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Ask Dr. David Your Own Question
Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 46953
Experience:  Board Certified Physician
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Can I speak to oncologist please?

Customer Question

Can I speak to oncologist please?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

I am an oncologist

Dr. David :

what questions do you have?

Customer:

Hi I wanted to ask ur advice . My dad us reallystruggling with the stoma bag. He has a rash near the surrounding area which is very painful, itchy and burns .Plus has hernia . They say if gets bigger it can b dangerous and then hard to operate . He's on third cycle of xeloda . Is there any way the reversal can be done n thereafterhere continue the xeloda ?

Dr. David :

he could have a fungal infection around his stoma bag.

Dr. David :

it sounds like his skin might be breaking down around his stoma bag as well.

Dr. David :

his doctors and surgeons should be talking to each other about a plan to fix his stoma

Dr. David :

and he might need a break from his xeloda chemotherapy.

Customer:

Lots of ointments have been tried but still no good plus the hernia a

Customer:

Big concern.

Dr. David :

I understand.

Dr. David :

so hopefully he can get his ostomy reversed soon.

Dr. David :

they did the ostomy as a temporary ostomy to allow his bowel anastamosis to heal.

Dr. David :

usually that can take 3-6 months to heal depending on his healing abilities.

Dr. David :

his doctors don't want his anastamosis to leak when his ostomy is reversed.

Customer:

Yes exactly they only did it temporarily .

Customer:

So can he have the reversal n then start the rest of chemo . Has 3 cycles to go

Dr. David :

yes, the worry is if his anastamosis has had enough time to heal.

Customer:

How can we know if it's healed? Surgery was in march ?

Dr. David :

usually it takes 3-6 months to heal

Dr. David :

his doctors can do a barium contrast study

Dr. David :

like a barium enema study to see if they can see the anastamosis

Dr. David :

and see if there is any leaking.

Dr. David :

and if there is no leaking, it could be healed up by now.

Customer:

Then could he continue chemo after ?

Dr. David :

yes, then he could continue on with xeloda chemo after his ostomy is reversed.

Dr. David :

let me know if you have other questions.

Dr. David :

if done, please leave positive feedback below the chat box

Dr. David :

thanks for using JustAnswer.com

Customer:

It's just that the dr say he must stop chemo before reversal ? Why is that ?

Dr. David :

so his immune system is not down and doesn't complicate the small surgery to reverse his ostomy.

Dr. David :

do you have any other questions?

Customer:

he has a scan in 2 weeks as we were worried Re his cea .is it notnsl

Dr. David :

don't worry about his CEA.

Dr. David :

his CEA of 6 is fine.

Dr. David :

I am not worried.

Customer:

I know I trust ur opinion alot but y from may to July Would it double from 3 to 6?

Dr. David :

these levels are still very low.

Dr. David :

any inflammation can cause that CEA level up to 6.

Dr. David :

without cancer in you and me, we could get CEA blood level of 6 very easily.

Dr. David :

CEA is not a very good blood test.

Dr. David :

it has never been shown to be a good way to detect early cancer for screening.

Customer:

Ok. I suppose the double increase got me frightened from 3-6 ESP as he had colon cancer surgery .so these figures would not suggest mets in the body. ?

Dr. David :

no, I have told you before they are not a sign of metastasis in the body.

Dr. David :

these levels are still too low.

Dr. David :

I have told you this before.

Customer:

Could xeloda cause it?

Dr. David :

possibly.

Dr. David :

xeloda can cause some inflammation in the body as well.

Customer:

With cea rise and blood in stool we r panicking ?

Dr. David :

talk to his doctors

Dr. David :

his doctor will also tell you not to panic.

Customer:

As he had surgey In march I suppose it would b too soon for mets to show up on scan right ?

Dr. David :

most likely his scan will not show mets.

Dr. David :

his surgery did not show any spread to lymph nodes, correct?

Customer:

It showed lymph nodes . 22 were removed and 10 bear the tumor site had cells in them but no other spread

Dr. David :

ok

Dr. David :

I remember now.

Customer:

What do you think of that ?

Dr. David :

that is fine

Dr. David :

he should be getting chemo.

Dr. David :

hopefully he won't have mets on his next scan.

Customer:

Yes he's on third cycle . Last q.Can inflammation on skin cause cea rise?

Dr. David :

yes, inflammation on the skin, or a hernia or bowel inflammation can all cause CEA to rise.

