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Are Metastatic Colon Cancers Resistant To Chemotherapy?
Question: Are metastic colon cancers resistant to all chemotherpay ?
Brief Answer:
Most metastatic colorectal cancers respond but some are chemo resistant
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Having worked in a cancer institute for few years, I have seen patients getting treated for colorectal cancer with metastasis. There are many methods to treat a colorectal cancer and the treatment is usually discussed on an individual case basis. Surgery of the primary colon cancer is the first treatment step (if tumor is resectable) and then cycles of chemotherapy are given.
Liver metastasis occurs in half of patients with colorectal cancer. Treatment of colorectal cancer with liver metastasis includes the following methods.
1. Surgery.
2. Neoadjuvant chemotherapy.
3. Local ablation (eg radiofrequency ablation).
4. Adjuvant chemotherapy.
5. Intra-arterial chemotherapy.
With regard to chemotherapy, advances taking place each day in the field of cancer treatment, many of the metastatic colorectal cancers have been seen to respond to chemotherapy. There what is called the first line chemotherapeutic agents and if they do not show response then second line of drugs are used.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Most metastatic colorectal cancers respond but some are chemo resistant
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Having worked in a cancer institute for few years, I have seen patients getting treated for colorectal cancer with metastasis. There are many methods to treat a colorectal cancer and the treatment is usually discussed on an individual case basis. Surgery of the primary colon cancer is the first treatment step (if tumor is resectable) and then cycles of chemotherapy are given.
Liver metastasis occurs in half of patients with colorectal cancer. Treatment of colorectal cancer with liver metastasis includes the following methods.
1. Surgery.
2. Neoadjuvant chemotherapy.
3. Local ablation (eg radiofrequency ablation).
4. Adjuvant chemotherapy.
5. Intra-arterial chemotherapy.
With regard to chemotherapy, advances taking place each day in the field of cancer treatment, many of the metastatic colorectal cancers have been seen to respond to chemotherapy. There what is called the first line chemotherapeutic agents and if they do not show response then second line of drugs are used.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thx
We have a big problem . Colon
Primary removed on march 14. Taken xeloda as adjuvant .
Then in august 2014- a liver met 1.5 cm and a lymph node . Started irinotcan 4 cycles in October .
XXXXXXX 2015 scan - increas in liver met to 4 cm, increase in node and a new pleural
Nodule .
So irinotecan failed .
Is irinotecan alone enough ?
Then his onco just said we can't
Do
Nothing and discharged . We got sec opinion who said he needs diff chemo and abaltion of liver met.
Went for abaltion but cancelled as not liver met 6.7 cm and 3 more spots on liver under 1 cm!
So since oct no
Chemo , as irinotecan did not work and then it was stopped in XXXXXXX and nothing since.
What we do ?
We have a big problem . Colon
Primary removed on march 14. Taken xeloda as adjuvant .
Then in august 2014- a liver met 1.5 cm and a lymph node . Started irinotcan 4 cycles in October .
XXXXXXX 2015 scan - increas in liver met to 4 cm, increase in node and a new pleural
Nodule .
So irinotecan failed .
Is irinotecan alone enough ?
Then his onco just said we can't
Do
Nothing and discharged . We got sec opinion who said he needs diff chemo and abaltion of liver met.
Went for abaltion but cancelled as not liver met 6.7 cm and 3 more spots on liver under 1 cm!
So since oct no
Chemo , as irinotecan did not work and then it was stopped in XXXXXXX and nothing since.
What we do ?
Brief Answer:
Giving other chemotherapy drugs might be given a thought
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Patient unable to fulfill criteria for radiofrequency ablation due to 7 cm size and appearance of three new lesions is a concern.
Present medical treatment guidelines for metastatic colorectal cancer suggests the following.
Currently, there are ten active and approved drugs for patients with metastatic colorectal cancer that are used alone and in combination with other drugs:
5-FU.
Capecitabine.
Irinotecan.
Oxaliplatin.
Bevacizumab.
FOLFOXIRI (irinotecan, oxaliplatin, leucovorin [LV], and 5-FU)
Cetuximab.
Aflibercept.
Panitumumab.
Regorafenib.
If irinotecan is the one that did not show response then other medications from the above list might be tried to slow disease progression. Details need to be discussed with treating oncologist and if required a second opinion should be considered. This way we can try to increase the survival.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Giving other chemotherapy drugs might be given a thought
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Patient unable to fulfill criteria for radiofrequency ablation due to 7 cm size and appearance of three new lesions is a concern.
Present medical treatment guidelines for metastatic colorectal cancer suggests the following.
Currently, there are ten active and approved drugs for patients with metastatic colorectal cancer that are used alone and in combination with other drugs:
5-FU.
Capecitabine.
Irinotecan.
Oxaliplatin.
Bevacizumab.
