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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45922
Experience:  Board Certified Physician
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Is a cea of 8 aGood number for a person with a liver met

Customer Question

Is a cea of 8 a
Good number for a person with a liver met ?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
Dr. David :

This is Dr. David

Dr. David :

some colon cancers do not secrete CEA

Dr. David :

so a CEA level has to be drawn when the colon cancer is still in the body to see if the CEA level is high.

Dr. David :

sometimes CEA does not help cancer doctors assess the status of colon cancer even when it has spread.

Dr. David :

and so use of CT scans or PET scans has to assess the status of the cancer in the body.

Dr. David :

if there is only a solitary liver metastasis and the patient can tolerate surgery, then surgery can be performed to cut out the single liver met.

Customer :

My dad has 1 liver met and 1 aortocaval node I spoke before with u . Cea was 9.8 now it's. 8. He's started folfiri he's on the second cycle . So far it's not been too bad but he does feel of food etc but no vomit or

Dr. David :

yes, chemotherapy can take away appetite.

Dr. David :

it can be tough to battle appetite loss during chemotherapy.

Customer :

No vomit and dirrhea thank god

Customer :

What

Customer :

What u think of this chemo folfiri ? He had 1 liver met at 16mm and 1 aortiaval node of 10 mm said to be a met ? Will it kill these 2?

Dr. David :

yes, folfuri chemo is aggressive

Dr. David :

and should kill the liver and aorticaval lymph node.

Customer :

I'm worried that if he's not got that bad effects does

Customer :

Does it mean not working?

Dr. David :

no,

Dr. David :

it does not mean it is not working.

Customer :

What I don't understand is there's 1 Small liver met on the edge of liver as liver funcation and blood work is good they said they could have done surgery but can't due to this aortocaval node ? Why would that be ?

Dr. David :

usually surgery is done only if there is a solitary cancer in the liver and the cancer is no where else.

Customer :

So with 1 node thy cant? His scan will b jan . Can more mets appear on the scan even with folfiri !

Dr. David :

it depends on the discretion of the surgeon.

Dr. David :

yes, there is a chance that more mets could appear possibly

Customer :

The aortocavam

Customer :

Aortocaval node was 10 mm which contained a met . can this be sorted with folfiri?

Customer :

Would

Customer :

Woudl

Customer :

Would he have a good prognosis if the chemo killed both?

Dr. David :

yes, if the chemo kills both, that would help improve prognosis

Customer :

Would a person have good prognosis if it's not large volume ?is it bad that the aortocaval node is involved ?

Dr. David :

it is not bad that the aortocaval node is involved.

Dr. David :

the lower bulk of disease the better.

Customer :

So of

Customer :

so if it's just these 2 , is

Customer :

Prognosis over 5 years ?

Dr. David :

that is impossible to say .

Dr. David :

that varies from person to person.

Dr. David :

but overall when colon cancer spreads to the liver, the prognosis at 5 years is low

Customer :

but with 1 met and 1 node

Customer :

So far it's not like we lookin at 1,2

Customer :

Years Right?

Dr. David :

again, no one can predict how long the patient will live for.

Customer :

What it depend on?

Dr. David :

survival for colon cancer patients to the liver often have a hard time predicting how long they will live for.

Dr. David :

it is impossible to say he will live for 1-2 years for sure.

Customer :

Ok. There is one met on liver . The uptake was 5.2. Is that high ? They also saw another lesion (new finding ) but that had no uptake could this be a killed met ?

Dr. David :

no, that is not high.

Dr. David :

it is unknown what that other spot is.

Customer :

that spot was not on the april

Customer :

That spot was not on April ct scan so cpuld

Customer :

Not be a cyst. What could it be ? A killed met?

Dr. David :

most likely a benign hemangioma in he liver.

Customer :

If the uptake of 5.2 is not high how can they say it's a met ?

Dr. David :

you have to ask your doctors this question.

Customer :

That's the problem thy are not

Customer :

Very helpful . They said it's a met and that uptake is 5.2

Dr. David :

well, a biopsy is really the only way to 100% know if it is a met in the liver.

Customer :

What uptake would be then considered high?

Dr. David :

it depends on the size of the lesion.

Dr. David :

small lesions can be bright at SUV of 5 or 8.

Dr. David :

larger lesions can be bright at SUV of 10 or 20 or more.

Dr. David :

but the liver itself can also take up uptake in the liver.

Customer :

This lesion is 16 mm so

Customer :

This lesion 16mm so uptake of 5.2 makes sense right?

Dr. David :

it depends on what the liver is taking up in other parts of the liver.

Customer :

are there cases where chemo

Customer :

Are there cases where chemo kills the mets and they never appear again ?

