How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. David Your Own Question
Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 46937
Experience:  Board Certified Physician
41363181
Type Your Medical Question Here...
Dr. David is online now

Can I Spk to oncologist?

Customer Question

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

This is Dr. David

Dr. David :

yes, I am an oncologist.

Dr. David :

I think we have spoken before.

JACUSTOMER-63qykhuk- : : New low attenuation 16 mm exophytic lesion in seg 6 does not show FDG uptake . This is compared to the background liver uptake with SUV Max upTo 3.4.There is however a 16 mm focus of intense tracer uptake peripherally in seg 6 with Max SUV of 5.2. A co registered ct lesion is not seen .Appearances are suspicious for a peripheral seg 6 liver metastasis. The exophytic seg 6 lesion seen on previous ct is not particularly fdg Avid.however as this is a new finding this should therefore be regarded as suspicious for a further mestases .Uptake in the mediastinal nodes is more indeterminate . This couldBe metastasis or represent a sarcoid like reaction .I need the above explaining I'mConfussed howThere are 2 lesions as the ct 2 weeks ago only showed 1 plus what does it mean that lesion not seen on co registered ct?
JACUSTOMER-63qykhuk- : This is the pet report
Dr. David :

the liver can move up and down with breathing during the scan.

Dr. David :

CT scans slice about 5mm worth of data into an image.

Dr. David :

so sometimes small spots in the liver can be seen or missed on scans.

Dr. David :

depending on where the liver is when the image is taken.

Dr. David :

it is like you are taking a 5mm slice of information and putting in into a picture.

Dr. David :

the other spot seen on the prior CT scan apprently was not seen on this PET/CT scan.

Dr. David :

but a new spot of 16mm was seen on the PET/CT

Dr. David :

hopefully they can biopsy this spot and confirm if it is spread of his colon cancer to the liver.

JACUSTOMER-63qykhuk- : They are not doing a biopsy . The dr just said 1 met and 1 node and saw liver surgeon who wants to operate .
JACUSTOMER-63qykhuk- : but there are 2 mets plus more nodes it says at the bottom
Dr. David :

I see.

JACUSTOMER-63qykhuk- : so I ain't get why their opinion diff from
JACUSTOMER-63qykhuk- : the pet report
Dr. David :

I'm not sure.

Dr. David :

you have to ask the surgeons why they think that.

Dr. David :

and have them review the scan with you.

Dr. David :

I can't see the scan

JACUSTOMER-63qykhuk- : But 1 spot no
Dr. David :

go with the patient to the surgeon meeting.

JACUSTOMER-63qykhuk- : fdg uptake so can that also be a met?
Dr. David :

which one are you talking about now?

JACUSTOMER-63qykhuk- :

One spot had fdg uptake and one does not right ?

JACUSTOMER-63qykhuk- :

Also re the nodes they say may be

JACUSTOMER-63qykhuk- :

Also re nodes may be metsases or sarcoid like reaction as fdg uptake was indeterminate . How can we know for sure?

Dr. David :

the 16 mm focus in the liver had Max SUV of 5.2

Dr. David :

the nodes in the mediastinum are in the chest

JACUSTOMER-63qykhuk- :

From the pet report what do u make out re thw spots and the nodes both?

Dr. David :

they are more questionable.

Dr. David :

they think the lymph nodes in mediastinum in the chest are questionable.

Dr. David :

they couldn't tell if it was metastasis or something else like sarcoidosis.

JACUSTOMER-63qykhuk- :

How can we know about the nodes for sure?

JACUSTOMER-63qykhuk- :

I am

JACUSTOMER-63qykhuk- :

I am concerned re nodes in the Chest . what treatment for nodes in chest ?

Dr. David :

they would have to be biopsied by an interventional pulmonologist

Dr. David :

if you want to know for sure.

Dr. David :

but most likely they are not metastatic colon cancer.

JACUSTOMER-63qykhuk- :

What do u think

JACUSTOMER-63qykhuk- :

Could

JACUSTOMER-63qykhuk- :

Could the nodes be mets ? But if we don't know for auew

JACUSTOMER-63qykhuk- :

If we don't know for sure how we plan treatment re the nodes?