FOLFOXIRI (irinotecan, oxaliplatin, leucovorin [LV], and 5-FU)
Cetuximab.
Aflibercept.
Panitumumab.
Regorafenib.
If irinotecan is the one that did not show response then other medications from the above list might be tried to slow disease progression. Details need to be discussed with treating oncologist and if required a second opinion should be considered. This way we can try to increase the survival.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can u please look these reports old and new . The new ct was done via a second opinion .
In XXXXXXX his onco told us there was 1 liver met and the ct done privately last week shows all this in the liver?
In XXXXXXX his onco told us there was 1 liver met and the ct done privately last week shows all this in the liver?
Brief Answer:
Only one report attached twice, please upload last week's CT scan report
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
I find only one CT scan report done in XXXXXXX 2015 uploaded twice.
Can you please upload the CT scan report done last week to understand better.
Regards,
Dr.Vivek
Only one report attached twice, please upload last week's CT scan report
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
I find only one CT scan report done in XXXXXXX 2015 uploaded twice.
Can you please upload the CT scan report done last week to understand better.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok u got it?
Brief Answer:
Disease is widely spread in the liver
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
After reading the report I feel that there are multiple areas in the liver where the disease has spread. With this picture, aggressive chemotherapy is the only way the disease can be slowed down for now. However the final outcome of the situation might not end in cure; however we must fight the battle with cancer till the end. Even if the life of the patient can be extended by about 6 months then chemotherapy is a good option.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Disease is widely spread in the liver
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
After reading the report I feel that there are multiple areas in the liver where the disease has spread. With this picture, aggressive chemotherapy is the only way the disease can be slowed down for now. However the final outcome of the situation might not end in cure; however we must fight the battle with cancer till the end. Even if the life of the patient can be extended by about 6 months then chemotherapy is a good option.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The dr are at fault right for not switching to a diff chemo as soon as irinotecan failed ?
But is irinotecan sufficient alone ?
Also, if chemo
Shrinks them etc , then can we do chemobolization?
Is it normal for this many mets to
Appear in 2 months ?
But is irinotecan sufficient alone ?
Also, if chemo
Shrinks them etc , then can we do chemobolization?
Is it normal for this many mets to
Appear in 2 months ?
Brief Answer:
Please find my observations below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. Cancer treatment is still under a lot of research and the doctors are not exactly at fault but might have thought that the disease will behave in a certain way and that did not happen. Some doctors follow particular regimen of chemotherapy agents. When irinotecan failed, a more aggressive chemotherapy plan should have been started, but at that time the CT scan showed only a single liver metastasis and the plan was to target it successfully using other ways.
2. Irinotecan alone might benefit some patients but is not the answer for everyone having colorectal cancer with liver metastasis.
3. Chemoembolization has certain criteria and with multiple big and small lesions, it might not work as intended.
4. Within two months, it is difficult to suddenly have so many metastases. The 2 to 2.5 cm ones might have been present even in scan done earlier but not too well seen.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find my observations below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. Cancer treatment is still under a lot of research and the doctors are not exactly at fault but might have thought that the disease will behave in a certain way and that did not happen. Some doctors follow particular regimen of chemotherapy agents. When irinotecan failed, a more aggressive chemotherapy plan should have been started, but at that time the CT scan showed only a single liver metastasis and the plan was to target it successfully using other ways.
2. Irinotecan alone might benefit some patients but is not the answer for everyone having colorectal cancer with liver metastasis.
3. Chemoembolization has certain criteria and with multiple big and small lesions, it might not work as intended.
4. Within two months, it is difficult to suddenly have so many metastases. The 2 to 2.5 cm ones might have been present even in scan done earlier but not too well seen.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
U see this ct is done by a second opinion radiologist who does not have all previous reports . Last year we were told my dad has liver cysts too ( benign ) so could
Some be those and he not realised ?
It's rare right I develop 7 mets in 2 monts ? But could
It be as he was not having chemo?
What is
Prognosis like if chemo
Works and we get SIRT or abaltion ? Can
Person survive few years ?
Some be those and he not realised ?
It's rare right I develop 7 mets in 2 monts ? But could
It be as he was not having chemo?
What is
Prognosis like if chemo
Works and we get SIRT or abaltion ? Can
Person survive few years ?
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. If he had liver cysts earlier then a more careful assessment is to be done and the second opinion radiologist should have been provided with previous records to eliminate any over estimation of disease. If you can send me the new CT scan images by uploading the CD on Dropbox and sending me the link then I can also make an attempt to review and say for sure if any cyst has been confused for a metastasis.
