm n 2.9 cm so cannot be removed with colonoscopy . Is there any other way?
Expert:  Dr. David replied 3 years ago.
those are very large polyps.

and should be cut out if close to the cancer.

they could contain cancer, even if the biopsies were negative.

they could be sateltite colon cancer lesions.
Customer: replied 3 years ago.
they are not close to the cancer . He wants to leave them
In and just have a hemi- collectomy done

Can I ask -kidney invasion goes not mean cancer cells in kidney right?
Expert:  Dr. David replied 3 years ago.
kidney invasion means cancer cells directly invading into the kidney from local extension from the colon cancer.

not metastatic to inside of the kidney.

there is a subtle differenc.e
Customer: replied 3 years ago.
So mets r different to local direct invasion?

Expert:  Dr. David replied 3 years ago.
yes, metastatic disease is different from loca direct invasion.

direct invasion is T4

metastatic disease travels through the blood stream and is M1

Customer: replied 3 years ago.
I wanted to ask although ct scans may show no mets, can there still be cancer cells in the body and how this can b found out?
Expert:  Dr. David replied 3 years ago.
small cancer cells can not be found out through scans.

only time can tell if they grow and are seen on scans.
Customer: replied 3 years ago.
oh I see. I'm trying if I can get the actual ct images . May be hard . Can they just not remove the tumor without having to remove kidney?
Expert:  Dr. David replied 3 years ago.
they can't do that if there is direct invasion of the cancer into the kidney.
Customer: replied 3 years ago.
sorry just wanted to check last thing . If invasion of kidney , does that mean there could be microscopic cancer cells in the kidney which a ct scan does not show and a pathological examination would have to be done?

Expert:  Dr. David replied 3 years ago.
yes.
Customer: replied 3 years ago.
Just say they remove partial n then cancer cells are in the kidney ?
Customer: replied 3 years ago.
is it uncommon for the kidney to be invaded?
Expert:  Dr. David replied 3 years ago.
it is uncommon for the kidney to be invaded directly by a colon cancer.
Customer: replied 3 years ago.
Without the fat plane it does not mean that kidney is Invaded right?

I know surgery will tell but if u had to put a percentage on it that it has invaded, what would you say ?

Sorry but all this waiting now really gettin stressfully for the family
Expert:  Dr. David replied 3 years ago.
I can't see the images, so I can't give you a precentage

I don't know. possibly 50/50?
Customer: replied 3 years ago.
Will the hosp give me images ? Cuz them ul have a better idea?
Expert:  Dr. David replied 3 years ago.

I don't know if your hospital will give you images.

 

you can ask for them.

Customer: replied 3 years ago.

Hi the ct report I sent you, can u tell


From therehave they have checked the lungs for spread ?

Expert:  Dr. David replied 3 years ago.
the CT report was for the abdomen and pelvis I think.

you need a chest CT scan report to check for metastatic spread to the lungs.
Customer: replied 3 years ago.
It does say lung basis are clear ?
Expert:  Dr. David replied 3 years ago.
yes, the top of the abdominal CT scan will show the lung base, just the bottom of he lungs

but you need a full chest CT to see the full lungs. I don't think that has been done yet.
Customer: replied 3 years ago.
u see he has a cough which is not
Clearing therefore I was concerned about lung mets
Expert:  Dr. David replied 3 years ago.
then he needs a chest CT scan.
Customer: replied 3 years ago.
hes had a chest X-ray and an echocardiogram - which was clear apart from
Bit mucus plugging . Would this detect it?
Expert:  Dr. David replied 3 years ago.
a chest xray is not as good as a chest CT scan.

I would get a chest CT scan.

it is more customary to do a chest CT scan here in the USA.

in the UK, they tend to cut costs and use a chest xray which is much cheaper. but chest xray technology is from the 1940s. and not as detailed as a chest CT scan.
Customer: replied 3 years ago.
the last chest ct was in december which was fine and then on this abdomen n pelvis one only the bases are shown. His op is next wed but we should request one right ?
Expert:  Dr. David replied 3 years ago.
if he had a chest CT scan in december and it was normal, then that is fine.
Customer: replied 3 years ago.
But could mets not have developed since ?He had 1 in January too for his pulmonary embolism
Expert:  Dr. David replied 3 years ago.
if he had a chest CT scan in december and in January, I would not worry about new lung mets now. that is fine

chances of new lung mets now are small.
Customer: replied 3 years ago.
Ok thanks
Expert:  Dr. David replied 3 years ago.
you are welcome

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here 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 3 years ago.
Wat does n1 mean?