Customer :

Says background liver uptake has SUV Max of 3.4 , no other fdg uptake on the liver seen

Dr. David :

I would have gotten a liver biopsy to confirm.

Dr. David :

that is only an SUV difference of 1.8

Dr. David :

which is not that big

Dr. David :

5.2-3.4

Customer :

So shoud

Customer :

Should there be a big differecve usually . It says no fdg uptake on rest of liver and liver background 3.4.

Dr. David :

yes, there should be a bigger difference in my opinion.

Customer :

Have u seen patients having mets still

Dr. David :

I would have gotten a liver MRI scan and a liver biopsy to confirm there was cancer in the liver.

Customer :

They did

Customer :

They did not agree . We said MRI they said no it's. 1 met

Customer :

If the aortocaval node has a met does this mean more nodes will have mets ?

Dr. David :

no, not definitely.

Dr. David :

do you have any other questions?

Dr. David :

if done, please leave positive feedback below.

Dr. David :

thanks for using JustAnswer.com

Customer :

I had one more question , would he b able to get stoma reversed on chemo ?

Customer :

Also would he permanently need folfiri noW ?

Dr. David :

usually stoma reversal has to be after chemo.

Dr. David :

he will need the folfuri for sometime.

Dr. David :

it can't be given forever.

Customer :

Ok thx . As he was getting chest tightness. , the onco has excluded the pump

Customer :

Which was given at home for 48 hours .does this make it less effective . It was via a pic line before due to the pump

Customer :

and now just via a canula

Dr. David :

no, this does not make it less effective.

Customer :

He does not get that extra 48 hou. Infusion at home though

Customer :

As was getting chest tightness

Dr. David :

no, this does not make his chemotherapy less effective.

Dr. David :

do you have any other questions?

Customer :

Last one - can stoma be removed on chemo as it's causing him pain

Dr. David :

usually the stomach has to wait until the chemotherapy is all done before it can be reverse

Dr. David :

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 :

Ok. Would

Customer :

Would this be a stage 4 or still a stage 3 with a recurrence ?

Dr. David :

colon cancer spread to the liver is considered stage IV

Dr. David and 4 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

I wanted to

ask that as the xeloda I assume did

not work - can it be the the folfiri

will not work too and he may get further mets whilst on it ?

Expert:  Dr. David replied 2 years ago.
yes, there is always a chance that the FOLFURI will not work

and he could get more mets or progression of his colon cancer.
Customer: replied 2 years ago.

Does it tend to work with most ?is it more aggressive than xeloda ?

Expert:  Dr. David replied 2 years ago.
yes, it is more aggressive than xeloda.

it tends to work in most patients.
Customer: replied 2 years ago.

is it likely to kill these 2 or just shrink them ?

Expert:  Dr. David replied 2 years ago.
it is likely to shrink them.
Customer: replied 2 years ago.

With them beimg small

especiallu the node at 10 mm

will it not make it go completly?

Expert:  Dr. David replied 2 years ago.
it is impossible to predict this

sometimes there is more colon cancer in the body that is too small to be seen by PET scan or MRI scan.
Customer: replied 2 years ago.

In sept the liver met n node was seen lbly

. for the scan in January can more show up or unlikely ?

Expert:  Dr. David replied 2 years ago.
more can show up possibly

only time can tell what the scan shows in January.
Customer: replied 2 years ago.

What kind of SUV uptake is High for a liver met ?

the more higher uptake , does this mean the tumor is more aggressive. ?

Expert:  Dr. David replied 2 years ago.
SUV of 10 or 20 is high for a liver met

the more update, the more metabolically active a tumor might be

it doesn't necessarily mean more aggressive.
Customer: replied 2 years ago.

What does metobolically active mean?

Expert:  Dr. David replied 2 years ago.
it means the cells are growing and eating sugar if they are more bright on PET scan.
Customer: replied 2 years ago.

So is it better that the SUV was lower ? Should my dad also avoid sugar then ? I've read they feed of sugar n grow more

Expert:  Dr. David replied 2 years ago.
avoiding sugar will not help

we all have sugar in our blood stream.

there is no way to avoid glucose in our blood stream.

our brains and heart need glucose constantly.

lower SUV is not better than higher SUV.
Customer: replied 2 years ago.

So it dont matter realky if suv is high or low?

Expert:  Dr. David replied 2 years ago.
no, it doesn't matter if the SUV is high or low.
Customer: replied 2 years ago.

I see. Is one better than the other out of wild KRAS and KRAS mutant ?

Expert:  Dr. David replied 2 years ago.
wild type KRAS is better than KRAS mutant.
Customer: replied 2 years ago.

have u heard of nano knife ? We were thinking if to go for this for the met and node but only 1 private hosp in uk does it . And the nhs won't like if we go private

Expert:  Dr. David replied 2 years ago.
we have talked about options for ablative therapy for his liver met before.

he has not had his liver or lymph node biopsied.

his doctors didn't think surgery was useful for him

you can always get another opinion about nano knife

but it may not help much
Customer: replied 2 years ago.

