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    What do these lab reports indicate?

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Posted on Mon, 10 Jul 2017 in Cancer
Question: Hi doctors
My father in law aged 62 years has 4th stage cancer found few days back.

He has descending colon growth , 3 metastatic deposit in liver.we have attached all the related reports for your reference.

Doctor advised us to go chemotherapy for 3 or 4 phases and after that can look into the growth and go for operation, and after operation doctors will proceed with remaining chemotherapy.

we have following queries.

1)is fourth stage cancer is having chance of curable? What is the life span of the patient if chemotherapy alone given and life span of patient if operation done.
2) What chemotherapy needs to choose between folfox and capeox ? What are side effects compared between this too. Doctor asked to choose between this too.plz explain on this.
3) Doctor informed about an additional (optional dose) MoAB .( monoclonal antibody ) Let us know the use of it? . seems little costlier. So request to provide the advantages using of it along with chemotherapy in respective to life span.
4) What are the possibilities / percentage of re occurrence of cancer after operation?
5) Please inform any new treatment available other than above mentioned? If so please advise.
6) As patient is going for operation after chemotherapy, advise us on food habits he needs to follow.(he is having diabetes )

Regards
XXXX






doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Yes this is stage 4 disease

Detailed Answer:
Hi
Thanks for your query.

This is indeed stage 4 disease. Stage 4 is incurable, unless there is limited liver metastasis which can be operated. Even then only one in four survive more than 5 years. Here, the liver lesions are larger and encompass multiple segments, so operation is not feasible now and there is very small chance of making it operable after chemo. So for all practical purpose, it is incurable. If some miraculous response occurs after chemo, then it is a different story.

You can go with capeox chemo. It is easier to administer and does not require chemoport insertion. Efficacy same as folfox. Side effects similar. Targeted therapy with monoclonal antibody is costly but improves survival by 6-12 months and increase liver operation rate from 5 to 10%. If liver inoperable, average survival around 2 yr with chemo and 2.5-3 yr with chemo plus targeted.

Even if colon lesions and liver lesions all removed, recurrences occur in more than 50%.

Newer treatment is RFA where without Surgery the liver lesions can be burnt. But preferably one or two lesions and size less than 3 cm.

Diet should be home cooked food with less oil or spicy. Rest OK.

Hope this helps. I wish him good response with chemo.
Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Indranil Ghosh 3 hours later
Hello Doctor ,

Thanks for your elaborated reply.

we have few more queries to get clarified.
1) is colon cancer is hereditary? what is test name to be performed to identify the cancer derived from hereditary?
2)if identified its from hereditary , what are the tests to be performed for their family members(blood relations) and from which age same needs to be done?
3)In general what are tests to be performed by any individual to know he is cancer free and how frequent same has to be tested?
4)still world is fighting with this deadly disease with out curable medicine.Any new study or research or positive happenings in medical world to over come the cancer?
6)what are side effects of chemotherapy ? and how to overcome the same?
7)other than chemotherapy any additional medicine can be taken in order to increase curable percentage to certain levels?
8)is liver transplantation is possible for him ?
9) how cancer is happening? (cancer which is not from hereditary). any solid study from medical world to prove the reasons behind N number of cancers?


Thanks
XXXX
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
sometimes hereditary

Detailed Answer:
1. In around 5-10% hereditary. If multiple family members affected then genetic testing is available.

2. If gene testing positive then other direct family members should be tested as well

3. Colonoscopy may be done from age 50 yr onwards, also mammograms for females after 40, PAP smears for females for cervicaL cancer, PSA for prostate cancer in males after 40 yr

4. Many new studies are going on and depending on their results, guidelines change every year, slowly progress is being made. 20 yr back colon cancer stage 4 survival was only 6 months

6. There are many side effects of chemotherapy like nausea/vomiting, diarrhea, fall in blod counts, hairfall, nerve damage. There are methods to reduce them but cannot be eliminated completely

7.No other than chemo and targeted therapy nothing is available

8. No it is likely not feasible

9. There are many reasons like smoking for lung cancer and western lifestyle and diet for colon cancer, for example. More research is definitely required.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1532 Questions

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