On ct it says fat stranding small volume lymph nodes noted but in the surgeons notes from mdt meeting he wrote n1. Does this mean camcerous nodes ?
Expert:  Dr. David replied 3 years ago.
it means it is worried about the possibility of cancerous lymph nodes.
Customer: replied 3 years ago.
Hi. My dad has a cough which is not going despite antibiotics . Should we request a chest ct? Could this mean spread to lungs ?
Expert:  Dr. David replied 3 years ago.
it could be viral

most likely not from cancer if her last CT scan was clear

that was done in January right?

so lung mets wouldn't grow and spread in 2 months to cause symptoms.

so his cough is more likely due to allergies or post nasal drip

does he smoke? that can cause cough as well
Customer: replied 3 years ago.
He's a heavy smoker yes. Although we do tell him to stop . Ct of chest was 5 January .

U know for say example a stage 3(b) are survival rates 5 years only about 45 percent?
Customer: replied 3 years ago.
Can't see him
Being less than stage 3 due to the t4 tumor and also if a t4 there must certainly be lymph node involvement
Expert:  Dr. David replied 3 years ago.
most likely his smoking is causing him to cough.

smoking can make his surgery more difficult as well.

that survival rate sounds about right. where did you get that information?

if T4, doesn't have to mean lymph node involvement. it can mean higher chances of lymph node involvement, but not necessarily the case.
Customer: replied 3 years ago.
i got that rate from Internet I'm
Reading up
Too much I think . That's not a very high rate is it ? Quite worrying. Yea ur right t4 dont always involve lymphs but on my dads ct they have stated that comment about small volume fat stranding lymph nodes noted keeping in line with tumor .

Wat does that mean - keeping in line with tumor
Expert:  Dr. David replied 3 years ago.
that means that that the nodes seen look like they could very well contain tumor spread.
Customer: replied 3 years ago.
is the 5 yr survival rate around 40 percent cuz with stage 3 the tumors later appear as mets to liver , lungs?
Expert:  Dr. David replied 3 years ago.
yes, these cancers can be more aggressive and spread later on.

Customer: replied 3 years ago.
even with chemo ?

Is it quite rare for kidney to b removed with Colom cancer ?

The fact that a urologist will b present does it suggest they will remove ?
Expert:  Dr. David replied 3 years ago.
it is rare for a kidney to have to be removed for colon cancer.

it means they might have to remove it depending on what is found.
Customer: replied 3 years ago.
Sorry last thing what goes it mean wen the radiologist states the small volume lymph nodes are keeping in Line with the tumor ?
Expert:  Dr. David replied 3 years ago.
that these small lymph nodes could contain colon cancer spread.
Customer: replied 2 years ago.

Hi I just wanted to check that if 1/4 of the kidney is removed is that alot ?

Expert:  Dr. David replied 2 years ago.
no, that is not alot

Customer: replied 2 years ago.
Wi he be able ul
Have chemo tablet form assuming lymph nodes are involved ?

Also it's been 9 days post surgery he getting lot of pain near wound n it's slightly tender and appetite Is still very little. Is this normal ?
Expert:  Dr. David replied 2 years ago.
yes, normal to have tenderness near wound

too early for chemo at this point.

chemo will depend on path findings and the preference of his medical oncologist.

Customer: replied 2 years ago.
what do the path findings look at?

Will it be grade, no of lymph nodes ?

What happens with that bit of the kidney they cut?
Expert:  Dr. David replied 2 years ago.
the pathology findings look at all of that.

the kidney will heal up.

the rest of the kidney will work normally.
Customer: replied 2 years ago.
The bit they cut of kidney, what would they test that for?
Expert:  Dr. David replied 2 years ago.
they will test for colon cancer invasion.
Customer: replied 2 years ago.
if ther Is invasion would it not have been safer to remove all kidney then?
Expert:  Dr. David replied 2 years ago.
the surgeons felt that the area at highest risk was cut out in the bottom 1/4 of the kidney.
Customer: replied 2 years ago.
I needed your advice . 9 days post surgery my dad has started to vomit since yesterday after eating even 2 spoons. Not eaten 2,3 days . He was doing ok before was able to eat bit by bit. He feeling b v weak cuz not eating

Stools are now passing.