Dr. David :

most likely they are not mets.

Dr. David :

your doctors are making an educated assessment.

JACUSTOMER-63qykhuk- :

Why most likely not mets?

JACUSTOMER-63qykhuk- :

Ok. So

JACUSTOMER-63qykhuk- :

Why u think they are most likely not nodal mets ?

Dr. David :

because the liver spot is small.

Dr. David :

and it is less likely that colon cancer would metastasize to the mediastinal lymph nodes.

JACUSTOMER-63qykhuk- :

So there is def 1 met right ? The one with uptake of 5.2?

Dr. David :

that liver spot is more likely to be metastasis.

Dr. David :

that will be confirmed with either biopsy or surgery.

JACUSTOMER-63qykhuk- :

The one with no fdg uptake is not likely right ?

Dr. David :

right.

JACUSTOMER-63qykhuk- : But is a new finding so what an it be ? And radiologist has said that it's suspicious for further met as new finding ?
Dr. David :

the mediastinal lymph nodes are not a new finding.

JACUSTOMER-63qykhuk- : Sorry I mean the other spot . He says ita a new finding in report , no fdg uptake but suspicious of further mestases ?
Dr. David :

yes, the liver spot is worrisome for spread of colon cancer to the liver.

JACUSTOMER-63qykhuk- : Im
JACUSTOMER-63qykhuk- : confussed I am . There are 2 liver spots right . One had fdg uptake and obendid
JACUSTOMER-63qykhuk- : And one did not so does that mean both are mets ? Or only
JACUSTOMER-63qykhuk- : 1 is met ?
Dr. David :

probably only one is a met.

JACUSTOMER-63qykhuk- :

So what could the other spot he which is also 16 mm ? It was not There before .

Dr. David :

it was probably missed by the last CT scan.

Dr. David :

most likely a benign hemangioma

JACUSTOMER-63qykhuk- : Ok also what is that 1 node them
JACUSTOMER-63qykhuk- : What is that 1 node they mention bring metastasis ?
JACUSTOMER-63qykhuk- : It was 10 mm on the ct
Dr. David :

those are mediastinal lymph nodes.

JACUSTOMER-63qykhuk- :

A aortacaval

JACUSTOMER-63qykhuk- :

The metastases lesion is consistent with A aortocaval nodal mestases.

Dr. David :

10mm node is normal size for aortacaval node.

JACUSTOMER-63qykhuk- :

the above I forgot to include in the report I sent you . What does this mean ?

Dr. David :

10mm is normal size.

JACUSTOMER-63qykhuk- :

Radiologist says aortocaval

JACUSTOMER-63qykhuk- :

Radiologist says a aortocaval nodal mestases - what is this?

JACUSTOMER-63qykhuk- :

So hoq

Dr. David :

hoq?

Dr. David :

what is this?

JACUSTOMER-63qykhuk- :

Sorry typo

JACUSTOMER-63qykhuk- :

Typo error

JACUSTOMER-63qykhuk- :

I don't get wat a aortocaval nodal mestases is? He said in report ... Consistent with a aortocaval nodal met?

Dr. David :

I don't think so.

Dr. David :

10mm is normal size.

Dr. David :

and if there is no PET uptake in the lymph node, it is probably normal

JACUSTOMER-63qykhuk- :

This is what he has stated in pet report :

JACUSTOMER-63qykhuk- :

Appearances are suspicious for a peripheral seg 6 metastasis and consistent with a aortocaval nodal metastasis.

Dr. David :

then it could be metastasis.

Dr. David :

but it doesn't say how much PET SUV uptake it has.

JACUSTOMER-63qykhuk- :

It is 1 node but where is this node ? I've never heard of it and how can they get rid of it ? Can they use sbrt ?

JACUSTOMER-63qykhuk- :

I have been reading about both xeloda and Celebrex works well together to prevent stem cells

JACUSTOMER-63qykhuk- :

y was 1 spot seen on ct and 1 was not even though they were both same size ?

Dr. David :

the node is next to the aorta and diaphram next to the liver.

