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Dr. Andrew Rynne

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Exp 50 years

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What causes sores in the mouth while treating colon cancer?

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Dr. Ivan R. Rommstein

General Surgeon

Practicing since :2008

Answered : 10330 Questions

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Posted on Fri, 24 Mar 2017 in Cancer
Question: I have BRAF assending colon cancer that metastasized to the liver.One foot of the colon was removed in XXXXXXX so cancer only in liver but in four places.Every cat scan showed reduction of tumors as much as 25% of original size some not as much.
I had 11 treatments of Folfox and Avastin and now I have had three treatments of Folfiri.The only difference between the two is Folfiri does not include Oxiplatin
Cat scan on 11/28 then on 2/5 showed only minor shrinkage.Doctor told me today probably no more shrinkage and 1-3 years to live.

.He said surgery is not an option.Do I have any other options.

My mouth is very sore and my bowel movements are extremely painful.Is there any suggestion you may have.

I am looking at adding alternate medicine


Vitamin C IVs injections


Glutathione IVs injecions

Mistletoe has the option of injections or coming to the clinic and getting it in IV form.

What is your opinion
doctor
Answered by Dr. Ivan R. Rommstein 3 hours later
Brief Answer:
See next

Detailed Answer:
Hi and welcome.
Vitamin c and glutathione are still scientifically unproved and the benefit of these is questionable. It may improve immune system and this may indirectly affect you general condition. However,I do think it will slow down tumor progression. In every case it won't be harmful.
Second,if there are no other metastasis in body then the only cure is liver resection or transplantation. I don't know if experienced hepatobiliarry surgeon is available at you place,but there are some newer procedure such as ALPPS or hepatic chemoembolization which may be a good option for inoperable liver metastases. Wish you good health. Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ivan R. Rommstein 8 hours later
Hi Doctor,

LIVER: There are 3 hypoenhancing hepatic lesions in segment VI. A lesion now measuring 3.4 x
4.1 x 4.2 cm is decreased from 8.1 x 9.9 x 8.0 cm. A 3.4 x 2.3 x 3.6 cm mass is seen in close
abutment, decreased from 5.7 x 6.7 x 5.9 cm. An inferolateral

lesion measuring 2.2 x 4.1 x 4.2 cm is also present and has decreased from 5.0 x 7.4 x 7.3 cm.

MY CEA is 13.5

My mouth is painful and my bowel movements both diarrhea and constipation are extremely painful.Do you have any suggestions

I was on Folfox for 12 treatments now Folfiri for the last three treatments. From what I have been told them only difference is oxiplatin was replaced with irinotecan

Thank you,
XXXXXXX
doctor
Answered by Dr. Ivan R. Rommstein 19 hours later
Brief Answer:
Right hepatectomy in certain conditions

Detailed Answer:
Hi

If only the segment VI is involved and even if whole right liver is involved, there is still a possibility for surgical resection called right hepatectomy. However, liver condition should be evaluated and other factors may have a role in decision making.
Your symptoms are probably side effect of chemotherapy- You need to have probiotics, high fiber diet, and take metoclopramide. Also, oncologist should recommend the way to treat chemotherapy side effects.
You should consult surgeon about liver resection. If this is limited to right liver lobe, I still think there is a possibility for surgical treatment.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ivan R. Rommstein 9 hours later
Hi Doctor,

Thank you for all of your advice.It has been quite helpful.Here is the cat scan done in May of 2016 prior to my colon surgery

It does appear the cancer at least most of it is confined to the right lobe

This will show you how much the chemo treatment have reduced the size of my tumors.