2. Developing 7 metastases in 2 months is rare. It must have been present at a smaller size in the previous CT scan.
3. Prognosis is different in every patient. However,
(i) considering that there are 7 metastases,
(ii) has shown resistance to irinotecan and
(iii) he will be getting chemotherapy and SIRT
then an average time of survival might be anywhere from 6 months to 15 months. Few patients can survive longer by few months.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. If he had liver cysts earlier then a more careful assessment is to be done and the second opinion radiologist should have been provided with previous records to eliminate any over estimation of disease. If you can send me the new CT scan images by uploading the CD on Dropbox and sending me the link then I can also make an attempt to review and say for sure if any cyst has been confused for a metastasis.
2. Developing 7 metastases in 2 months is rare. It must have been present at a smaller size in the previous CT scan.
3. Prognosis is different in every patient. However,
(i) considering that there are 7 metastases,
(ii) has shown resistance to irinotecan and
(iii) he will be getting chemotherapy and SIRT
then an average time of survival might be anywhere from 6 months to 15 months. Few patients can survive longer by few months.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I've attached blood report. We know hb always even bit low and patalet count . Are liver ones etc normal ?
I will get the images soon for
You
I will get the images soon for
You
Brief Answer:
Liver functions are almost normal
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. Surprisingly the liver functions are almost normal. GGT is at upper limits of normal and not too high.
2. Platelet levels are high. This assumes importance if the preoperative levels were normal. If preoperative platelet count was normal and has recently increased then this shows a progression of disease in colorectal cancer with metastases to liver.
3. Please upload entire CD contents to Dropbox and send me the link. That will help me see the images in exact detail and allow me to differentiate cysts from metastasis lesions.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Liver functions are almost normal
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. Surprisingly the liver functions are almost normal. GGT is at upper limits of normal and not too high.
2. Platelet levels are high. This assumes importance if the preoperative levels were normal. If preoperative platelet count was normal and has recently increased then this shows a progression of disease in colorectal cancer with metastases to liver.
3. Please upload entire CD contents to Dropbox and send me the link. That will help me see the images in exact detail and allow me to differentiate cysts from metastasis lesions.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I've got the copy version I attached if XXXXXXX 2015 scan .
Il send you recent one XXXXXXX
Is it good liver function Normal? Is the patalet count a concern ?
Il send you recent one XXXXXXX
Is it good liver function Normal? Is the patalet count a concern ?
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. It saw your image attached, it is showing the two subcapsular lesions; I will see the most recent images and then communicate in detail.
2. The liver is a large organ and even if metastasis is present, the rest of the liver is compensating for liver function and tests are almost normal. This should not be taken as normal liver but the fact is function of the affected part of liver is being taken care of by the rest of it.
3. Platelet count which is consistently higher and increasing is a concern for disease progress.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my observations below.
1. It saw your image attached, it is showing the two subcapsular lesions; I will see the most recent images and then communicate in detail.
2. The liver is a large organ and even if metastasis is present, the rest of the liver is compensating for liver function and tests are almost normal. This should not be taken as normal liver but the fact is function of the affected part of liver is being taken care of by the rest of it.
3. Platelet count which is consistently higher and increasing is a concern for disease progress.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Will send other one soon .
What can be done re high palet count ?
Also do u see the cysts on the scan ?
What can be done re high palet count ?
Also do u see the cysts on the scan ?
Brief Answer:
Treatment with interleukin-6 antibody siltuximab might normalize platelets
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
One approach to treating high platelet count in patients with cancer is to reduce the production of interleukin-6. The interleukin-6 antibody siltuximab, which is being tested in the United Kingdom, is one means of doing this. Please discuss this with your doctor.
The subcapsular areas looked like cysts. To confirm they are cysts, we should measure the density of the lesions and it is possible with CD images in DICOM format.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Treatment with interleukin-6 antibody siltuximab might normalize platelets
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
One approach to treating high platelet count in patients with cancer is to reduce the production of interleukin-6. The interleukin-6 antibody siltuximab, which is being tested in the United Kingdom, is one means of doing this. Please discuss this with your doctor.
The subcapsular areas looked like cysts. To confirm they are cysts, we should measure the density of the lesions and it is possible with CD images in DICOM format.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok give me a day or so to get the disc to u.
U been helpfull
If chemo works n SIRT can he survive few years ?
U been helpfull
If chemo works n SIRT can he survive few years ?
Brief Answer:
SIRT might work best for him
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Praying that your father survives as much possible and wins he fight with cancer.
I will wait for your CD images.
Your father is an ideal candidate for SIRT. The high rate of response and encouraging survival from SIRT have been reported for liver metastases from colorectal cancer and can add a few months or year hoping that the response to treatment will be as expected.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
SIRT might work best for him
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Praying that your father survives as much possible and wins he fight with cancer.
I will wait for your CD images.
Your father is an ideal candidate for SIRT. The high rate of response and encouraging survival from SIRT have been reported for liver metastases from colorectal cancer and can add a few months or year hoping that the response to treatment will be as expected.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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