Dr. David :

ask your doctor to see how bright it was on PET scan.

Dr. David :

xeloda can be used to treat his colon cancer.

JACUSTOMER-63qykhuk- :

What can be done about this node ?

Dr. David :

it can be watched.

Dr. David :

chemotherapy like xeloda can be used.

JACUSTOMER-63qykhuk- :

He has been offered surgey for the liver met . Would we be making a mistake to refuse it ?

Dr. David :

no, it wouldn't be a mistake to refuse it.

JACUSTOMER-63qykhuk- : But they r saying surgery gold standard and with curative intent. ? Is this true
JACUSTOMER-63qykhuk- : We are thinking about microwave ablation
Dr. David :

surgery is standard if only one spot of cancer in the liver.

Dr. David :

but he might not be able to tolerate surgery and surgery has risks.

JACUSTOMER-63qykhuk- :

They are thinking keyhole . But microwave ablation can also kill that spot right ? The main is to kill the microscopic cells right ? As it's those cells that form mets . Even with surgery he can get a met elsewhere right or agsin in same place ?

Dr. David :

yes, even with surgery, he can get mets elsewhere as well.

JACUSTOMER-63qykhuk- :

Exactky

JACUSTOMER-63qykhuk- :

Thats y I don't see why go through all that with surgery ?

JACUSTOMER-63qykhuk- :

When ablation can get rid of the spot too right

Dr. David :

then refuse the surgery and ask for ablation.

JACUSTOMER-63qykhuk- :

whar best for killing cells that can't b seen ?

JACUSTOMER-63qykhuk- :

I'm reading abt a trial in America with xeloda and Celebrex both ?

Dr. David :

that is a research trial.

Dr. David :

for focal ablation stereotactic radiosurgery is best or radiofrequency ablation.

JACUSTOMER-63qykhuk- : Ok. What is option for micro cells ?
Dr. David :

most likely chemotherapy

Dr. David :

like 5FU or xeloda

JACUSTOMER-63qykhuk- :

But he had xeloda 4 cyvles and this met appeared ?

Dr. David :

he would need another type of systemic chemotherapy

Dr. David :

like FOLFOX

Dr. David :

or 5FU

JACUSTOMER-63qykhuk- : Does this tend to work then ?
JACUSTOMER-63qykhuk- : Also
JACUSTOMER-63qykhuk- : also with a single met is it curable ?
Dr. David :

his chance of cure are small

Dr. David :

his colon cancer is aggressive and has several lymph nodes involved.

Dr. David :

he is also not in the greatest of health.

JACUSTOMER-63qykhuk- :

U mean the nide

Dr. David :

?

JACUSTOMER-63qykhuk- :

U mean the node on the met report or previous nodes that were involved from the colon tumor ?

Dr. David :

previous nodes involved with his colon cancer surgery.

Dr. David :

is has advanced age.

Dr. David :

he can not tolerate more aggressive chemotherapy regimens.

Dr. David :

he has a quick spread of cancer to his liver.

Dr. David :

so his chances for cure is small.

JACUSTOMER-63qykhuk- : Because sfter the colon surgery a met is seen in liver 5 months after ? But all this time he had the tumor there was no spread . This only seems to have happened after surgery .
JACUSTOMER-63qykhuk- : He tolerated xeloda well
JACUSTOMER-63qykhuk- : Could the met have formed after surgery or could it been there ages ago but was just too small yo
JACUSTOMER-63qykhuk- : to see?
JACUSTOMER-63qykhuk- : Could it be that the met is removed and that's it ? Sons ppl
JACUSTOMER-63qykhuk- : some ppl don't develop further mets right ?
Dr. David :

we don't know when the met started

Dr. David :

chances are if the met was removed, there would be other mets which pop up later.

JACUSTOMER-63qykhuk- : All scans prior to surgery were clear . Is it that cells escaped during surgery .?
JACUSTOMER-63qykhuk- : And if xeloda worked , it Would have killed this met right ?
Dr. David :

his xeloda didn't work.