Why u think they have not done biopsy ?

ppl

wit. Several liver mets even have had surgery so why must they want to do chemo first with 1 liver met ?

Expert:  Dr. David replied 2 years ago.
maybe because they think your father will not be able to handle the surgery.
Customer: replied 2 years ago.

so this chemo they hav started is it pallative ?

Expert:  Dr. David replied 2 years ago.
yes, you can say palliative or maintanence chemotherapy.
Customer: replied 2 years ago.

How can it be maintenance with just 1 met and node ? Y

Expert:  Dr. David replied 2 years ago.
to maintenance and keep those areas from growing and enlarging.
Customer: replied 2 years ago.

i see hence that would increase survival?

i know it depends on things but in ur opinion, based on 1 liver met n the aortocaval node ( with these sizes ), and hoping more don't appear, what u think duration of survival ?

Expert:  Dr. David replied 2 years ago.
it is impossible to predict survival his situation.

i can't see him and can't review medical records.

I don't give survival estimates for even the cancer patients I treat myself when they have spread of cancer to the liver.
Customer: replied 2 years ago.

is it good sign that blood work is normal like liver function etc and they r small at all,

Expert:  Dr. David replied 2 years ago.
yes, that is a good sign.
Customer: replied 2 years ago.

Do I think I'm over worrying ?

Expert:  Dr. David replied 2 years ago.
yes, I think you are over worrying
Customer: replied 2 years ago.

im more

worries re the prognosis . do u see patients with far more liver mets ?

Expert:  Dr. David replied 2 years ago.
yes, I see patients with far more liver mets.

it does sound like you have bad anxiety over your dads colon cancer.

no one can give you precise information about his prognosis accurately.

patients can always do better or worse than the averages.

you might need treatment for your own anxiety symptoms to help decrease your anxiety and worry about your dad's colon cancer if your anxiety is bad about this.

I would trust his doctors to treat him.
Customer: replied 2 years ago.

I don't know I'm so worried . I don't want to see him suffer and now I'm more worried re his mets.

i worry that xeloda

did

not work so folfiri may not too

Expert:  Dr. David replied 2 years ago.
I know you are worried

but being more worried will not fix the situation.

and will not help his situation any more.
Customer: replied 2 years ago.

Do ppl

with limited mets do

well usually ?

Customer: replied 2 years ago.

Do ppl

with limited mets do

well usually ?is the node more

of a issue than the liver

met ?

Expert:  Dr. David replied 2 years ago.
no, the lymph node is not more of an issue than the liver

patients with limited mets can do ok for a period of time, but usaully if given enough time, their cancers will grow and spread eventually.
Customer: replied 2 years ago.

when u say period if

time , do u mean few years or?

so the liver is more

comcern than the distant node ?

Expert:  Dr. David replied 2 years ago.
it is impossible to know the length of time.

for some patients its months

or some patients its years.
Customer: replied 2 years ago.

What would u say with this met and the size ? In ur view . As an estimate .

Expert:  Dr. David replied 2 years ago.
it is impossible to know how long he will live for.
Customer: replied 2 years ago.

Can alcohol affect the way chemo works ?

Expert:  Dr. David replied 2 years ago.
yes, chemo can cause dehydration and cause the chemo not to work as well.
Customer: replied 2 years ago.

U mean it can cause chemo to not work ?

Expert:  Dr. David replied 2 years ago.
alcohol never helps a situation and would not help chemo to work better.
Customer: replied 2 years ago.

He needs to stop . is chest tightness a side effect of folfiri ? He gets chest pains whilst on this.

Expert:  Dr. David replied 2 years ago.
chest tightness can be from acid reflux from his alcohol use,

or could be from asthma or copd or shortness of breath

FOLFURI can cause esophagitis inflammation of his esophagus from the 5FU part of the chemo.

he could be having heart troubles as well while on chemo.

he should see his doctors about his chest tightness to see if he is having heart troubles.
Customer: replied 2 years ago.

he did go hosp where they did a ECG and blood tests and all were fine . He will mention agsin to oncologist this week when sees him . is it true Tumeric works well with chemo in killing cells better ?

Expert:  Dr. David replied 2 years ago.
tumeric is not proven to work well with chemotherapy to kill cancer cells.
Customer: replied 2 years ago.

I need your advice .... My dad's cea was 9.8 in sept , oct was 8, December is 9.

does this mean the chemo not working as it's gone up by 1 point

Expert:  Dr. David replied 2 years ago.
please start a new question here.

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

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