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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 9867
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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What is best treatment for a liver met of 16 mm and a aortocaval

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What is best treatment for a liver met of 16 mm and a aortocaval node of 10 mm?
Dr Uzair :

Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Dr Uzair :

What was the primary and how was it treated?

Dr Uzair :

Please enter chat and use reply to respond.

Customer :

Hi surgery march for colon cancer . Was dukes c1. started xeloda but late . Cea was rising and recent pet scan showed 1 16 mm liver met and 1 aortocaval node .

Customer :

Had 1 session folfiri but as chest tightness now only irinotecan , will irinotecan be effective and also his cea is not decreasing , it was 9.8 in august, october

Customer :

October was. 8 and now dec was 9

Customer :

Should the cea decrease if working ? He started this chemo in oct

Dr Uzair : Yes CEA should decrease. I would suggest that you take this on proactively and discuss it with his surgeon as soon as possible.
Dr Uzair : Surgical resection of the metastatic lesion will be the best option since the chemo does not seem to be effective.
Customer :

Well unsee

Customer :

U see. On xeloda cea went to 3,4,6,9.8. But after 4 cycles when stopped it fell to 8 then once this chemo started it gone up 1 point to 9. That's what I don't understand

Customer :

Is irinotecan

Customer :


Customer :

Is irinotecan effective chemo ? Can mets still appear with it?

Dr Uzair : The metastasis has already appeared as I understand.
Dr Uzair : Mans chemo is not taking care of it.
Dr Uzair : It would be better to consult his surgeon since surgery is a viable option at this point in time.
Dr Uzair : I wouldn't sit on this.
Dr Uzair : If the surgeon thinks the metastatic lesion is unapproachable surgically or unrest table then chemo should be considered.
Customer :

That's what u don't get, why they did not resect this and went for chemo ? Is it as there is the node involved ?

Customer :

Well it is approachable as it's on liver edge and small he said but e said as there is a node involved vhemo

Customer :


Customer :

It's a aortocaval node

Dr Uzair : 1 cm aortic avail nodes are borderline lesions so I persume the oncologist wants to give a trial to avoid surgery
Dr Uzair : aortocaval nodes are resectable surgically
Dr Uzair : that is why I think consulting a surgeon will give you a more precise idea of your options.
Dr Uzair : CEA is rising. There are two metastatic lesions that are resectable. Chemo does not seem to be working. I think these are reasons enough to decrease the metastatic burden and consider surgery as an option.
Dr Uzair : Let me know if you have more queries.
Dr Uzair : If you do not have more queries, please leave a positive rating for the service.
Dr Uzair : Best.
Customer :

It's the liver surgeon who said chemo . Should get a second opinion right ? We don't want to waste time and wana gets these removed ASAP . They said that they wana target the microscopic cells by chemo ?

Customer :

Cea has risen 1 point so far but should

Customer :

But should decrease right?

Dr Uzair : Yes it should. You can wait for another cycle of chemo to be completed and if the CEA does not decrease then you should get surgery done. In the meantime you can get a second opinion.
Dr Uzair : No point in targeting micromets in presence of obvious macro mets.
Dr Uzair : Please leave a positive rating for the service of you do not have any further queries.
Dr Uzair and 3 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

The cea was 9 after 3 cycles . Wht is prognosis like for this situation ?

I can't assess the prognosis with the limited information that I have. It might be misleading and inaccurate.
But I do believe the prognosis can be improved by taking care of the solitary metastatic lesion in the liver and the node.
Customer: replied 3 years ago.

Is it true that cant be resected if you have a node ? Node was 10 mm and liver met 16mm

Customer: replied 3 years ago.

The suv uptake

for the liver met was 5.2. Is

that high?

Well a surgeon with access to the latest scans (ct scan ) will be the best judge but I believe they should be resectable.
Customer: replied 3 years ago.

Ok. Can further mets appear on irinotecan?

Well there is always a chance.
Customer: replied 3 years ago.

what if we resect it and no chemI after?

Let your oncologist decide about chemo.