JACUSTOMER-63qykhuk- : He does have alcohol so coujd this have caused xeloda not to work or to multiply the cells ?
JACUSTOMER-63qykhuk- : Y could it be that xeloda not worked ? Any reason ?
Dr. David :

he drinks alcohol?

Dr. David :

he shouldn't be drinking alcohol.

Dr. David :

the alcohol would not have caused the xeloda not to work.

JACUSTOMER-63qykhuk- : Can alcohol cause cells to grow more ?yes he has it
Dr. David :

nol

Dr. David :

no.

JACUSTOMER-63qykhuk- : If xeloda not worked then another one may not work too right ?
Dr. David :

right.

JACUSTOMER-63qykhuk- : But there are many that even with many mets do well
JACUSTOMER-63qykhuk- : for years right ?
JACUSTOMER-63qykhuk- : Is there any reason xeloda may not worked ? But he only had 4 cycles so far
Dr. David :

he is probably not going to do well for years.

JACUSTOMER-63qykhuk- : Would u advise surgery ?
Dr. David :

no.

JACUSTOMER-63qykhuk- : Why?
Dr. David :

because of his age and his alcohol issues

Dr. David :

I don't think he will do well going through that type of surgery.

JACUSTOMER-63qykhuk- : Ur right . It's very major I read about it.
JACUSTOMER-63qykhuk- : If he did ablation method etc n then chrmo
JACUSTOMER-63qykhuk- : How long would he b ok for? He may not get further mets right or may not for a long time ?
Dr. David :

you just keep asking questions.

Dr. David :

it doesn't seem like you will be satisfied.

Dr. David :

you seem so anxious.

Dr. David :

I bet he will continue to get mets

Dr. David :

since he got mets quickly now after his surgery.

JACUSTOMER-63qykhuk- : I find it strange that A this time no met then after the operation he gets it .
Dr. David :

that is not strange.

JACUSTOMER-63qykhuk- : Most ppl get it after a year or two
JACUSTOMER-63qykhuk- : But it is only 1 met
JACUSTOMER-63qykhuk- : Some ppl
JACUSTOMER-63qykhuk- : get several in the liver
JACUSTOMER-63qykhuk- : Can curcumin help
Dr. David :

most likely curcumin won't help.

Dr. David :

your father has a worse colon cancer than most

JACUSTOMER-63qykhuk- : But it's only 1 met ?
Dr. David :

1 met for now.

Dr. David :

that is his first scan.

Dr. David :

with more time, most likely he will develop more.

Dr. David :

the scan can only see mets the size of 1/8 of a sugar cube

Dr. David :

there is most likely smaller mets in his liver which will grow larger with more time.

JACUSTOMER-63qykhuk- : And all this time for years he had no spread. ? It was a grade 2.
Dr. David :

we don't know when his colon cancer spread.

JACUSTOMER-63qykhuk- :

So a pet scan only can detect a certain size met ? So there could b more not detected ?

Dr. David :

yes there could be more not detected

Dr. David :

please leave positive feedback for the help I have given you in this question series so far.

JACUSTOMER-63qykhuk- :

So

Dr. David :

thanks for using JustAnswer.com

Dr. David :

thanks.

JACUSTOMER-63qykhuk- :

So what the point in the team operating or ablating mets if more may b there. ?

JACUSTOMER-63qykhuk- :

How long does it usually take for a met to form?

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

So what's the point of surgery or ablation if more will form ?

Expert:  Dr. David replied 3 years ago.
ablation is less risky and is reasonable

the point is from this study

http://www.ncbi.nlm.nih.gov/pubmed?term=19495884

which showed that surgical resection of patients who have liver metastasis survived longer than patients who had surgical resections of mets outside of the liver

however, I think your father is too frail to tolerate any surgery at this piont

he was barely able to tolerate his colon cancer surgery.
Customer: replied 3 years ago.
I see what U mean . But the main issue with colon surgery was lack if appetite for 2 weeks only and pain which is expected otherwise had no issues or complication . Plus he has no high bp, no diabetes no other heart issues . He had clots 1, year ago which r now gone
Customer: replied 3 years ago.
What is best for long term survival ? That is what we want .
Expert:  Dr. David replied 3 years ago.
he could have extra hepatic metastasis with the aortocaval lymph node involvement.

