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What Can Be Done For Metastases To Peritonium?

Posted on Mon, 11 May 2015

Question: What can be done for metastases to peritonium?

Answered by Dr. Praveen (29 minutes later)

Brief Answer:
I would suggest surgery with chemo

Detailed Answer:
Hi dear.Thanks for your query.

For treatment of metastases due to colon cancer, I would recommend cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy(CRS-HIPEC). This is one of modalities of reducing the cancer cell burden and evidence has shown that it prolongs the life of colon cancer individuals with metastasis.

Regards
Dr.Praveen PVVSB

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Praveen (6 minutes later)

But the prob is he has liver mets too about 8/9? It can't be done then right ?

Also he has started chemo oxyplatin and raltitrexed recently . He's had 1 round an his cea beofre it was 65 and now 3 weeks later it is 78!if chemo was working the cea would
Have reduced right ?

Answered by Dr. Praveen (30 minutes later)

Brief Answer:
Increase in CEA is commonly seen after chemo

Detailed Answer:
Hi dear.Thanks for your query.

As per your description, I were to recommend chemotherapy which your physician has already started.Suggest to complete the cycles with oxaliplatin and raltitrexed for a better response and improving the survival.

Increase in the CEA by 10-15 units is due to chemotherapy and does not point the failure/resistance to drug like Oxaliplatin therapy.Hence its really not required to worry about it.

Regards
Dr.Praveen PVVSB

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Praveen (15 minutes later)

I was really worried that it's cuz the treatement failing .

He was on irinotecan alone before from oct - dec and his cea was rising by 1-2 points per month . Eg nov was 9, December was 12.

Then there was no treatment from jan-march and his cea at 27 march was 65!

A big jump . So on irinotcan cea was also rising slowly and a scan showed disease profression so I'm thinking as this cea rising the chemo not working .

Answered by Dr. Praveen (7 hours later)

Brief Answer:
Initial rise of CEA is less likely be related to therapeutic failure

Detailed Answer:
Hi dear.Thanks for sharing the information.

I completely understand your concerns.
CEA rise post chemo is due to various reasons.I am happy that there is only a marginal rise initially, which is less likely of therapeutic failure.CEA has to be monitored after 3-4 cycles and only then the values can be commented.

Hope CEA has been done in the same lab throughout.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Praveen (31 minutes later)

What does initial
Rise mean?

Answered by Dr. Praveen (9 hours later)

Brief Answer:
Rise due to chemo

Detailed Answer:
Hello dear.

I meant CEA rise post chemotherapy with oxyplatin and raltitrexed.
This can be presumed due to chemo since the rise is not significant.

Please keep me posted in case you have any doubts.

Regards
Dr.Praveen PVVSB

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Praveen (1 hour later)

On irinitecan the cea was also rising as follows

Oct was 9
Nov was 10
Dec was 12

And a scan showed progression . Then from dec-march it went to 65!

I'm wondering if same happening this time ?

If working would cea not reduce ?

Answered by Dr. Praveen (39 minutes later)

Brief Answer:
It cannot be concluded unless the CEA are reasonably high

Detailed Answer:
Hi dear.Thanks for the quick revert.

A transition from 9 to 12 is not clinically significant.But from 9 to 65 is definitely important and reflects disease progression/reduced effect of the drug provided he has completed the cycles as per your physician's advice.It is important test the CEA in the same labs.

It cannot be surely said that the same will occur with his current chemotherapy as well.But it is important to monitor CEA after 3 cycles as discussed earlier.At times CEA rise shall purely depend on the progression of the disease(as a part of its natural course).This simply means progression of the disease is more compared to the drug therapy which is being deployed to treat the same.

I am very sure that your dad shall do well on the current chemo regimen and do not panic.Be watchful.Also, discuss with your physician about the CEA values at subsequent cycles.

Hope this clarifies your query.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Praveen (8 hours later)

If irinotecan has failed can this still
Work in a stage 4 patient ?

Also is it betwe adding avastin. ?

Answered by Dr. Praveen (1 hour later)

Brief Answer:
Avastin is approved as first/second line

Detailed Answer:
Hi dear.Thanks for writing me back.

Yes Avastin (Bevacizumab) is a VEGF inhibitor and is approved for treating metastatic colon cancer.

VEGF is a hormone which will increase the growth growth of cancer cells in colon cancer.Inhibition of these cells by Avastin is proven in the research.It is added(as first or second line) if the individuals has progressed despite chemotherapy.

Hope this answers your query.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Praveen (32 minutes later)

Ok can it be added to oxyplatin ?

Answered by Dr. Praveen (17 minutes later)

Brief Answer:
Yes it can be added

Detailed Answer:
Hello again.

Yes it can be added along with oxaliplatin.

Regards
Dr.Praveen

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar