Brief Answer:
Explained

Detailed Answer:
Hello and Welcome

I appreciate your concern.

Xeloda (capecitabine) is used to treat:
•cancer of the colon or rectum (colorectal cancer) that has spread to other parts of the body (metastatic colorectal cancer). Xeloda is used as a single drug to treat metastatic colorectal cancer
•cancer of the colon after surgery

Please mention if your father is a diagnosed case of colorectal cancer or not ?

The report quality is very bad. Please upload a good quality picture to be able to read and interpret it for you.

Let me know if you have any query

wishing you best of health

Thanks

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Brief Answer:
explained

Detailed Answer:
Hello again,

Fluorodeoxyglucose (FDG), an analogue of glucose is used as a tracer, if there was no uptake, it means that the area was metabolically inactive. Those with high uptake have high metabolic activity.

Liver metastases, usually signifies advanced disease , unless the lesion is primarily in the liver , which doesn't seem to be the case in your father's report, as explained by you. Unless the primary tumor history is not known one can only do intelligent guess work about these foci.

I would again suggest you to let me know why the PET scan was indicated, was there any history of colorectal cancer ? What were the findings on the colonoscopy if done previously ?

The report quality is very bad. Please upload a good quality picture to be able to read and interpret it for you.

Let me know if you have any query

wishing you best of health

Thanks

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Brief Answer:
explained

Detailed Answer:
hello,

I appreciate your concern for your father.

Isolated ablation or destruction of patches of foci of malignancy has shown no benefit in reducing mortality or morbidity, so isn't the standard of care.

A single metastatic focus in liver can be indication for resection of that focus. For widespread disease you should opt for chemotherapy.Although systemic chemotherapy for metastatic colorectal cancer has not significantly improved five-year survival rates, it has produced meaningful improvements in median and progression-free survival. These benefits are most pronounced with regimens containing irinotecan or oxaliplatin in combination with 5-fluorouracil (5-FU); median overall survival durations consistently approach 20 months, and in some studies, as high as 24 months. In contrast, among patients receiving supportive care alone for metastatic disease, median survival durations are five to six months.

Chemo isn't curative in wide spread metastases, its role is palliative.

May the odds be in your favor.

Please let me know if any thing is unclear, I am here to help you clear things out

thanks

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Brief Answer:
explained

Detailed Answer:
Hello and Welcome

I appreciate your concern.

Lymph node involvement is an adverse prognostic factor itself and ablation alone cant be used as it will recur in another node later own via drainage, even if the aortocaval is removed.

Ablation / resection would have been a better option if it was a single liver metastatic focus.

Cancer cells can become resistant to chemo. Tumors that come back often do not respond to treatment as well as the first tumors did.

The length of time between the original diagnosis and recurrence, the aggressiveness of the cancer cell type, age, overall health status, how well tolerance to treatment is there, the length of time of the treatment, will be some of the factors that need to be considered before chemo is under taken.

Chemo is a better option than local resection. Please understand the goals and benefit before choosing radical intervention that may be more painful and have a lesser outcome than with no treatment. These issues are difficult to discuss and you need to have a detailed discussion with the medical team.

hope this helps.


Let me know if there are any other clarifications.

thanks





Let me know if you have any query

wishing you best of health

Thanks

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Brief Answer:
explained

Detailed Answer:
hi,

With Chemo many patients can go into prolonged phases of remission. Clearing it completely or sustained remission is rare.

The timeline can be predicted if exact dates of xeloda and recurrence of tumor is known. But most likely, it didn't respond to xeloda.

Not necessarily dead if fdg negative, just metabolically inactive or very low metabolic activity. False positives are common in PET scan assessment aided by FDG , the radiologist has to make a subjective assessment on the malignancy of the focus by considering its location and nature of appearance. It cant be ruled in 100 percent unless histology is done.

hope this helps

thanks.

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Brief Answer:
explained

Detailed Answer:
hi,

You should trust your medical team but demand a compassionate sit in with the head of the team to discuss the ultimate outcome. Do take into consideration what your dad has to say in undergoing repeated chemo.

You said Xeloda was started late because your dad wasn't sure. When the colon got resected , what grade and stage was it in march, can you please tell me the exact grade and stage it was then in march. Because at some stage and grades post resection chemo is preferred and leads to better outcome.

Its not one met, its one in liver plus lymph node involved in aortacaval area.

hope this helps

thanks.

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Brief Answer:
explained

Detailed Answer:
hi,

Cancer located upto B1 is easily resected ie upto Submucosa, and doesn't require chemo.

C 1 is widespread as C shows nodal involvement and definitely required chemotherapy as resection alone is not right.

So, yes missing xeloda was a mistake and the secondaries may have appeared even before the chemo was started, overwhelming it thus.

I am sorry for your distress.
Hope you see it in the proper perspective.

thanks

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