What could this be?
Expert:  Dr. David replied 2 years ago.
He could be having excessive stomach acid

Or still have some mild paralysis of the stomach

Is he getting out of bed and walking some?
Customer: replied 2 years ago.
hes walking very little cuz he getting lot of pain still .

But anything eating since Thursday he vomitting it out. They will
Do a abdominal X-ray . Will they check
For obstruction?
Expert:  Dr. David replied 2 years ago.
They should check an X-ray and check on bowel has patterns
Customer: replied 2 years ago.
Ok. It not likely to be a leak right ? He is since last few days taking morphine bit too again due to pain .could it b as a result of that?
Expert:  Dr. David replied 2 years ago.
no, not likely to be a leak

morphine can upset the stomach and cause nausea

have them give his morphine by vein.
Customer: replied 2 years ago.
U know as the surgeon cut bit of the kidney , the tumor itself is definitely a t4 now then isn't it . I cannot b a t3 right ?
Expert:  Dr. David replied 2 years ago.
it depends on the findings of the pathology report.
Customer: replied 2 years ago.
Hi can I just ask last question please . As bit of kidney has been cut does this mean tumor has spread to a nearby organ and if also lymph nodes Involved , it would mean its a 3c stage ?

I was just reading up the stages
Expert:  Dr. David replied 2 years ago.
if the pathology report shows that there is kidney invasion, and if there is also lymph node invasion as well, then it would be T4N1 disease

yes, I think that would be stage IIIc colon cancer.
Customer: replied 2 years ago.
My dad has lot gas I think. Burping, hiccups , food comes back up and burning. Therefore 3 days
Now not eaten at all. What could this be?
Expert:  Dr. David replied 2 years ago.
he could be having excessive stomach acid.

he might do better with an antacid for his stomach.
Customer: replied 2 years ago.
could this be sign of
Obstruction ? His tummy looks bloated too
Expert:  Dr. David replied 2 years ago.
if he is having bowel movements then most likely not obstruction

but he should get an xray of his abdomen to look for free air and air fluid levels.

he is in the hospital so it should be easy to get an abdominal xray.
Customer: replied 2 years ago.
They have done X-ray this morning just waiting result . Could it b anythin serious?
Expert:  Dr. David replied 2 years ago.
hopefully nothing serious.
Customer: replied 2 years ago.
Could something gone wrong Inside?
Expert:  Dr. David replied 2 years ago.
the xray can get more information.
Customer: replied 2 years ago.
could he have ileus as not eating, bloating , burping and abdominal discomfort ? Also
Noticed the vomit yest was green
Expert:  Dr. David replied 2 years ago.
if he had ileus, he would not be passing stools or gas.

the xray of the abdomen can check for ileus.
Customer: replied 2 years ago.
For intestinal
Obstruction can u still pass stool.?
Expert:  Dr. David replied 2 years ago.
for partial small bowel obstruction, he might be able to pass some stool.
Customer: replied 2 years ago.
Ok. Path results out Tom so will let you know. Really worried re that too.

For a stage 3c , would you say there's a high chance of spread or does it just depend .? Now I'm Worrief that if a 3c mets can appear
Expert:  Dr. David replied 2 years ago.
for stage IIIc, there is a high chance for spread

but all of his scans prior have not shown spread to the liver which is the first place of spread.

let me know what the path shows. get a full copy of the report
Customer: replied 2 years ago.
Can the spread take place after once the tumor removed?Like weeks or months after or even years!
Expert:  Dr. David replied 2 years ago.
yes, tumor can spread.

so that is why he most likely will need chemo after he recovers from his surgery to help decreaes the risks for spread.
Customer: replied 2 years ago.
The pathology report shows dukes c1 with no kidney invasion?
Expert:  Dr. David replied 2 years ago.
good. no kidney invasion.

so Not T4

so it should be T3

but because dukes c, there is lymph node involvement.
Customer: replied 2 years ago.
So does c1 mean a 3a?