I think it would be best to treat him with external beam stereotactic radiation therapy to the liver lesion or radiofrequency ablation and more chemotherapy.

this will be less stressful on his body and will be less of a break from chemotherapy than wtih a large surgery procedure.
Customer: replied 3 years ago.
What is survival like with the above u have suggested ?
Expert:  Dr. David replied 3 years ago.
that is impossible to know for one patient.

I think his survival will be less than others because of his age and his early cancer spread to liver on xeloda.

I know you want him to survive as long as possible, but his colon cancer is aggressive

and I suspect that most likely he will die from his colon cancer eventually.

you must be prepared for that real possibility.
Customer: replied 3 years ago.
Yes u are right . U say early spread but he had colon tumor for years dr said but all this time did not spread . So how com after surgery it did?
Expert:  Dr. David replied 3 years ago.
most likely it had spread prior to surgery and it was just too small to see on scans.
Customer: replied 3 years ago.
So only after a certain size they are detectable by pet?is there nothing that will come out to stop micro cells . ? I have read about a few drugs .
I have read xeloda and Celebrex for stem cells ?
Expert:  Dr. David replied 3 years ago.
you can talk to his doctors abotu xeloda and celebrex for stem cells

aspirin also has been studied also to fight against colon cancer as well

ask his doctors to test his colon cancer for KRAS and EGFR mutation if they haven't done that yet.

some colon cancers spread no matter what we try

I wish there better treatments and drugs to fight colon cancer.
Customer: replied 3 years ago.
His surgeon did not seem too worried he said it's a small met on ten edge and some ppl have 10-20?
Expert:  Dr. David replied 3 years ago.
yes, some people hav 10-20.

but those patients who have 10-20 mets only live for a few weeks to a few months.
Customer: replied 3 years ago.
I will def check
What type tumor it was KRAS or what
. Is one more aggressive than the other ?
Expert:  Dr. David replied 3 years ago.
yes, KRAS positive mutation tumors can be more aggressive
Customer: replied 3 years ago.
If xeloda worked then would the liver met have died ?
Expert:  Dr. David replied 3 years ago.
right

but the xelda didn't work.
Customer: replied 3 years ago.
Is there any reason it may not have a worked ?
Also for testing 1 is KRAS mutant and what is the other ?
Expert:  Dr. David replied 3 years ago.
KRAS normal is called KRAS wild type

KRAS mutant is more aggressive colon cancer which does not respond to EGFR targetting treatments like erbitux

we don't know why the xeloda didn't work.
Customer: replied 3 years ago.
May be it's KRAS mutant therefore xeloda not worked ?
Have u had patients where xeloda not worked and another form of chemo
Has worked ?
Expert:  Dr. David replied 3 years ago.
it is very unlikely that other chemo will work if xeloda didn't work

the chances of other chemotherapy working become less and less

it also means by what you define as "working"

no chemotherapy agent will cure him of his colon cancer.

some chemotherapy may slow down or even shrink his colon cancer for a period of time, but eventually the colon cancer will figure out how to grow in time.

so what do you mean by "working"
Customer: replied 3 years ago.
I thought it can kill
The micro cells and in the body which go on to
Form mets .
Expert:  Dr. David replied 3 years ago.
that is the purpose of chemotherapy

but unfortunately, it often doesn't work and the cancer continues to spread and the micrometastasis don't get killed.
Customer: replied 3 years ago.
So sometimes it's useless taking it then right ?can a strict raw veg diet with curcumin , ip6 etc work rather than Chemo
U think ?
Expert:  Dr. David replied 3 years ago.
I don't think it is useless, chemotherapy in some cases can slow down the growth of the cancer, but eventually the cancer will grown and he most likely will pass eventually from his colon cancer.

you have to be prepared for that.

you don't seem prepared for that.

raw veg diet with curcumin and ip6 most likely will not work either.
Customer: replied 3 years ago.
ok. So as it stands at the mo With say 1 met what are we looking in Terms of prognosis ?
So it's worth still having chemo then ?
Expert:  Dr. David replied 3 years ago.
it is up to you and him and his doctors to decide if he wishes to take more chemotherapy side effects in the hopes of slowing down his colon cancer.

