This is Dr. David
some colon cancers do not secrete CEA
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.
sometimes CEA does not help cancer doctors assess the status of colon cancer even when it has spread.
and so use of CT scans or PET scans has to assess the status of the cancer in the body.
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.
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
yes, chemotherapy can take away appetite.
it can be tough to battle appetite loss during chemotherapy.
No vomit and dirrhea thank god
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?
yes, folfuri chemo is aggressive
and should kill the liver and aorticaval lymph node.
I'm worried that if he's not got that bad effects does
Does it mean not working?
it does not mean it is not working.
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 ?
usually surgery is done only if there is a solitary cancer in the liver and the cancer is no where else.
So with 1 node thy cant? His scan will b jan . Can more mets appear on the scan even with folfiri !
it depends on the discretion of the surgeon.
yes, there is a chance that more mets could appear possibly
Aortocaval node was 10 mm which contained a met . can this be sorted with folfiri?
Would he have a good prognosis if the chemo killed both?
yes, if the chemo kills both, that would help improve prognosis
Would a person have good prognosis if it's not large volume ?is it bad that the aortocaval node is involved ?
it is not bad that the aortocaval node is involved.
the lower bulk of disease the better.
so if it's just these 2 , is
Prognosis over 5 years ?
that is impossible to say .
that varies from person to person.
but overall when colon cancer spreads to the liver, the prognosis at 5 years is low
but with 1 met and 1 node
So far it's not like we lookin at 1,2
again, no one can predict how long the patient will live for.
What it depend on?
survival for colon cancer patients to the liver often have a hard time predicting how long they will live for.
it is impossible to say he will live for 1-2 years for sure.
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 ?
no, that is not high.
it is unknown what that other spot is.
that spot was not on the april
That spot was not on April ct scan so cpuld
Not be a cyst. What could it be ? A killed met?
most likely a benign hemangioma in he liver.
If the uptake of 5.2 is not high how can they say it's a met ?
you have to ask your doctors this question.
That's the problem thy are not
Very helpful . They said it's a met and that uptake is 5.2
well, a biopsy is really the only way to 100% know if it is a met in the liver.
What uptake would be then considered high?
it depends on the size of the lesion.
small lesions can be bright at SUV of 5 or 8.
larger lesions can be bright at SUV of 10 or 20 or more.
but the liver itself can also take up uptake in the liver.
This lesion is 16 mm so
This lesion 16mm so uptake of 5.2 makes sense right?
it depends on what the liver is taking up in other parts of the liver.
are there cases where chemo
Are there cases where chemo kills the mets and they never appear again ?
Says background liver uptake has SUV Max of 3.4 , no other fdg uptake on the liver seen
I would have gotten a liver biopsy to confirm.
that is only an SUV difference of 1.8
which is not that big
Should there be a big differecve usually . It says no fdg uptake on rest of liver and liver background 3.4.
yes, there should be a bigger difference in my opinion.
Have u seen patients having mets still
I would have gotten a liver MRI scan and a liver biopsy to confirm there was cancer in the liver.
They did not agree . We said MRI they said no it's. 1 met
If the aortocaval node has a met does this mean more nodes will have mets ?
no, not definitely.
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I had one more question , would he b able to get stoma reversed on chemo ?
Also would he permanently need folfiri noW ?
usually stoma reversal has to be after chemo.
he will need the folfuri for sometime.
it can't be given forever.
Ok thx . As he was getting chest tightness. , the onco has excluded the pump
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
and now just via a canula
no, this does not make it less effective.
He does not get that extra 48 hou. Infusion at home though
As was getting chest tightness
no, this does not make his chemotherapy less effective.
Last one - can stoma be removed on chemo as it's causing him pain
usually the stomach has to wait until the chemotherapy is all done before it can be reverse
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Would this be a stage 4 or still a stage 3 with a recurrence ?
colon cancer spread to the liver is considered stage IV
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 ?
Does it tend to work with most ?is it more aggressive than xeloda ?
is it likely to kill these 2 or just shrink them ?
With them beimg small
especiallu the node at 10 mm
will it not make it go completly?
In sept the liver met n node was seen lbly
. for the scan in January can more show up or unlikely ?
What kind of SUV uptake is High for a liver met ?
the more higher uptake , does this mean the tumor is more aggressive. ?
What does metobolically active mean?
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
So it dont matter realky if suv is high or low?
I see. Is one better than the other out of wild KRAS and KRAS mutant ?
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
Why u think they have not done biopsy ?
wit. Several liver mets even have had surgery so why must they want to do chemo first with 1 liver met ?
so this chemo they hav started is it pallative ?
How can it be maintenance with just 1 met and node ? Y
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 ?
is it good sign that blood work is normal like liver function etc and they r small at all,
Do I think I'm over worrying ?
worries re the prognosis . do u see patients with far more liver mets ?
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
not work so folfiri may not too
with limited mets do
well usually ?
well usually ?is the node more
of a issue than the liver
when u say period if
time , do u mean few years or?
so the liver is more
comcern than the distant node ?
What would u say with this met and the size ? In ur view . As an estimate .
Can alcohol affect the way chemo works ?
U mean it can cause chemo to not work ?
He needs to stop . is chest tightness a side effect of folfiri ? He gets chest pains whilst on this.
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 ?
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