Is it good that no kidney invasion ?
Expert:  Dr. David replied 2 years ago.
it would mean stage IIIa or IIIb, depending on the number of lymph nodes were involved

find out how many lymph nodes contained cancer and how many lymph nodes were taken out.

yes, good news no kidney invasion!
Customer: replied 2 years ago.
28 taken
Out
Expert:  Dr. David replied 2 years ago.
awesome! how many had cancer?
Customer: replied 2 years ago.
Think
10 did but only the lower ones dr said were affected which Apparantly they stated as good !

But 10 is an awful
Lot. Ppl have 1-3 usually
Customer: replied 2 years ago.
I don't get how they say dukes c1 if 10
Nodes affected? I am
Confussed
Expert:  Dr. David replied 2 years ago.
that would be dukes C2

or stage IIIC T3N2M0
Customer: replied 2 years ago.
They said c1?
Expert:  Dr. David replied 2 years ago.
  • Stage C1: Extending into muscularis propria but not penetrating through it. Nodes involved
  • Stage C2: Penetrating through muscularis propria. Nodes involved

double check this to make sure it is C1

Customer: replied 2 years ago.
Yea we checked twice it's def c1. Do
What stage is that?
Expert:  Dr. David replied 2 years ago.
I don't have his full pathology report.

I need to see it

you can read about staging here.

http://en.wikipedia.org/wiki/Colon_cancer_staging

C1 is T2N1M0
Customer: replied 2 years ago.
Ok
Il try get it and send you . Are 28 nodes too much to
Take out?
Expert:  Dr. David replied 2 years ago.
no, 28 nodes are fine

10 nodes are a lot of nodes to contain colon cancer. that is N2 disease.

he will definitely need chemotherapy.

N1 is 1-3 LN
N2 is 4 or more LN containing cancer.
Customer: replied 2 years ago.
But they said that Apparantly none top
Ones were affected only bottom ones and thats good ?

What they mean by that ?

So for it to be a c1, would this be a t2 tumor?
Expert:  Dr. David replied 2 years ago.
I dont' know what they mean by top or bottom lymph nodes.


I think so.
Customer: replied 2 years ago.
May be there are not 10 involved. My brother was talking to the dr at hosp.

But it's strange if from a t4 it now a t2 right ?
Customer: replied 2 years ago.
Just spoke to consultant on phone . He saying def c1. But the top lymph nodes, none were affected . Does he mean distant lymph nodees?

Would a c1 be a stage 3c then ?
Expert:  Dr. David replied 2 years ago.
Yes unusual to be t2 now

I don't know what the top lymph nodes mean
Customer: replied 2 years ago.
they said all the top nodes were clear . The ones close to tumor only affected and is c1 with no kudney invasion .

U don't just understand wat the t would b and the actual stage
Expert:  Dr. David replied 2 years ago.
the pathology report should say for sure if it is a T2 or T3 colon tumor

and were the lymph nodes were taken from

I would ask your doctors for a copy of the full pathology report.

I would be happy to review it with you
Customer: replied 2 years ago.
Will try get it but with 10 nodes could it still be a dukes c1?

Expert:  Dr. David replied 2 years ago.
yes.

dukes staging system does not differentiate between how many nodes are involved.

if one node involved or 20 nodes involved, they are all duke C stage.

the TNM staging system does differentiate the difference.

N1 means 1-3 nodes
N2 means 4 nodes or more.
Customer: replied 2 years ago.
Ok. Would it be a 3a, 3b, 3c if a c1?

It's a t3. I just double checked it . Not t4.
Expert:  Dr. David replied 2 years ago.
T3N2 would be stage C2 staging

  • Stage C1: Extending into muscularis propria but not penetrating through it. Nodes involved
  • Stage C2: Penetrating through muscularis propria. Nodes involved
T3: Tumor invades subserosa or beyond (without other organs involved)

if a tumor is T3, then it has gone through teh muscularis propria and then the subserosa or the wall of the colon bowel

Customer: replied 2 years ago.
Yea that's what I'm reading . I think my brother has misunderstood somewhere . U can't have a c1 if 10 nodes involved right cuz if 10 nodes involved it would be a c2?
Expert:  Dr. David replied 2 years ago.
no. the difference between C1 and C2 is the depth of tumor invasion. not the number of lymph nodes.

N1 and N2 of the TNM system is number of lymph nodes.
Customer: replied 2 years ago.
So a c1,n2 would be What staging ?
Expert:  Dr. David replied 2 years ago.
we don't mix Dukes staging (A,B,C)

and TNM staging.

