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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44346
Experience:  Board Certified Physician
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Can colon cancer spread to adrenalGland ?

Customer Question

Can colon cancer spread to adrenal
Gland ?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
Dr. David :

This is Dr. David

Dr. David :

yes.

Dr. David :

colon cancer can spread to adrenal glands.

JACUSTOMER-22pj9brw- :

If u recall about my dad .... I have few queries .

JACUSTOMER-22pj9brw- :

He had a scan after 4 rounds irinitecan .

JACUSTOMER-22pj9brw- :

Following noted :

JACUSTOMER-22pj9brw- :

Increase in the previous liver lesion and aortocaval node, new nodule in left adrenal gland, new nodule in sub pleural left lower lobe.

Dr. David :

it sounds like the irinotecan didn't work.

Dr. David :

and the cancer is growing and spreading.

JACUSTOMER-22pj9brw- :

They started folfiri first but then after 1 round just started irinotecan as he had chest tightness

JACUSTOMER-22pj9brw- :

Is folfiri better?

JACUSTOMER-22pj9brw- :

What u think we can do ? Are these nodules mets then ?

Dr. David :

folfiri has irinotecan in it.

Dr. David :

the I in folfiri is irinotecan.

Dr. David :

those nodules are most likely metastatic colon cancer.

JACUSTOMER-22pj9brw- :

he had a adrenal gland nodule on previous ct too but that was nothing .

JACUSTOMER-22pj9brw- :

The lung nodule is 0.5 cm and the adrenal gland one is under 1 cm

Dr. David :

yes, those nodules can be signs of the colon cancer spreading.

JACUSTOMER-22pj9brw- :

I know this may sound silly but could chemo be actually causing mets ?

Dr. David :

no, chemo will not cause mets.

Dr. David :

his cancer is spreading.

JACUSTOMER-22pj9brw- :

What should be the next steps ? Should they change chemo as we are thinking of nano knife procedure

Dr. David :

there is no one right answer.

JACUSTOMER-22pj9brw- :

can the nodules b killed as they are tiny?

Dr. David :

they can change chemo.

Dr. David :

they can try focused radiation thearpy.

Dr. David :

the nodules can be killed.

Dr. David :

but it won't prevent other new spots from growing.

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

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Thanks for using JustAnswers.com

JACUSTOMER-22pj9brw- :

exaxtly these an be targeted but what's best way to prevent further spots ?

Dr. David :

chemo is the only thing which can be tried to prevent future spots.

Dr. David :

but his cancer is acting aggressively.

Dr. David :

and even further chemo may not work.

JACUSTOMER-22pj9brw- :

Could it be that fact that they left the liver met in that causes further spots ?

Dr. David :

the cancer came from the colon cancer which spread to the lymph nodes

Dr. David :

so the cells have spread through the blood system to get to the liver and lungs and adrenal glands.

Dr. David :

cells can take months to slowly start to grow and show up on CT scan.

JACUSTOMER-22pj9brw- :

The thing is he had no distant mets until he first started chemo ( xeloda) back in June .

JACUSTOMER-22pj9brw- :

So the cells escaped during the surgery ? As all 3 cans prior were fine

Dr. David :

he most likely did, they were probably just too small to see on CT scan.

JACUSTOMER-22pj9brw- :

How many mets u need to have and how big should they be to class the cancer as terminal ?

Dr. David :

that varies from patient to patient

Dr. David :

but his cancer now is metastatic and is not curable in the long run.

Dr. David :

he can continue to get treatments to try to slow down his cancer, but most likely with enough time, he will pass from his metastatic colon cancer

Dr. David :

so you can say his cancer is now terminal and he will eventually pass from his colon cancer.

Dr. David :

it could take 6 months or 12 or 24 months, or longer, no one can know for sure how long he will live

JACUSTOMER-22pj9brw- :

If these current spots get ablated then does a person have few years ?

JACUSTOMER-22pj9brw- :

As a oncologist wha would u advise as a treatment plan

Dr. David :

ablation of those spots will not prevent new spots from growing and most likely will not help the patient live longer.

Dr. David :

the patient needs to be involved with the treatment plan.

Dr. David :

one option is no chemo and no treatment and hospice comfort care.

Dr. David :

if he has been having bad side effects from the chemo, it is up to the patient to decide if they want to get more chemotherapy.

Dr. David :

there is no one right treatment plan in this situation.

Dr. David :

I can't see him and talk to him so therefore I can't advise a treatment plan.

JACUSTOMER-22pj9brw- :

He has no symptoms , tolerated chemo well . Only chest tightness with folfiri .

JACUSTOMER-22pj9brw- :

which chemo

JACUSTOMER-22pj9brw- :

Which chemo would you recommend that could help ?

