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Surgery done for rectal cancer. Having pelvic pain. No relief from medicine. PET scan done

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my question is on behalf of my mother who had rectal cancer, had surgery in july 2012 and had radiation 25 times and chemo medicine xeloda. Due to pelvis pain currently having pain medication and injection for calcium. We took bone scan and had hotspots which followed by PET scan as doctor was not sure about the bone scan as CEA results did not show any sign of local recurrence. Please review the PET scan report and advise the best treatment options.
Posted Mon, 25 Mar 2013 in Colon Cancer
 
 
Answered by Dr. Jawahar Ticku 4 hours later
Dear XXXXXXX,

According to the treatment prescribed to your mother it appears she has not only localized disease but has metastasis as well that means disease has gone out of rectum to bones as well though locally there is no disease after treatment by surgery and radiation. For local rectal disease, your mother has been adequately treated. CEA abnormality is not ment for local recurrence. A number of times in spite of the disease present CEA is normal.

I strongly feel that your mother needs active treatment for metastatic disease, which may be in the bones or liver.

Your doctor must be very much aware of it. I hope my concern is clear to you. I shall be happy to answer you if any other query.

Truly,
Dr. Ticku Jawahar.
Above answer was peer-reviewed by
 
Follow-up: Surgery done for rectal cancer. Having pelvic pain. No relief from medicine. PET scan done 1 hour later
Would the treatment be chemo or radiation. Do you have an advise. Also did you review the PETS scan report, is the cancer only on the bone system.

Please let me know what you would recommend if you were my doctor.
 
 
Answered by Dr. Jawahar Ticku 4 hours later
Dear XXXXXXX,

I have gone through the pet scan report. As per this report there is widespread metastasis in the bones. No other part of the body has picked up FDG which suggests that no other body part is involved. Normally the GIT tumors particularly colon and rectum travel first through the liver which might have been involved first. This means there is unidentified wide spread disease in the body which needs active management.

Your doctor has rightly prescribed bone calcifying drug which I am sure must be Zoledronic Acid (Zometa 4mg. every three weeks). In addition to this I would recommend combination chemotherapy instead of single drug capacetabine. Your Oncologist will know it better if it shall be suitable for her because he is physically seeing the patient. Adding radiation will be necessary if there is gross disease any where in the bone which is causing lot of pain or there is tendency to fracture.

Your Oncologist will definitely advise you better.

Hope your question is fully answered.

Truly,
Dr. Ticku XXXXXXX
Consultant Clinical Oncologist
Above answer was peer-reviewed by
 
Follow-up: Surgery done for rectal cancer. Having pelvic pain. No relief from medicine. PET scan done 45 minutes later
thanks for your response. Yes she has been getting Zoledronic Acid injection. She has pain the pelvis area probably due to the tumor in that area.

I am not clear about your response "This means there is unidentified wide spread disease in the body which needs active management ". Could you clarify, does this mean a body part not identified in the report might have been effected ??

Based on the Bone Scan and PET scan the bone system has been affected but no other body part. Would that mean that the spread might have come from the rectal tumor before it was removed ?? Or would the bone be affected from not a local recurrence.
Could you clarify your response "A number of times in spite of the disease present CEA is normal". If this is the case how would one detect the disease effecting the bone system as is the case here. Do you have to do bone/pet scan regularly.

Do you have cases as this where chemo has worked and stopped further spreading.



 
 
Answered by Dr. Jawahar Ticku 28 minutes later
Dear XXXXXXX,

The disease must have spread prior to the removal of the rectum. Most often there is micrometastasis which is not picked up at the initial stage.. Pelvic bony pain could be addressed by local radiotherapy for which your oncologist is the right person to tell you if it shall be useful.

PET is not showing any local recurrence, but still to confirm, sigmoidoscopy (endoscopy) can be done. Since the disease has metastasized, confirming local recurrence is irrelevant.
You do not need to do PET scan regularly, once the bone disease is established there is no need for PET. At the most, this can be done once bone disease is treated completely and assess the response to treatment.

There is some Occult spot which is showing the metastasis. zoledronic acid is a good drug for bone involvement but the occult disease needs to be tackled. May be even by targeted chemotherapy for which a Medical Oncologists opinion is needed.

Truly,
Dr. Ticku Jawahar
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