I think he has a C2 Dukes stage

or a T3N2M0 AJCC stage IIIC colon cancer.
Customer: replied 2 years ago.
Ok. Is it good 28 nodes were taken out ?
Expert:  Dr. David replied 2 years ago.
yes, that is fine that 28 nodes were taking out.

it doesn't improve the odds of survival or local control by having more lymph nodes taken out.

but there is a minimum of 12 which need to be taken out. he had more than the minimum required taken out
Customer: replied 2 years ago.
So a c1 duke stage cannot be a IIIc right but c2 dukes stage can be a IIIc?
Expert:  Dr. David replied 2 years ago.
Dukes C1 would be a T2N1or2 stage

Dukes C2 would be T3N1or2 stage
Customer: replied 2 years ago.
I emailed him again .

T3 tumor
C1 dukes stage
He said the tumor had not gone all
The way through
10 nodes affected
Expert:  Dr. David replied 2 years ago.
any penetration through the wall of the colon is a T3 tumor.

if he says T3 then, he has T3 tumor.

Some old time doctors don't use the C1 or C2 designation for Dukes. they just say Dukes A or B or C.

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here 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 2 years ago.
I understand it's dukes c, but then u get 3a,3b,3c so which it would fall
Under? Sorry last question
Expert:  Dr. David replied 2 years ago.
here read this webpage

there is a good chart on the page which explains it

http://www.hopkinscoloncancercenter.org/CMS/CMS_Page.aspx?CurrentUDV=59&CMS_Page_ID=EEA2CD91-3276-4123-BEEB-BAF1984D20C7

Customer: replied 2 years ago.
Thx u think he should have chemo
And If he does Is prognosis better?
Expert:  Dr. David replied 2 years ago.
yes he should receive chemotherapy

his prognosis is better if he gets some chemotherapy.
Customer: replied 2 years ago.
I read that link
But as you say for a c1 it got to be a t2 or t3 with less than 4 nodes . I don't know how they have put him as a c1
Expert:  Dr. David replied 2 years ago.
bring the link to her cancer doctors and have them explain it.
Customer: replied 2 years ago.
.ok. So can a t3,n2,m0 de a dukes c1?

Sorry final question
Expert:  Dr. David replied 2 years ago.
no, that would be dukes C2
Customer: replied 2 years ago.
May be there are not 10 nodes il check again but thx so much for ur help
Expert:  Dr. David replied 2 years ago.
you are welcome

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here 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 2 years ago.
Can I just check with u, what is the cure rate / survival for dukes c1?
Expert:  Dr. David replied 2 years ago.
about 47% survival at 5 years

see here

http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bowel/survival/bowel-cancer-survival-statistics
Customer: replied 2 years ago.
Is c1 equivalent to a 3c?
Expert:  Dr. David replied 2 years ago.
haven't we been through all of this already?

Customer: replied 2 years ago.
Oh yes we did sorry .

Will b 6 months ?
Expert:  Dr. David replied 2 years ago.
6 months what?
Customer: replied 2 years ago.
Chemo will b 6 month?
Expert:  Dr. David replied 2 years ago.
it depends on the regimen they recommend.
Customer: replied 2 years ago.
They said no nodes above diaphagram
We're not affected . Does that make a difference ?
Expert:  Dr. David replied 2 years ago.
why would they take out lymph nodes above diaphram from a right colon surgery?

no nodes above diaphram would be seen on CT scan of the chest

lymph nodes above abdomen would be considered metastatic disease
Customer: replied 2 years ago.
They said all top nodes were fine so that means above abdomen ?
Expert:  Dr. David replied 2 years ago.
I guess that is what they mean.

it seems quite a silly thing to say.

colon cancer spreads most commonly to lymph nodes in the abdomen and around the colon and to the liver first. that is where colon cancer would go first.

spreading to lymph nodes above the diaphram is rare.

these lymph nodes above the diaphram are not taken out during surgery.


we see them on CT scan of the chest.

so these top nodes were known to be free of cancer before the surgery
Customer: replied 2 years ago.
U think I'm worrying too much ?

There still a risk right of liver mets then ?
Expert:  Dr. David replied 2 years ago.
yes, I think you are worrying too much

the preoperative CT scans showed no liver mets.

please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

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