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Daniel Sheibley, MD
Daniel Sheibley, MD, Doctor
Category: Medical
Satisfied Customers: 1834
Experience:  MD Grad Jefferson Medical College 2009. Internal Med intern 2010 & Radiology residency 2011. Husband & father of two.
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What do a aortocaval region ?

Customer Question

What do a aortocaval region ?
Submitted: 2 years ago.
Category: Medical
Expert:  Daniel Sheibley, MD replied 2 years ago.
Daniel Sheibley, MD :

that is the area surrounding the aorta (the largest artery draining blood from the heart to the lower body) and inferior vena cava (the biggest vein draining blood from the lower part of the body back to the heart)

Daniel Sheibley, MD :

there are lymph nodes all throughout that area so i'm assuming you're wondering about aortocaval lymph nodes?

Daniel Sheibley, MD :

basically there are lymphatic structures and fat in that area

Customer:

Well my dad had colon surgery kn march and a tumor was removed . He was a dukes c1. A recent scan shows 1 aortocaval node met of 10 mm. I was lnt sure where this area was and whether 10 mm node is large ?

Customer:

They have started irinotecan alone , can this be effective in treating this ( eg can it get rid of it)?

Daniel Sheibley, MD :

1mm is exactly at the limit of what a "normal" lymph node could be. It is a large enough lymph node that if it were pathologically enlarged (i.e. metastatic disease) that it should show up on a PET scan.

Daniel Sheibley, MD :

they have to be about 7mm or larger to be reliably seen on pet scans if they are enlarged due to metastatic disease

Customer:

and theres 1 liver met of 16 mm with uptake of 5.2,

Daniel Sheibley, MD :

so I'd recommend a PET-CT

Daniel Sheibley, MD :

that is significant enough to be considered a met, yes. Did the lymph node show positive?

Daniel Sheibley, MD :

if it didn't show significantly above background that doesn't mean that it is not a metastasis in development

Customer:

Thy say on a pet scan it did .

Daniel Sheibley, MD :

Then yes it would most likely be caused by a metastasis

Daniel Sheibley, MD :

in that lymph node

Customer:

Can the chemo treat the 2 mets?

Customer:

I was wondering y they cannot remove / ablate them

Daniel Sheibley, MD :

yes it would treat all metastases throughout the body. Some may respond better than others but that can only be determined with a repeat PET after treatment

Customer:

There seems

Customer:

To be 2 at present so I was wondering as the cea is 9

Customer:

Cea has not come down and he's had 4 sessions of irinotecan

Customer:

August was 9.8, sept was 8 for some reason and December 9.

Customer:

What would prognosis be like for such a situation ?

Daniel Sheibley, MD :

that is elevated and if he still is having PET-positive metastases and he has been under 4 rounds of chemotherapy perhaps the oncologist will investigate either a new medication and/or method of drug delivery such as transarterial chemoembolization or percutaneous (through the skin) ablative techniques such as radiofrequency or microwave ablation.

Customer:

If there is a lesion which has no

Customer:

yes that's what we want ablative techniques or surgery but they only doing chemo

Daniel Sheibley, MD :

chemo can be used in tandem with the other techniques

Daniel Sheibley, MD :

and often are synergistic - in other words when used together they provide better improvement in disease progression

Daniel Sheibley, MD :

these are performed by interventional radiologists (you need a referral by the oncologis)

Daniel Sheibley, MD :

Did I answer your question?

Customer:

Oh I see

Customer:

So we need to push for something along with chemo right nt just chemo ?

Customer:

Is irinotecan

Customer:

Is irinotecan effective ?

Daniel Sheibley, MD :

yes but one chemotherapy does not fit all patients

Customer:

Is it as there's a node there they can only do vhemo

Daniel Sheibley, MD :

adjunctive therapy such as percutaneous ablation or chemo-embo would be the next option in my opinion

Daniel Sheibley, MD :

yes only chemo for a node

Customer:

chemo

Customer:

So nothing can

Customer:

So nothing can work on the node ?

Daniel Sheibley, MD :

external beam radiation can target nodes even in conjunction with chemotherapy, however that would need to be discussed with his oncologist

Daniel Sheibley, MD :

whether they feel it is a viable option.

Customer:

If kept under control can survival rate be good? Are we talking less than 5 yrs ?

Customer:

All they saying is chemo

Customer:

So I need a second opinion as ppl

Daniel Sheibley, MD :

if hepatic metastases are kept under control and do not cause any biliary obstructive problems or overt liver failure then yes a 5 year survival is not impossible

Customer:

As with 2 mets I find it hard to believe they can't do much

Daniel Sheibley, MD :

but that is speaking in general

Daniel Sheibley, MD :

i would suggest seeking consultation with an interventional radiologist through his oncologist to discuss adjunctive therapies

Daniel Sheibley, MD :

yttrium-90 radioembo, chemoembo, bland embo, or percutaneous ablative therapies would all potentially be options

Customer:

Yes will do that then ASAP . So it's not like at present the patient haa like 1-2 Years only ?

Daniel Sheibley, MD :

No. You can't say that as a blanket statement.

Customer:

U have been very helpfull thank you very much .

Daniel Sheibley, MD :

Glad to have helped!

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