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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45205
Experience:  Board Certified Physician
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Adjutant chemo following surgery cancer.

Customer Question

Adjutant chemo following surgery for bowel cancer.
Submitted: 11 months ago.
Category: Medical
Customer: replied 11 months ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Customer: replied 11 months ago.
Sorry - adjuvant!
Expert:  Dr. David replied 11 months ago.

This is Dr. David

I am a cancer doctor

what stage was your bowel cancer which was found with surgery?

was there spread to lymph nodes?

have you consulted with a medical oncologist yet after surgery?

are they recommending chemotherapy for you?

in the USA, chemotherapy doctors tend to recommend FOLFOX chemotherapy regimen after colon cancer surgery which include 5FU, oxaliplatin and leukovorin as a combintation.

I can talk to you more by phone if you accept phone consultation.

let me know if you have questions.

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45205
Experience: Board Certified Physician
Dr. David and 6 other Medical Specialists are ready to help you
Customer: replied 11 months ago.
I think I answered all of your questions in my initial symptom box! I am not the patient; my mother is:Stage 3 (low end).
Yes, but apparently "minimally".
Yes.
No, as she underwent angioplasty last year and her haemoglobin level is still low. We now feel that her chronic anaemia was responsible for what was thought to be angina at the time.I do not wish to throw good money after bad, so please help me via this page if you are able.Kind regards,Jane
Expert:  Dr. David replied 11 months ago.

are you having to pay for your mother's chemotherapy?

what do you mean by " do not wish to throw good money after bad"

are you paying for private doctor care in the UK?

I would get a copy of her pathology report. I would be able to tell her stage and lymph node invasion from that pathology report from the surgery.

Customer: replied 11 months ago.
In a nutshell, I would like to know what her chances of a recurrence are given successful surgery, and how chemo might/might not improve her chances.
Customer: replied 11 months ago.
No, chemo would be free on the NHS, but her oncologist didn't recommend it on the basis of her previous cardiac history and the relatively low risk of metastasis, despite the minor changes in her abdominal lymph nodes. They think the < 2cm to our had been growing for maybe 10 years.
Customer: replied 11 months ago.
By good money after bad, I was referring to your asking me several key questions that I had already answered. Sorry! ��
Expert:  Dr. David replied 11 months ago.

your fee pays for the duration of this conversation. not per reply

I see.

I didn't know about her heart condition.

Customer: replied 11 months ago.
I would like a better understanding of the stats. By all accounts her probability of further problems is quite low, but she was given this figure of 10-15% mitigation if she did have the chemo.If that refers to a reduction of acute recurrence being reduced from, say, 30% to 20% then that is one scenario. If it means that her 5 year survival odds are raised, then that is quite different. If it means that she is probably cured but chemo would dimish her potential propensity to develop other cancers, then that is yet another situation (apologies - I work in credit risk survival analysis). This is what I would like to be clarified.I mentioned both her angioplasty and chronic anaemia in my initial post, but never mind ��
Customer: replied 11 months ago.
In your opinion how important is adjutant chemo when there has been some lymphatic/vascular involvement??
Expert:  Dr. David replied 11 months ago.

https://www.mskcc.org/nomograms/colorectal/disease-free-probability

is a good website

to put in her tumor information and get disease free survival information with adjuvant chemotherapy and without adjuvant chemotherapy.

because her tumor is stage III, chemotherapy will decrease the chances of her colon cancer spreading.

http://www.texasoncology.com/types-of-cancer/colon-cancer/stage-iii-colon-cancer

with just surgery alone, her long term cure rate is only in the 40-50% range

with the addition of chemotherapy, we can raise up her cure rate up to the 70-75% range.

so that is significant.

lymphatic vascular space involvement in the tumor specimen is a predictor of if there is spread to adjacent lymph nodes

in the USA, we have found that patients who have 12 or more lymph node removed with the colon cancer surgery do better than those with less than 12 removed.

so we have put into place efforts to try to make sure all patients who have colon cancer have at least 12 lymph nodes removed at the time of surgery.

this we think is therapeutic as well as prognostic in giving information about if the cancer has spread to lymph nodes or not.

let me know when you would like me to give you a call.

Customer: replied 11 months ago.
OK - thanks for your help.
Expert:  Dr. David replied 11 months ago.

you are welcome

I'm at work right now seeing patients.

I may be able to call you in 10-20 minutes.

Expert:  Dr. David replied 11 months ago.

I called just now. no answer.

I hope I didn't call to late.

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