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What Does This CAT Scan Report Indicate?
Question: Hi Doctor,
I was diagnosed with BRAF colon cancer in the asending colon that had metasticized to the liver in XXXXXXX of 2016.One foot of the colon and a tumor was removed.I had to wait for three weeks for the chemo to start and during that time there was tumor growth.
This is from a cat scan just prior to chemo
6/21
LIVER: There are multiple hypodense lesions in the liver consistent with metastatic disease. These
lesions have increased in size and number from the prior study. The largest lesion is again seen in
the right lobe and now measures up to 11.8 x 10.0 cm compared to 10.2 x 8.9 cm on the previous
study. A lesion in the left lobe on image #33 now measures up to 2 cm in diameter compared to 1.1 cm on the prior study. Several hypodense lesions measuring up to 1.1 cm in the right lobe on image #26 appear to be new from the prior exam.
11/4 after 9 chemo treatments
ABDOMEN/PELVIS: Multiple hepatic metastases are redemonstrated, generally smaller and less
conspicuous. Dominant lesion in the right hepatic lobe inferiorly measures 5.0 x 4.7 cm compared to
5.9 x 5.1 cm previously. Spleen is not enlarged. Pancreas and adrenal glands appear grossly stable.
Gallbladder is contracted and contains multiple calcified gallstones, which are greater in number
compared to prior study. Kidneys are stable.
My concern is my CEA level which had been going down since chemo started but then the last three test showed an increase. 1.1 in two days 11/16-11/18.
Is this an indication that the current chemo has stopped working and the tumor is growing or is this not unusual?
6/30/16 8/2/16 8/18/16 8/30/16 9/14/16 10/4/16 10/19/16 11/2/16 11/16/16 11/18/16
14.8 20.8 16.5 14.4 11.4 10.2 8.8 11.7 14.6 15.7
Thank you,
XXXXXXX
I was diagnosed with BRAF colon cancer in the asending colon that had metasticized to the liver in XXXXXXX of 2016.One foot of the colon and a tumor was removed.I had to wait for three weeks for the chemo to start and during that time there was tumor growth.
This is from a cat scan just prior to chemo
6/21
LIVER: There are multiple hypodense lesions in the liver consistent with metastatic disease. These
lesions have increased in size and number from the prior study. The largest lesion is again seen in
the right lobe and now measures up to 11.8 x 10.0 cm compared to 10.2 x 8.9 cm on the previous
study. A lesion in the left lobe on image #33 now measures up to 2 cm in diameter compared to 1.1 cm on the prior study. Several hypodense lesions measuring up to 1.1 cm in the right lobe on image #26 appear to be new from the prior exam.
11/4 after 9 chemo treatments
ABDOMEN/PELVIS: Multiple hepatic metastases are redemonstrated, generally smaller and less
conspicuous. Dominant lesion in the right hepatic lobe inferiorly measures 5.0 x 4.7 cm compared to
5.9 x 5.1 cm previously. Spleen is not enlarged. Pancreas and adrenal glands appear grossly stable.
Gallbladder is contracted and contains multiple calcified gallstones, which are greater in number
compared to prior study. Kidneys are stable.
My concern is my CEA level which had been going down since chemo started but then the last three test showed an increase. 1.1 in two days 11/16-11/18.
Is this an indication that the current chemo has stopped working and the tumor is growing or is this not unusual?
6/30/16 8/2/16 8/18/16 8/30/16 9/14/16 10/4/16 10/19/16 11/2/16 11/16/16 11/18/16
14.8 20.8 16.5 14.4 11.4 10.2 8.8 11.7 14.6 15.7
Thank you,
XXXXXXX
Brief Answer:
This is not significant increase
Detailed Answer:
Hi and welcome.
These are small fluctuations of cea marker and I don't think there is good correlation between disease progression and these values. Cea may fluctuate even from day to day in such small ranges. Disease progression would manifest with double or triple these values. generally,this is advanced disease and prognosis is not favorable,but if there will be continuous shrinkage of tumor size in liver then you can hope for future liver resection. at this point,it is important to continue with chemo and cea levels should not concern you as long as there is improved ct scan finding. Wish you good health. Regards
This is not significant increase
Detailed Answer:
Hi and welcome.
These are small fluctuations of cea marker and I don't think there is good correlation between disease progression and these values. Cea may fluctuate even from day to day in such small ranges. Disease progression would manifest with double or triple these values. generally,this is advanced disease and prognosis is not favorable,but if there will be continuous shrinkage of tumor size in liver then you can hope for future liver resection. at this point,it is important to continue with chemo and cea levels should not concern you as long as there is improved ct scan finding. Wish you good health. Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi Doctor Thank you for your answer.Would you consider the progress of the tumor shrinkage to be normal.My doctors were quite surprised and did not expect to see such improvement.I will go to MC XXXXXXX tomorrow and go to XXXXXXX XXXXXXX on December 7th to see a liver surgeon.Would you have any idea how much my tumors would have to shrink to b a candidate for liver resection?
Thank you.I appreciate your concern
XXXXXXX
Thank you.I appreciate your concern
XXXXXXX
Brief Answer:
Hi
Detailed Answer:
Hi again.
Yes,I have to admit that we rarely see efficiency of chemotherapy on liver metastases. However,it is possible and then if there is significant tumor shrint, it is called"downstaging" which means that tumor may become resectable. I have to highlight that this is rare scenario and we consider that 30 % of healthy liver tissue is required for possibility of liver resection. if this percentage cant be achieved then there are some possible alternatives such as portal vein embolization or ALPPS but this is not time to discuss it .
Hi
Detailed Answer:
Hi again.
Yes,I have to admit that we rarely see efficiency of chemotherapy on liver metastases. However,it is possible and then if there is significant tumor shrint, it is called"downstaging" which means that tumor may become resectable. I have to highlight that this is rare scenario and we consider that 30 % of healthy liver tissue is required for possibility of liver resection. if this percentage cant be achieved then there are some possible alternatives such as portal vein embolization or ALPPS but this is not time to discuss it .
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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