This is Dr. David
yes, I am an oncologist.
I think we have spoken before.
the liver can move up and down with breathing during the scan.
CT scans slice about 5mm worth of data into an image.
so sometimes small spots in the liver can be seen or missed on scans.
depending on where the liver is when the image is taken.
it is like you are taking a 5mm slice of information and putting in into a picture.
the other spot seen on the prior CT scan apprently was not seen on this PET/CT scan.
but a new spot of 16mm was seen on the PET/CT
hopefully they can biopsy this spot and confirm if it is spread of his colon cancer to the liver.
I'm not sure.
you have to ask the surgeons why they think that.
and have them review the scan with you.
I can't see the scan
go with the patient to the surgeon meeting.
which one are you talking about now?
One spot had fdg uptake and one does not right ?
Also re the nodes they say may be
Also re nodes may be metsases or sarcoid like reaction as fdg uptake was indeterminate . How can we know for sure?
the 16 mm focus in the liver had Max SUV of 5.2
the nodes in the mediastinum are in the chest
From the pet report what do u make out re thw spots and the nodes both?
they are more questionable.
they think the lymph nodes in mediastinum in the chest are questionable.
they couldn't tell if it was metastasis or something else like sarcoidosis.
How can we know about the nodes for sure?
I am concerned re nodes in the Chest . what treatment for nodes in chest ?
they would have to be biopsied by an interventional pulmonologist
if you want to know for sure.
but most likely they are not metastatic colon cancer.
What do u think
Could the nodes be mets ? But if we don't know for auew
If we don't know for sure how we plan treatment re the nodes?
most likely they are not mets.
your doctors are making an educated assessment.
Why most likely not mets?
Why u think they are most likely not nodal mets ?
because the liver spot is small.
and it is less likely that colon cancer would metastasize to the mediastinal lymph nodes.
So there is def 1 met right ? The one with uptake of 5.2?
that liver spot is more likely to be metastasis.
that will be confirmed with either biopsy or surgery.
The one with no fdg uptake is not likely right ?
the mediastinal lymph nodes are not a new finding.
yes, the liver spot is worrisome for spread of colon cancer to the liver.
probably only one is a met.
So what could the other spot he which is also 16 mm ? It was not There before .
it was probably missed by the last CT scan.
most likely a benign hemangioma
those are mediastinal lymph nodes.
The metastases lesion is consistent with A aortocaval nodal mestases.
10mm node is normal size for aortacaval node.
the above I forgot to include in the report I sent you . What does this mean ?
10mm is normal size.
Radiologist says aortocaval
Radiologist says a aortocaval nodal mestases - what is this?
what is this?
I don't get wat a aortocaval nodal mestases is? He said in report ... Consistent with a aortocaval nodal met?
I don't think so.
and if there is no PET uptake in the lymph node, it is probably normal
This is what he has stated in pet report :
Appearances are suspicious for a peripheral seg 6 metastasis and consistent with a aortocaval nodal metastasis.
then it could be metastasis.
but it doesn't say how much PET SUV uptake it has.
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 ?
I have been reading about both xeloda and Celebrex works well together to prevent stem cells
y was 1 spot seen on ct and 1 was not even though they were both same size ?
the node is next to the aorta and diaphram next to the liver.
ask your doctor to see how bright it was on PET scan.
xeloda can be used to treat his colon cancer.
What can be done about this node ?
it can be watched.
chemotherapy like xeloda can be used.
He has been offered surgey for the liver met . Would we be making a mistake to refuse it ?
no, it wouldn't be a mistake to refuse it.
surgery is standard if only one spot of cancer in the liver.
but he might not be able to tolerate surgery and surgery has risks.
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 ?
yes, even with surgery, he can get mets elsewhere as well.
Thats y I don't see why go through all that with surgery ?
When ablation can get rid of the spot too right
then refuse the surgery and ask for ablation.
whar best for killing cells that can't b seen ?
I'm reading abt a trial in America with xeloda and Celebrex both ?
that is a research trial.
for focal ablation stereotactic radiosurgery is best or radiofrequency ablation.
most likely chemotherapy
like 5FU or xeloda
But he had xeloda 4 cyvles and this met appeared ?
he would need another type of systemic chemotherapy
his chance of cure are small
his colon cancer is aggressive and has several lymph nodes involved.
he is also not in the greatest of health.
U mean the nide
U mean the node on the met report or previous nodes that were involved from the colon tumor ?
previous nodes involved with his colon cancer surgery.
is has advanced age.
he can not tolerate more aggressive chemotherapy regimens.
he has a quick spread of cancer to his liver.
so his chances for cure is small.
we don't know when the met started
chances are if the met was removed, there would be other mets which pop up later.
his xeloda didn't work.
he drinks alcohol?
he shouldn't be drinking alcohol.
the alcohol would not have caused the xeloda not to work.
he is probably not going to do well for years.
because of his age and his alcohol issues
I don't think he will do well going through that type of surgery.
you just keep asking questions.
it doesn't seem like you will be satisfied.
you seem so anxious.
I bet he will continue to get mets
since he got mets quickly now after his surgery.
that is not strange.
most likely curcumin won't help.
your father has a worse colon cancer than most
1 met for now.
that is his first scan.
with more time, most likely he will develop more.
the scan can only see mets the size of 1/8 of a sugar cube
there is most likely smaller mets in his liver which will grow larger with more time.
we don't know when his colon cancer spread.
So a pet scan only can detect a certain size met ? So there could b more not detected ?
yes there could be more not detected
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So what the point in the team operating or ablating mets if more may b there. ?
How long does it usually take for a met to form?
So what's the point of surgery or ablation if more will form ?
he can talk to his doctors about clinical and research trials that are available to him to try.
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