Dr. David :

he has tried xeloda already.

Dr. David :

and folfuri.

Dr. David :

and irinotecan

Dr. David :

he can try avastin.

Dr. David :

or 5FU.

JACUSTOMER-22pj9brw- :

what would you say to German cancer clinic ? They d. Dendetric cell, hyperthermia etc ?ive read alot of positive stories for ppl in far worse cases

JACUSTOMER-22pj9brw- :

No

Dr. David :

the prey on desperate patients willing to pay cash for experimental therapy with very little proven results.

JACUSTOMER-22pj9brw- :

Sorry folfiri only 1 round .

JACUSTOMER-22pj9brw- :

I see

JACUSTOMER-22pj9brw- :

If further mets can b stopped that is the key right. ?

Dr. David :

chances are very small that they can be stopped.

JACUSTOMER-22pj9brw- :

As these current ones can be ablated right ?

Dr. David :

they can be

JACUSTOMER-22pj9brw- :

With a lot of ppl chemo controls it right ?

Dr. David :

we have talked about all of this already.

Dr. David :

no, for many patients, their colon cancers continue to grow

Dr. David :

most patients chemotherapy eventually doesn't work and the cancer continues to grow.

JACUSTOMER-22pj9brw- :

An he still have up to 5 years ?

Dr. David :

he needs mutation testing of his colon cancer to check for KRAS mutation.

JACUSTOMER-22pj9brw- :

Can

Dr. David :

if he has no KRAS mutation then Erbitux is an option.

Dr. David :

most likely he will not live 5 years.

JACUSTOMER-22pj9brw- :

We don't know what it is

Dr. David :

ask his doctors about KRAS mutation testing.

JACUSTOMER-22pj9brw- :

What about uft pills ?

Dr. David :

uft pills?

JACUSTOMER-22pj9brw- :

I read about them from japan

JACUSTOMER-22pj9brw- :

Ok so can they start folfiri ?

Dr. David :

http://news.cancerconnect.com/uft-taken-by-mouth-may-be-effective-with-cisplatin-for-treatment-of-non-small-cell-lung-cancer/

Dr. David :

for lung cancer.

Dr. David :

yes, they can start folfiri.

Dr. David :

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

JACUSTOMER-22pj9brw- :

if the cancer didnt spread this many years and was grade "2, how can it b aggressive ?

Dr. David :

it is slowly spreading now

Dr. David :

and has not responded to xeloda and other chemotherapy agents.

Dr. David :

and it had spread to many lymph nodes at the time of the surgery.

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44346
Experience: Board Certified Physician
Dr. David and 3 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

Can zaltrap

be used?

Expert:  Dr. David replied 2 years ago.
yes, Zaltrap, also known as ziv-aflibercept can be tried.
Customer: replied 2 years ago.

They have not really bothered to advise anything to b honest. Do you agree there are few more optionS? He has been approved for

nano knife . Is this a good one ? Only 1 uk hosp has it

Customer: replied 2 years ago.

Can I send you the reports as I am confussed . Can you please advise what are the new mets . It just does not make sense

Expert:  Dr. David replied 2 years ago.
some treatments can be very expensive.

and they don't like that in the UK.

new mets are new growths compared to prior studies

which are in places where colon cancer can spread to like the lungs and adrenal glands.
Customer: replied 2 years ago.

Can I email report to you ?

Expert:  Dr. David replied 2 years ago.
sure

type a word in the textbox and highlight it

then select the "chain" icon above the textbox or the paper clip icon to upload a jpg

this opens a window where you can click next to the text box to select the jpg or pdf file on your computer to upload into JustAnswer

http://ww2.justanswer.com/how-do-i-send-photo-or-file-expert

or email to

info @ justanswer . com
Customer: replied 2 years ago.

Customer: replied 2 years ago.

Expert:  Dr. David replied 2 years ago.
sorry. those didn't go through.
Customer: replied 2 years ago.

When I click paperclip

icon just a blank page come up

Expert:  Dr. David replied 2 years ago.
read the instructions here.
Customer: replied 2 years ago.

Expert:  Dr. David replied 2 years ago.
sorry, that didn't work.
Customer: replied 2 years ago.

http://www.mediafire.com/view/r64eqctxkdmvnuc/image(2).jpg

Customer: replied 2 years ago.

http://www.mediafire.com/view/khoq9c42bedhmb7/image.jpg

Expert:  Dr. David replied 2 years ago.
yes, I got it

it sounds like the colon cancer has spread, to the adrenals and the lung pleural nodule

and the lymph node in the aortocaval area is larger as well.
Customer: replied 2 years ago.

