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CT scan done. Have dukes b colon cancer no lymph node involvement. What treatment should be done?

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Jan 2013
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hi i had a ct scan on my lungs yesterday to see if any change had occured to 2 lung spots on aprevious scan 3 months ago and the radiographer came in and said no XXXXXXX was required which was good can i read anything into this ie no change in spots or not I am very anxious about results I have dukes b colon cancer no lymph node involvement
Posted Mon, 23 Jul 2012 in Colon Cancer
 
 
Answered by Dr. Mayank Bhargava 1 hour later
Hi XXXXXXX

1) Your query showed some suspicion between metastasis or simple lung spot.

2) Kindly mention following queries in detail:
a) Site of lesion-right colon/ left colon/ rectum. Rectal cancer are most likely
spread to lungs.
b) Preoperative serum Carcinoembyonic antigen (CEA)
c) Preoperative Colonoscopy findings
d) Preoperative Chest x XXXXXXX finding- lesions present today are newly developed or
persisting since cancer detection.
e) Preoperative CT/ MRI scan finding- whether liver metastasis was present or
not.
f) How many years have passed after cancer detection & surgery?

3) Although you have been diagnosed as Duke's B with no lymph node involvement, but 22% patient has stage IV disease at the time of disease detection (spread to liver, lung) regardless of depth of tumor invasion in bowel wall/ lymph node status. 5 year survival rate is 5-7%.(Tadataka Yamada, textbook of gastroenterology, 5th edition page 1700).

4) Duke's B stage without lymph node involvement is labelled as T3N0M1 (in TNM staging). This stage has 84.7% 5 year survival rate.(Tadataka Yamada, textbook of gastroenterology, 5th edition page 1694).

5) Post-operative surveillance strategy:
a) History & Physical examination: every 3 months for 2 years and every 6
months for 3 year (National Comprehensive cancer network), every 3-6
months for 3 years then annually (American society of clinical oncology).
b) CEA test: every 3 months for 2 years and every 6 months for 3 year (National
Comprehensive cancer network).
c) Colonoscopy: After 1 year of surgery, then every 1 year if abnormal/ every 3
years if no polyp was found.

6) You should go for CEA test & Positron emmision test (PET) if you are in doubt regarding lung spots.

7) PET shows presence of any metastasis arising from previous site, whether present in liver/ lung/ vertebrae/ local, not detectable with CT/ MRI scan. PET also show whether lung spots are metastasis or pleural thickening/ adenoma, a benign lung lesion.(Tadataka Yamada, textbook of gastroenterology, 5th edition page 1689).

8) Raised level of CEA show recurrence of disease and close scrutiny of primary and metastatic disease.

Hope this will solve your query and give your required details.

Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: CT scan done. Have dukes b colon cancer no lymph node involvement. What treatment should be done? 19 minutes later
2a site of cancer right ascending colon
b cea not known
c cadencarcinoma r/h side no liver mets or lymphnode
d2no lung spots 1 left upper 1 right uper section of lung
e ct scan to chest 2no spots present pre op
f 3months

 
 
Answered by Dr. Mayank Bhargava 24 minutes later
Hi XXXXXXX

Thanks for sending your information.

1) Absence of lung spot in CT chest preoperatively and presence after 3 months indicate some sort of metastasis.

2) You should go for CEA level and PET scan to rule out metastasis.

3) You should follow the Post operative surveillance strategy (as mentioned previously) in future.

Hope this will solve your query

You can post any other query if you have

Regards,

Dr. Mayank Bhargava

Above answer was peer-reviewed by
 
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