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Colon cancer, meta-sized into liver, tumors not removed. After chemo, morphine drip. Will the treatment help?

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My brother in law was diagnosed with colon cancer last month. They opened him up for surgery and said it metastasized in to his liver and organs. They did a iliostomy and closed him without removing the tumors because there were too many. They gave him two rounds of chemo and then put him on a morphine drip.

He and my sister are divorced and don't speak but my niece is 22 and has been by his side through all of this but has no real idea what this means. Last night he threw up for three hours straight and it was only bile. My niece is incredibly upset and keeps talking about the chemo working.

I would like to know if the chemo ever works when the cancer is this far along? Can you tell me if the morphine drip typically means hospice and he could pass any day?

I need to know how to talk to her and best help - we are very close, but my brother in law's new girlfriend wants nothing to do with our side of the family.

Honest answers would be greatly appreciated.
Posted Fri, 20 Apr 2012 in Colon Cancer
Answered by Dr. Indranil Ghosh 8 hours later

I am sorry to hear about your brother-in-law. It seems that he is suffering from metastatic colon cancer. In this situation, the primary treatment is chemotherapy with or without targeted therapy (monoclonal antibodies). The objective of treatment is palliation and probably prolongation of survival.

It has been seen that in patients with good general condition, an average life-span of 1 and 1/2 to 2 years can be expected. But patients with poor general condition (because of age, other disorders, advanced cancer) survive much less and probably do not benefit from chemotherapy also.

Regarding your brother-in-law, it seems that the general condition is not very good. The fact that he had persistent bilious vomiting suggests that he still has intestinal obstruction, even after the surgery. This is probably due to obstruction at multiple levels and is difficult to correct by surgery. It may improve with chemotherapy provided he is able to tolerate it.

Monoclonal antibodies are also not magic bullets and have small additional benefit over chemotherapy. They have very little role if administered alone (without chemo).

The morphine drip is to control pain and not necessarily a hospice. It is not clear that he is currently on chemotherapy also. If the doctors have stopped chemotherapy, then he is only on supportive care now. This means that he is unable to tolerate chemotherapy and may not survive for long. But at the same time, we should not predict survival and just provide him with whatever care possible.

Being an incurable condition, preserving the quality of life is of paramount importance. We should not continue with chemotherapy if it causes a deterioration in the quality of life without any observable benefit.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Above answer was peer-reviewed by
Follow-up: Colon cancer, meta-sized into liver, tumors not removed. After chemo, morphine drip. Will the treatment help? 1 hour later
Thank you so much, what I am mostly trying to figure out - without being able to talk to his doctors personally is if he is still being treated in hopes for some type of remission or if the end is near, he has had two rounds of chemo and was expected to have more, although I am not sure if he will be having more, my niece said they will do a test dec 1 or there about to see if the chemo is working, but that was before he was throwing up and they put him on the morphine drip- his first surgery after being diagnosed with cancer was expected to remove the tumors, but as I said previously
there was so much cancer so they did not take anything out. His cancer was advanced into the organs and there was no way for them to remove it surgically - so when I heard he was on the morphine drip I thought it might be hospice as I don't know if chemo alone can kill the tumors and it seems his organs are failing - at this point I have no idea if they still plan on doing more chemo and still doing the test in early dec or whether this is the end, but it sounds like it could be either- is there any way for you to know, from what I have told you?
Answered by Dr. Indranil Ghosh 29 minutes later
Hi again,

It is difficult for me to guess regarding the actual condition of the patient. Chemotherapy is used when surgery is not possible due to spread of the disease and the doctors were right in doing so as the initial treatment.

But now that he is still requiring morpine drip and organs are failing, I feel that chemotherapy may not be possible further. He is probably on end-of-life care only.

Hope I answered all your questions. Please accept my answer in case you do not have further queries.

Above answer was peer-reviewed by
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