again, it is impossible to know how long he will live for.

he could live for 6 months or 12 months or 18 months or longer.

it is impossible to know

you keep asking me this question

you can ask his doctors this same question. they will have a hard time predicting how long he will have to live for as well.
Customer: replied 3 years ago.
They have just not discussed anything re survival only said surgery , then chemo .
Have u seen cases where after 1,2 mets are resected or ablate son
Further mets appear ?I
I
Just want him to beat this
Expert:  Dr. David replied 3 years ago.
I know you want him to beat this

but I also want you to be prepared of his cancer continues to win.

yes other mets can appear if he just ablates or resects that one liver met.
Customer: replied 3 years ago.
Yea I know wht u mean . U have been so helpful . His bloodwork n health is ok otherwise .
Is there not any new drug u would
Recommend ?
Expert:  Dr. David replied 3 years ago.

he can talk to his doctors about clinical and research trials that are available to him to try.

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.
Well we called about 1 trial and Thry said it's only for ppl where all treatments have failed
Expert:  Dr. David replied 3 years ago.
there are many different types of trials.

he has failed xeloda already.

research trials are not only for people who have failed all types of treatments already.

he might have to travel to another hospital for a larger selection of clinical research trials.
Customer: replied 3 years ago.
Ok then. Where am we check re trials ? U think it's worth it? There is a curcumin trial
Here in uk
Expert:  Dr. David replied 3 years ago.
you can search here

http://www.ukctg.nihr.ac.uk/search?query=keyword:colon&resultsfrom=1&resultsto=20000&pagesize=20000

http://www.ukctg.nihr.ac.uk/default.aspx
Customer: replied 3 years ago.
Ok. Can sbrt be used for this 1 node?
Expert:  Dr. David replied 3 years ago.
SBRT can be used for any spot which is known to be cancer
Customer: replied 3 years ago.
Ok. His grade was a 2. So
Does this mean it was KRAS wild ?
Expert:  Dr. David replied 3 years ago.
no. grade does not affect KRAS mutation status.
Customer: replied 3 years ago.
Wat does
Grade mean ?
Plus he's not been on chemo for a month due to scan etc so it's best they start soon right a diff form an surgery will delay all that ?
Expert:  Dr. David replied 3 years ago.
grade is a description of how bizzar the cancer cells look under the microscope

grade is on a scale from 1-3.

yes surgery will delay chemo

he can start on a new chemo regimen at any time.
Customer: replied 3 years ago.
Ok is a trial worth a shot?
Expert:  Dr. David replied 3 years ago.
sure.
Customer: replied 3 years ago.
Are there some good new treatments via trial ?
Expert:  Dr. David replied 3 years ago.
http://www.sciencedaily.com/news/health_medicine/colon_cancer/

you can read some here.
Customer: replied 3 years ago.
So thT spot with no fdg uptake on liver , an that still be a met ? As radiologist has stated it as being suspicious if a met As a new finding
Expert:  Dr. David replied 3 years ago.
it could be a met possibly.
Customer: replied 3 years ago.
Can a met still have no fdg uptake
Expert:  Dr. David replied 3 years ago.
if it is very small.

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.
It Same size
As the other one - 16 mm. I'm confused if this is a met or not with no uptake ?
Expert:  Dr. David replied 3 years ago.
you should review the report with his doctor and see what they say.

