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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54817
Experience:  GP in the United States
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I have questions for a senior consultant / doctor

Customer Question

I have questions for a senior consultant / doctor
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 3 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

I am a licensed and practicing senior doctor in my practice and head of my department.

I can help

What is your question?
Customer: replied 3 years ago.
Hi my dad got his pathology report today re removal of colon tumor . They said dukes c1 stage .

28 nodes were taken
Out N I think they said 10 involved but only the ones closest to tumor , not elsewhere.

Tumor is a t3.

But I'm confussed that with a t3 n may be 10 nodes involved how if can be a c1?
Expert:  Dr. Phil, MD replied 3 years ago.
This is two different ways to describe the tumor

The C1 describes that the tumor penetrates through a certain layer in the intestine

T3 describes the depth of the tumor as well.

It would a T3N2M0 tumor with Dukes stage C1
Customer: replied 3 years ago.
Wen I read on Line a t3,n2 I'd dukes c2?

The dr also said none of the top nodes were affected just bottom ones. I didn't get what he meant by that
Expert:  Dr. Phil, MD replied 3 years ago.
C2 indicates that the tumor has penetrated through the muscularis propria

C1 is when it hasn't penetrated through

So his has not penetrated through

He means that nodes above the diaphgram are not affected

This is good and doesn't mean widespread disease
Customer: replied 3 years ago.
Is prognosis better then ? What are approx cure rates ?I read online that t3, n2 ,m0 is a c2 but they saying dukes c1
Expert:  Dr. Phil, MD replied 3 years ago.
C1 is better yes. Alot better

The 10 years survival for C1 is 75% versus 32% for C2

So very good odds here
Customer: replied 3 years ago.
Plus will give him
Chemo too which we are happy for him to
Have.

Are 10 nodes involved not an awful lot ? I was expecting 1-3?
Expert:  Dr. Phil, MD replied 3 years ago.
It is not a little or a lot

It is a medium amount

I wish him great luck in this.

Please don't forget a positive rating. I appreciate it
Customer: replied 3 years ago.
I wanted to just ask - afternoon
Which was 12 days ago he had lot bloating , burping couldn't eat etc. the did a abdominal ct scan today which showed a lot of fluid .

They have therefore inserted a ng tube. Is this worrying ?
Expert:  Dr. Phil, MD replied 3 years ago.
No, this just means that the tumor is blocking the gut

He will need surgery
Customer: replied 3 years ago.
They said no
Blockage and the tumor already removed 12 days ago .
Expert:  Dr. Phil, MD replied 3 years ago.
Oh ok

Then this is known as an ileus

The gut stops working after surgery sometimes and needs time to start again

this is common and it will reverse
Customer: replied 3 years ago.
Thx. Could mets still appear now that tumor is removed ?
Expert:  Dr. Phil, MD replied 3 years ago.
yes, it is possible

It needs to be watched closely
Customer: replied 3 years ago.
But could the chemo
Stop this?

Expert:  Dr. Phil, MD replied 3 years ago.
of course

that is the whole purpose of chemo

his prognosis is good.

Let's just hope :)
Customer: replied 3 years ago.
But can u have
Chemo and mets still form?

So c1 not too bad then?
Expert:  Dr. Phil, MD replied 3 years ago.
yes, you can still have mets form

it is possible

C1 10 year survival 75%

That is excellent

Please don't forget a positive.

I appreciate it
Customer: replied 3 years ago.
Sorry can I just ask, does a abdominal ct check liver too?
Expert:  Dr. Phil, MD replied 3 years ago.
Yes it does
Customer: replied 3 years ago.
With 10 lymph modes and a t3 tumor can he be a duke stage c1 ?
Expert:  Dr. Phil, MD replied 3 years ago.
Yes if it didn't penetrate the muscularis propria

Please don't forget a positive rating
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54817
Experience: GP in the United States
Dr. Phil, MD and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Even with 10 nodes only at bottom affected , is survival rate still good for c1 stage ?
Expert:  Dr. Phil, MD replied 3 years ago.
Yes I would say 75% 10 years is darn good
Customer: replied 3 years ago.
So what stage would a duke c1 be?

3a,3b, 3c?

Expert:  Dr. Phil, MD replied 3 years ago.
T3N2
Customer: replied 3 years ago.
The fact he had 10 nodes involved nr tumor only , does that not make his prognosis worse? Is 10 nodes an awful lot?
Expert:  Dr. Phil, MD replied 3 years ago.
No, it doesn't. 5 or more is the same prognosis

10 is a medium amount
Customer: replied 3 years ago.
Shud he accept chemo ?