The only issue is which I'm confussed .

in new report says new left adrenal gland node but on old report that was also noted . So can't be a new funding right

Also it says , upper lobe nodule remains unchanged . But a upper lobe nodule was never mentioned in any previous report .

Expert:  Dr. David replied 2 years ago.
radiologist can be inconsistant like this

ask your doctor to review the images with you and show you the CT scan

I do this for my cancer patients all the time.
Customer: replied 2 years ago.

U see I'm a lawyer and I do medical negligwince work therefore I'm aware of a few things.

the onco sat and went thru the scan with my dad .this was the first time she looked at it too and she did not even have the previous report . She said some more nodes are seen .

i was not there.

but then when I read both repost I thought that a nodule is not a lymph node.

also radiologist put new nodule on adrenal but that was already in previous report as a non met

Expert:  Dr. David replied 2 years ago.
the only way to know the truth is to look at the CT scan images yourself with the oncologist or radiologist .
Customer: replied 2 years ago.

What would this mean to you .

old report - small nodule on left adrenal

new report - new nodule on left adrenal

gland

it woould be the same spot right?

Expert:  Dr. David replied 2 years ago.
it would be the same spot.

I don't know if it is larger or same size.

poor radiology report.

need to look at images to see if the adrenal nodule is larger.
Customer: replied 2 years ago.

He's not even put whether it's large or smaller . As far as ww know that previously was not a met according to the team.so it may be the same one .

is a 0.5 cm lung nodule very small n can it be ablated ?

Expert:  Dr. David replied 2 years ago.
yes, 0.5cm is 5mm and is very small and can be ablated by radiation like stereotatic radiosurgery.

but it will not prevent new spots from popping up.

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
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44346
Experience: Board Certified Physician
Dr. David and 3 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

Is the neo 2 treatment any good?

Expert:  Dr. David replied 2 years ago.
I am not familiar with that treatment.
Customer: replied 2 years ago.

Ok.shoukd we go for IRE (nano knife).? Wiuld

it be best to ablate all the tumors as they are tiny. There are 3,4 altogether I think.

Expert:  Dr. David replied 2 years ago.
yes, nano knife can ablate small tumors

but it will not prevent new spots from manifesting.
Customer: replied 2 years ago.

Ok what would u advise for new spots ? As an oncologist which chemos do you think will

help to try stop the spots ? I know there are many still to try

Customer: replied 2 years ago.

I far he has tolerated all chemo well and a bloodwork has been fine each time .

Expert:  Dr. David replied 2 years ago.
we have talked about this already.

avastin, 5FU are options.

he needs KRAS testing to see if erbitux will work for him.

maybe his doctors are not giving him high enough doses of his chemo if he has been tolerating it fine.
Customer: replied 2 years ago.

i think he's KRAS wild .

one last quesion , could this be a mistake as radiologist says

new report - upper lobe nodule remains unchanged

old report - has no mention of a upper lobe nodule

what at could this mean to you

Expert:  Dr. David replied 2 years ago.
that the upper lobe nodule was small before and was not mentioned in the prior CT scan report.
Customer: replied 2 years ago.

I see . It is mentioned on this one but says unchanged . So not likely to be a met right ?

Expert:  Dr. David replied 2 years ago.
yes, not likely to be a met.

but has to be reviewed by your oncologist. he should review the images with you.
Customer: replied 2 years ago.

U will b surprised bur we saw a registrar who didn't even I know what nodules are as she said they are lymph nodes ! It's only after I read report I thought nodules are not lymph nodes

Expert:  Dr. David replied 2 years ago.
nodules is a very non specific and not precise word.

sort of like "lesion"

it is a fancy medical way of saying "it" or "that"
Customer: replied 2 years ago.

Ok. The previous ct says no lung lesions . But this new report says ANOTHER upper lung nodule but remains unchanged.so it this a new finding ?

Expert:  Dr. David replied 2 years ago.
only reviewing the lung scan images can tell for sure.
Customer: replied 2 years ago.

hi we got told today that the only extra spot is on the lower lobe which is. Under 0.5 cm.

prob they r having is with 5 fu he had muscle spasm on chest . so don't wNa risk any 5fu chemo .

what alternatives are there that are affective

Expert:  Dr. David replied 2 years ago.
avastin, erbitux,

there is no guarantee that other agents will be effective.
Customer: replied 2 years ago.

Is it better that only 1 tiny nodule has appeared?

Expert:  Dr. David replied 2 years ago.
better than more nodules.
Customer: replied 2 years ago.

is zaltrap any good ?

Expert:  Dr. David replied 2 years ago.
yes, Zaltrap, also known as ziv-aflibercept can be used

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