I can't see the images to help .
Customer: replied 3 years ago.
What I'm
Confussed is radiologist stated 16 mm lesion with no fdg uptake but suspicious of a met as a new finding . However his onco following a mdt meeting said there is only one met ?but there are 2 spots and radiographer stated it's suspicious for further met
Expert:  Dr. David replied 3 years ago.
you need to review that with your doctors

I can't see your scans or your full reports.
Customer: replied 3 years ago.
What U think
About xeloda and Celebrex together ?
Expert:  Dr. David replied 3 years ago.
that is fine

most likely not any better than xeloda by itself
Customer: replied 3 years ago.
We met with the
Surgeon and onco today . There is only 1 net in liver and that 1 node . They have decided
To first try systematic chemo as there is 1 node and operation will
Not kill any micro cells but only that 1 met .
Then in 6 weeks will scan again .
What do U think ?
Expert:  Dr. David replied 3 years ago.
I think that is fine.

what chemo to try now? FOLFOX?

did you ask about xeloda and celebrex?

did you ask about clinical trails?
Customer: replied 3 years ago.
I don't know
Which one as his own onco was not there . But I will
Ask about xeloda and Celebrex as I've read promising things
Do thy usually do this ? I thought they need to get rid that met first
Expert:  Dr. David replied 3 years ago.
I think xeloda and celebrex is still being studied and is not researched enough yet.
Customer: replied 3 years ago.
Why they wana do chemo
First ?
Customer: replied 3 years ago.
Why must they be doing chemo first?
Expert:  Dr. David replied 3 years ago.
to see if chemo can help kill off and disappear the spot in the liver without having to do surgery.
Customer: replied 3 years ago.
But most ppl have surgery or ablation
Etc
Then chemo . Why in this case they want to do chemo first .? They said if he does get more mets in liver then will operate or use ablation
Expert:  Dr. David replied 3 years ago.
if he gets more mets in liver, then surgery and ablation will be useless.
Customer: replied 3 years ago.
But with ablation you can use it several times to kill liver mets right ?
Expert:  Dr. David replied 3 years ago.
you can.

but ablation itself does not prevent new mets from coming.
Customer: replied 3 years ago.
I suppose they want to try targeting these cells right first ?
Expert:  Dr. David replied 3 years ago.
chemo would be less traumatic for him than a surgery procedure.

I am not sure they have anyone there who can do radiofrequency ablation.
Customer: replied 3 years ago.
Yes they do RFA here too but they furst want to see I think if any more mets appear and if liver met and that node goes with chemo .
Would u take this approach first ?
Expert:  Dr. David replied 3 years ago.
chances are that liver met and node will get bigger with the second course of chemo since the xeloda didn't work

what second line chemo are they proposing?
Customer: replied 3 years ago.
We will find out tomorrow .
Which u say us best ?
So why are they risking this and not just removing it and then giving chemo ? They will scan again in 6 weeks
Expert:  Dr. David replied 3 years ago.
there is no one best regimen.

removing with surgery is a big surgery. I'm not sure he will be able to tolerate such a big surgery

we have talked about this before.
Customer: replied 3 years ago.
what would you have done leaving surgery aside . Would you have ablated it then chemo or done what they are doing here (trying chemo first )
Expert:  Dr. David replied 3 years ago.
I would ablate with radiation therapy or radiofrequency ablation and then give more chemo.
Customer: replied 3 years ago.
i think they wana start chemo ASAP cuz of the node . They are more concerned about the node than the met. Can
They grow in space if 4-6 weeks ?
Expert:  Dr. David replied 3 years ago.
sure nodes can grow in 4-6 weeks.

stereotactic radiosurgery can take care of both areas.
Customer: replied 3 years ago.
But chemo is the only poss option that can target micro cells right ?
Why do
They want to target the the micro cells
First ?
Customer: replied 3 years ago.
you know
From
Pet report that other lesion with no
Uptake, they saying it either a cyst ( but it's separate from the oter liver cysts he has) or could have been a met that has died. Can there be a met that has
Died?
Expert:  Dr. David replied 3 years ago.
no, there wouldn't be a met that has died.
Customer: replied 3 years ago.
After ablation do u have to wait long for chemo
Expert:  Dr. David replied 3 years ago.
no, you don't have to wait long after radiofrequency ablation or stereotactic radiosurgery abalation to start chemotherapy.
Customer: replied 3 years ago.
There's 1 small met n 1 node , are they thinking no hope and so just doing chemo ?
Ppl even with lots met have op or ablation many times
Expert:  Dr. David replied 3 years ago.
this thread has gone for 3 days now

please start a new question series for me here

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

thanks for using JustAnswer.com