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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45228
Experience:  Board Certified Physician
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Metastic colon cancer , pt in hosp with enteritis . On antibiotics. Has

Customer Question

Metastic colon cancer , pt in hosp with enteritis . On antibiotics.
Has fever on and off,appetite loss and bilirubin fluctuating like:
12,19,12,30 units uk based . Is liver failing ?
Alp- 103
Alt-105
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. David replied 1 year ago.
This is Dr. David

doesn't look like liver is failing.

bilirubin up could be from small bile stones in the liver from dehydration

enteritis doesn't help and can cause dehydration.

ALP and ALT not in dangerous range.

I don't see signs of liver failure.

sounds like chemotherapy has been difficult.
Customer: replied 1 year ago.

Ok thx a lot . He has fluctuating fever too . Was on oxyplatin and raltitrexed . 3 rounds so far .

Then ct scan showed bowel thickening and enteritis is noted ... Says could be infection or ischaemic .

on antibiotic but fever still fluctuating , past two days nausea and appetite loss. Hardly eaten past week .

plus bilirubin fluctuating so I'm concerned what this is all

Expert:  Dr. David replied 1 year ago.
it sounds like a bad reaction to his chemotherapy

oxaliplatin and raltitrexed can cause bowel ischemia and enteritis.

he needs to have his chemo held until he is doing better.

hoepfully his bowel inflammation will get better with time.
Customer: replied 1 year ago.

Yes it's on hold.

My worry if fever not going plus he can't eat ?snd nausea

His WBC abc platlet count was low too few days ago plus his haemaglobin dropped to 6.9.

also as mentioned bilirubin fluctuating . If he has liver mets would this not b liver failure ,

can an enteritis cause the above symptoms?

Expert:  Dr. David replied 1 year ago.
he doesn't have liver failure.

yes, enteritis and his recent chemotherapy can cause all of his symptoms
Customer: replied 1 year ago.

He had ct scan 3 days ago and 2 liver metastases wete like 9 cm and 4 peritineal nodules .

symptoms are can't eat ESP since in hospiral, fever, tierdness and weight loss as not eating , plus bilirubin fluctuating.

Hes oes not had chemo for even 3 weaks so I'm just worried how enteritus can cause all these symptoms ?

Expert:  Dr. David replied 1 year ago.
chemotherapy is long known to be able to cause long term enteritis and all of these symptoms

http://www.ncbi.nlm.nih.gov/pubmed/15233387

it can take longer than 3 weeks to resolve

he most likely needs to go on TPN or total parenteral nutrition at this point if he is not eating.
Customer: replied 1 year ago.

The hosp are not putting him on that. Said they will send dietician first.

can enteritis cause not able to eat?

plus he's on antibiotic since Sunday last week and is not better

Expert:  Dr. David replied 1 year ago.
yes, enteritis can cause him not to eat.

he needs to go on TPN.

his bowels will not heal without nutrition in his blood.

he is not getting nutrition since he is not eating.
Customer: replied 1 year ago.

I see that's why he's feeling like this more . Ok we will raise this today .

we we have been worried it's liver failure or liver starting to fail ?

his cea has been

round 1 of chemo -80

roubd 2 of chemo -55

round 3 of chemo -40

what can this pattern mean ?

Expert:  Dr. David replied 1 year ago.
his CEA is coming down. that is good

but you have to get his bowels to start working or he will die from his enteritis.

he needs food and nutrition and TPN or else he could die from his enteritis.
Customer: replied 1 year ago.

What is tpn ?

Expert:  Dr. David replied 1 year ago.
total parenteral nutrition through the vein given by IV
Customer: replied 1 year ago.

Ok so could it be that as no nutrition it's not getting better ? They have just given antibiotic and coedine .

and salt water .

does this condition cause fever?

Expert:  Dr. David replied 1 year ago.
yes, severe enteritis can cause fever

IV fliuds of saline is not enough

he needs at least D5NS with dextrose sugar in the water normal saline to give him some calories.

but TPN would be better by vein
Customer: replied 1 year ago.

Il raise this today

do u think the liver metastses could be causing these symptoms ?

Expert:  Dr. David replied 1 year ago.
no, his liver mets are not causing his symptoms

he has enteritis

he is not going into liver failure

please leave positive rating below the chat box so I can get credit for helping you today

Thanks for using JustAnswers.com
Customer: replied 1 year ago.

Thx

exact words on ct are :

mural thickening odema, mucosal hypwellerenhancement and perientric fat stranding involving the terminal 50cm of the small bowel , in keeping with enteritis. Cause could be infection or ischamia

what do u think ?

Expert:  Dr. David replied 1 year ago.
most likely not infection . he has been on antibiotics.

most likely enteritis of the terminal ileum from his prior chemotherapy.
Customer: replied 1 year ago.

Ok thanks. I had just one question please .ct scan was does Tuesday .

his cea reading werr as I said

before chemo -65

afternround 1-80

after round 2-55

after round 3-40

irinotecan was stopped in dec as no response and liver met increased from 2cm to 4 cm, so a private scan was done in march as no chemo for 3 months . Private scan showed 7.5 cm liver met and few more mets and 4 peri nodes . This scan was done in march this year - 2nd march

new chemo regime started April . oxy and raltitrxed .

Ct to report now states 2 liver met sizes increased but does not mentioned rest of the small liver mets at all.

with cea dropping could it be that the liver mets increased since march till April -4 weeks ( till the new chemo started )? And no body knows about this and think size has increased as they are going by the march scan and not taking into account the 4 weeks gap there was before start of the new chemo ?