LIVER: Enhancing solid masses are seen within the right lobe of the liver most pronounced
inferiorly. Large hepatic lesions measuring up to 10.2 cm on image 200, 7.3 cm on image 216 and 5.9
cm on image. In the left lobe smaller focus is seen in the lateral segment measuring 1.3 cm on image
178 with small focus in the anterior segment of the right lobe measuring 1.1 cm on image 173.
Additional faint focus is suspected in the dome of the left hepatic lobe laterally measuring up to
1.4 cm.Hi Doctor,

I forgot to include this from my most recent cat scan

A tiny hypoattenuating focus in the inferior right hepatic lobe measures 0.6 x 0.7 x 0.9 cm appears decreased from 1.3 x 1.5 x 1.2 cm
doctor
Answered by Dr. Ivan R. Rommstein 1 hour later
Brief Answer:
hi

Detailed Answer:
yes, there are suspicious lesions in the right lobe as well.
However, this still may be resectable if some complex liver procedures are performed.
If you were my patient, I would do exploratory laparotomy to see if sufficient healthy liver tissue can be preserved. If not, then portal vein thrombosis or ALPPS can be done. There is a good response on chemotherapy and this is a good sign.
But only surgery can offer long term survival.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ivan R. Rommstein 44 hours later
Hi Doctor,

I intend to make an appointment with XXXXXXX XXXXXXX They appear to be the most advanced hospital in liver resection and have expert liver surgeons..In advance cancer sometimes they do one resection and a second at a later date.

They have two ways to work with you.One is to take an MRI and send it to them the second is to take the MRI and go there to meet the surgeon.

Do you think it make a difference whether I am there or not?

Thanks
XXXXXXX
doctor
Answered by Dr. Ivan R. Rommstein 1 hour later
Brief Answer:
follow-up

Detailed Answer:
Hi again,

Well, I am not familiar with proton therapy but I know that this is still in early research phase. However there are some promising results published.

About this first thing... MRI images and previous history of treatment are enough for possible surgical plans so I don't think you need to go there if you ask me.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ivan R. Rommstein 1 hour later
Hi Doctor,

Thank you
XXXXXXX
doctor
Answered by Dr. Ivan R. Rommstein 11 hours later
Brief Answer:
hi

Detailed Answer:
You re welcome.
If you have any further questions be free to ask
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ivan R. Rommstein 5 hours later
Hi Doctor, XXXXXXX XXXXXXX is considered the best for liver resection.Making the Determination for Liver Resection

Liver surgeons at the Johns XXXXXXX Medicine Liver Tumor Center are highly skilled in treating patients with advanced liver disease. In combination with other members of the multi-disciplinary team, your surgeon will assess if it is possible to remove the entire tumor or all of the disease while leaving enough liver behind.

In some instances it may appear that the disease involves a large majority of your liver, and it may be determined that surgery is impossible. However, at our center, sometimes with the combination of chemotherapy to shrink the tumor and portal vein embolization to help the liver “grow” before the surgery, our surgeons are able to remove all the cancer in the liver.

In some instances it may appear that the disease involves a large majority of your liver, and it may be determined that surgery is impossible. However, at our center, sometimes with the combination of chemotherapy to shrink the tumor and portal vein embolization to help the liver “grow” before the surgery, our surgeons are able to remove all the cancer in the liver

What would you consider the large majority of the liver? Why cant they remove the right side of the liver on the first operation and once the liver regrown get the cancer from the left side where there is very little cancer.

Without this I have no chance.The 15 rounds of strong chemotherapy is cumulative and can not continue forever.I will die from this maybe sooner than from cancer.
XXXXXXX



doctor
Answered by Dr. Ivan R. Rommstein 29 hours later
Brief Answer:
follow-up consultation

Detailed Answer:
Hello again,

It is considered that at least 35% of healthy liver should be preserved in order to perform curative liver resection.

Right lobe accounts for around 60% of the total liver volume. It means that right lobe resection can be safely performed if there are no metastases in left lobe and if there is no cirrhosis. If chemotherapy didn't cause any tumor shrinkage, then portal vein embolization, 2 staged hepatectomy and ALPPS may be considered if you are in a good general health.

I'm repeating again, if tumor is limited to right lobe and there are no signs of extrahepatic disease, then only resection is possible...

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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