Dr. David :

let me know if you have other questions

Dr. David :

if done, please leave positive feedback below

Dr. David :

we only get credit for helping clients after positive feedback

Dr. David :

thanks

Customer:

Thx so much .

Dr. David and other Medical Specialists are ready to help you
Customer: replied 3 years ago.

Can blood in the stool mean hernia is causing obstruction. ?

Expert:  Dr. David replied 3 years ago.
many things can cause blood in the stool.

constipation or ischemic cholitis or bowel allergy or severe constipation.

if he is having bowel movements and his ostomy is functioning and putting out stool, then most likely there is no obstruction.
Customer: replied 3 years ago.

Can hernia b serious ?

Expert:  Dr. David replied 3 years ago.
only if the hernia is trapping the bowel

it is called incarceration of the bowel

we have talked about this before.
Customer: replied 3 years ago.

How can they find if trapping bowel ?


 


Im surprised the onco is not doing any tests to find this out.


 


Bur as he bleeding with stools could this mean re growth of tumor in bowel ?

Expert:  Dr. David replied 3 years ago.
an ultrasound and an abdominal xray can look for trapped bowel

or he can wait until his CT scan in 2 weeks.
Customer: replied 3 years ago.

With his hernia too is or better he gets this sorted and the reversal ?


 


Will him starting chemo after reversal put him at a disadvantage ?


 


And lastly how long does he have to stop chemo


For before the reversal ?

Expert:  Dr. David replied 3 years ago.
if the hernia is bothering him or causing problems, it is best to get fixed

his surgeons can fix this when they reverse is ostomy

he will be fine to resume chemo xeloda pills after his reversal. there is no disadvantage to this.

his surgeons will advise him of how long he needs to stop his xeloda.
Customer: replied 3 years ago.

Thx. due to bleeding And steady cea rise could this suggest regrowth of the same tumor ?

Expert:  Dr. David replied 3 years ago.
his CEAs are only at 6. this is too low to suggest anything.
Customer: replied 3 years ago.

Ok he has not had a cea done this month yet but say it rose again to 8/9 - would this mean something is not right as it keeps going up and up ?

Expert:  Dr. David replied 3 years ago.
no, if it rose up to 8 or 9, that is still low, that would not be worrisome.
Customer: replied 3 years ago.

With low cea levels can u still have mets?'


 


I get worried as when I read up it says smokers cea is up to 5 and non smokers 1-3. That's y I think why my dads rising from 3,4 and then 6.

Expert:  Dr. David replied 3 years ago.
yes, with low CEA levels, patients can in rare cases have mets.

some colon cancer does not make CEA levels.

but his prior scans haven't shown mets.
Customer: replied 3 years ago.

The last scan done was in February which did not show .6 months has passed so next scan in 2 weeks .


 


Although on the net it says up to 5 for smokers , the fact he is above 5, does it indicate something abnornal going on in body ?

Expert:  Dr. David replied 3 years ago.
no, I have told you before that a CEA of 6 does not indicate something going on somewhere else in the body

you have asked this before.

I keep giving you the same answer.

CEA is not very good of a test to monitor colon cancer.
Customer: replied 3 years ago.

Ok . Thanks so much really appreciate it

Expert:  Dr. David replied 3 years ago.
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.

Excellent service. We received a letter from the oncologist today following his meeting stating that cea is just above normal and a scan will be done to


Check for a relapse ? Does this mean


He's suspecting a recurrence ?

Expert:  Dr. David replied 3 years ago.
no, I don't think he is suspecting recurrence.
Customer: replied 3 years ago.

Hi


 


I wanted to ask that if there were mets in liver /lungs would any other blood tests be Abnormal?

Expert:  Dr. David replied 3 years ago.
large amounts of liver metastasis could affect liver function enzymes such as AST and ALT

but the best test to detect spread would be the CT scan with contrast.
Customer: replied 3 years ago.

Ok . I suppose even if cT in march was fine , things could have spread after right and may show this time ?


 


I had a look at the colom


Club forum whuch got me worried as ppl


With cea rises of 5,6 etc had liver mets.

Expert:  Dr. David replied 3 years ago.
you need to start a new question for me here

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

you need to stop reading forums

they are not doctors there

I am a cancer doctor
Customer: replied 3 years ago.

Hi

Expert:  Dr. David replied 3 years ago.
hi