Expert:  Dr. David replied 1 year ago.
CEA is only one way we assess colon cancer.

CT scan also is another objective way to assess colon cancer metastasis

if the CT scan shows growth in 2 liver mets, most likely the cancer is growing.

some colon cancer cells don't make CEA.

the radiologist don't care about chemo

they only look at prior CT scans and measure size on CT

if the CT report shows growth, the 2 mets are growing.

if the new chemo will work, the 2 mets will shrink on subsequent scans

but if his enteritis doesn't get better, he won't be able to get more chemo.
Customer: replied 1 year ago.

With previous chemo his cea has always gone up and up . First time on this new one it's dropping each cycle .

plus no new mets and do u know y they may not mentioned the othwr liver mets ? He only mentions 2?

can I send report ?

Expert:  Dr. David replied 1 year ago.
I don't know why your radiologist didn't mention those other metastasis

perhaps they shrunk and disappeared

sometimes cancer can have a partial response where parts of the cancer grows and parts shink away

this happens when the cancer becomes more heterogenous or have different clones which responds differently to therapy

we see this frequently.
Customer: replied 1 year ago.

I have a feeling that's happened and that explains the drop in cea every 3 Weeks .

how can I send you report ?

Expert:  Dr. David replied 1 year ago.
you can attach the pdf file report here from a laptop or computer browser window

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
Customer: replied 1 year ago.

I can't attach . Is there another way ?

Expert:  Dr. David replied 1 year ago.
you can mail the report to

info @ justanswer . com

and moderators can forward it to me in several hours.
Customer: replied 1 year ago.

Ok il try that . The hosp dr said today the bowel is inflammed and rejecting food . What can be done here for treatment ?

Expert:  Dr. David replied 1 year ago.
TPN can help the bowels heal and to calm down the enteritis
He needs IV fluids with dextrose in it to help give him some glucose
Customer: replied 1 year ago.

Ur right they are starting tpn Monday and said to have light soups etc only .snd also said as a resul of chemo

should he start chemo again ? What if we decide no chemo are there other options

Expert:  Dr. David replied 1 year ago.
he can't start chemo until his enteritis is better.

if no further chemotherapy, he can ask for hospice care for comfort care only

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

we only get credit for helping clients after positive feedback

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: replied 1 year ago.

I have emailed the reports to just answer .com

Expert:  Dr. David replied 1 year ago.
I'll let you know when I get it.
Customer: replied 1 year ago.

I don't think reports have come to you . But so radologists usually knly comment on large mets ,

in march approx 7/8 were noted on liver , 2 large and rest tiny . But the rafiologist on the recent scan only mentions an increase of the 2 large ones . No mention of the others . If thy were not there would

he not say they have disappeared or shrank ?

Expert:  Dr. David replied 1 year ago.
the radiologist should report on all of the lesions in the liver

it sounds like the radiologist are being a bit sloppy there in their reporting.
Customer: replied 1 year ago.

Yes so at the mo we don't know what stands with the rest

the dr came to see my dad today and yes starting tpn tomorrow . He has not eaten since Wednesday hardly . Therfore now very tierd .

will tpn work ?

also she says he has lot inflammation in bowel and called it colitis . But the antibiotics are not doing much I think and his crp was 222 today . He having vomitting and can't eat -

Expert:  Dr. David replied 1 year ago.
I hope the TPN will work.

there is never any guarantees in medicine or cancer therapy.
Customer: replied 1 year ago.

How can they get rid of this ? So it the chemo or cancer that caused this ?they saying another week or 2 but I can't see improvement

Expert:  Dr. David replied 1 year ago.
only time and TPN therapy can help calm down enteritis and colitis from prior chemotherapy.

the TPN therapy will hopefully help give him nutrition so he can have time to heal his own enteritis and colitis.
Customer: replied 1 year ago.

I see .

Can chemo cause a reaction like this . If after this we choose no chemo can we do any it get treatment like SIRT or tace ? Also do vitamin c infussions etc work ?

are there any new drugs coming out ?

Expert:  Dr. David replied 1 year ago.
chemo can cause enteritis and colitis.

he can try stereotactic radiation therapy after chemo

vitamin C infusions don't work to fight cancer.
Customer: replied 1 year ago.

Ok what's ur opinion on further chemo .

with this ,cea has come down a lot, no new mets , no pleural effusions , no fluid etc , and says some nodules are stable but liver mets increase .

with peri mets can radiation be done still ?

can prognosis n good still?

Expert:  Dr. David replied 1 year ago.
his cancer has grown and gotten larger or all of the chemotherapy he has used before.

and his chemotherapy has caused him a lot of side effects and toxicity.

what does he want to do?

his prognosis is poor and he will eventually pass away from his metastatic colon cancer.
Customer: replied 1 year ago.

hes not keen on chemo .

can SIRT work and is survival good with it ?

Expert:  Dr. David replied 1 year ago.
SIRT doesn't improve survival.

it only shrinks the cancer at the area the radiation is aimed at.
Customer: replied 1 year ago.

What is survival like ? He's had this since November 2013 but wa a stage 3 initially

Expert:  Dr. David replied 1 year ago.
no one can predict how long he will live for.
Customer: replied 1 year ago.

ur right no one can . Would u advise a low dose chemo

Expert:  Dr. David replied 1 year ago.
that will most likely be not effective to controlling his cancer

his prior high doses of chemo have not controlled his cancer.
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45228
Experience: Board Certified Physician
Dr. David and other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Is avastin better ? Less toxic .

the oncologist wil go through measurenent he says as his cea dropping so he feels it could hsve worked

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