Is it worse if the nodes above the diaphragm were affected too ?
Expert:  Dr. Phil, MD replied 3 years ago.
yes, he should definiteyl accept it

if they were above the diaphragm that would be much worse
Customer: replied 3 years ago.
We dont have to worry too much then that there r 10 nodes affected ?
Expert:  Dr. Phil, MD replied 3 years ago.
no more so than if there were 5
Customer: replied 3 years ago.
Ok. What is approx chance of re occurrence with c1?
Expert:  Dr. Phil, MD replied 3 years ago.
All I can tell you is 10 year survival is excellent

But even if it recurs, prognosis is still good.

colon cancer is a cancer that is highly treatable even in late stages
Customer: replied 3 years ago.
Thx lot for your help . Just that when I read websites for stage 3 with more lymph nodes, it always gives low stats like 30-40 percent curable
Expert:  Dr. Phil, MD replied 3 years ago.
It depends on the dukes stage and the specific stage 3

C1 has about 75% 10 year survival

that's all that really matters
Customer: replied 3 years ago.
So is dukes c1 same as a stage 3a?

Would he not be a 3a, 3b or 3c?
Expert:  Dr. Phil, MD replied 3 years ago.
It is a different classification system

He is 3c due to the fact that 10 lymph nodes are involved using this system

every system is different and there are many

please don't forget a positive rating. I appreciate it
Customer: replied 3 years ago.
But for 3c the 5 yr survival is about 40 percent
Expert:  Dr. Phil, MD replied 3 years ago.
I can't explain that differential

That has to do with the difference in staging/grading systems

Customer: replied 3 years ago.
But then can c1 still
Have good survival rate ?
Expert:  Dr. Phil, MD replied 3 years ago.
yes of course
Customer: replied 3 years ago.
Sorry -1 more thing. I just found out that the nodes in bowel
We're affected only . Not the ones elsewhere . What does this mean ?
Expert:  Dr. Phil, MD replied 3 years ago.
That just improves prognosis
Expert:  Dr. Phil, MD replied 3 years ago.
I appreciate the excellent rating.

I would be happy to help you in the future. Just ask for feedback. Thank you. :) Dr. Phil in your question opening or bookmark this page http://www.justanswer.co.uk/medical/expert-irondoc/

I greatly appreciate a positive rating in the customer satisfaction survey that you will receive via email. It is important for me to get your feedback. Thank you. :)
Customer: replied 3 years ago.
U say c1 had about 70 percent 10 yr survival .

He is equivalent to a 3c with 10 nodes - so the prognosis for 3c is only 45 percent ?

I am a little confussed .
Expert:  Dr. Phil, MD replied 3 years ago.
Yes it depends on the staging system.

They are not interchangeable nor are they 100% accurate

Why are you so fixated on survival chance? It changes nothing in regards XXXXX XXXXX plan
Customer: replied 3 years ago.
Im just worried that he's got 10 nodes involved . So u think he got good chances?
Expert:  Dr. Phil, MD replied 3 years ago.
Yes I do
Customer: replied 3 years ago.
Hi it's been over 2 weeks since myDads bowel surgery and he just cannot seem to eat. He has about 3-4 spoons of Anythjng we give him.An abdomen ct detected fluid in the andomen . They put an ng tube but nothing came out .Is this normal n what can be done?
Customer: replied 3 years ago.
Hi we are worried as my dad home now however cannot seem to eat. It's over two weeks since operation .

He will eat only few spoonfuls. He cannot taste the good, feels bloated and full. Is this normal.

When they did a abdominal ct it did reveal fluid lots but an ng tube did not drain it out. Could this b the reason ?I
Expert:  Dr. Phil, MD replied 3 years ago.
Yes, like I said before he has an ileus

The bowel is paralylzed

It will return back to normal
Customer: replied 3 years ago.
But he passing stools the issue is with food only ?
Expert:  Dr. Phil, MD replied 3 years ago.
I would need to know more about the case
Customer: replied 3 years ago.
Passing stool . Main issue is eating with bloating . Therefore lost lots of weight too . We r worried he won't b fit for chemo in 4 weeks.ct showed no blockage etc just excessive fluid in andomen - a distorted abdomen
Expert:  Dr. Phil, MD replied 3 years ago.
infection should be considered

what do his doctors think?
Customer: replied 3 years ago.
They can't figure out what it is .
Expert:  Dr. Phil, MD replied 3 years ago.
what medicine is he on including pain medicine?
Customer: replied 3 years ago.
Was on codine and still
Given bit morphine due to pain .

But since 2 dsys morphine stopped
Expert:  Dr. Phil, MD replied 3 years ago.
all pain meds should be stopped

they paralyze the gut

please don't forget a positive rating. I appreciate it

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