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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does my lab test report indicate?

Answered by
Dr.
Dr. Iven Romic Rommstein

General Surgeon

Practicing since :2008

Answered : 13177 Questions

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Posted on Tue, 5 Sep 2017 in Lump
Question: Hi Doctor Rommstein,

I just received the results of my first scan since my surgery on May 18th.Two one centimeter lesions and 2-3 subcentimeter lesions.My oncologist who I am losing confidence in suggested enrolling in a unproven BRAF colon cancer test.He gave me no other options.Prior to the cat scan my oncologist at the University of XXXXXXX said if some small lesions came back there were several wayds to treat them other than chemotheraphy.One wasy was to stick a needle into the tumor and kill it with heat.Do you think this is an option after reviewing my cat scan summery.

Here is what XXXXXXX XXXXXXX had to say after receiving the cat scan report

"Those are very small, often CT scans don’t even pick up lesions less than a centimeter.
Those are your lab results attached. Were these biopsied? You have pathology? They are very small to even biopsy.

I am not sure they can be ablated since they are so small"


We need the CT to review before any plan.

Here is a copy of the cat scan report.Any suggestions from you would be greatly appreciated.

Comments from the Doctor's Office XXXXXXX - there are several small new lesions in your liver. I will show you at our meeting. They are very small but look new and real.
A Hantel
Study Result
Impression
CONCLUSION:     
1. There are a few centimeter-sized and subcentimeter hypoenhancing hepatic lesions which are apparently new and highly suspicious for progression of metastatic disease.

2. Postoperative changes of wedge resection of the inferior right hepatic lobe.

3. Splenomegaly.

4. Status post right hemicolectomy.

5. Interval operative intervention of cholecystectomy. Minimal intrahepatic and borderline intrahepatic biliary dilatation noted.

6. At L2, there is a grossly stable hemangioma.

7. Lesser incidental findings as above.
Narrative
PROCEDURE:     CT CHEST ABDOMEN PELVIS (ALL CONTRAST ONLY) (CPT=71260/74177)

COMPARISON:     Elmhurst Memorial Hospital, CT CHEST+ABDOMEN+PELVIS(ALL CNTRST ONLY)(CPT=71260/74177), 2/04/2017, 10:36.

Additional comparison is made to outside CT of the chest, abdomen, and pelvis performed at Clay CT DMG on 05/31/2016, contrast enhanced CT of the chest, abdomen, and pelvis from M.D. XXXXXXX conducted on 11/23/2016, and contrast-enhanced CT of the
abdomen performed at Johns XXXXXXX on 04/05/2017.

INDICATIONS:     Malignant adenocarcinoma of the ascending colon, complicated by hepatic metastatic disease, and status post wedge resection of metastatic lesions involving segment V and VI (05/18/2017).

TECHNIQUE:     Multidetector CT images of the chest, abdomen and pelvis were obtained with intravenous contrast material. Automated exposure control for dose reduction was used. Adjustment of the mA and/or kV was done based on the patient's size. Iterative
reconstruction technique for dose reduction was employed.

FINDINGS:
DEVICES:     There is a left-sided Port-A-Cath with tip terminating in the distal SVC.
CARDIAC:     The heart is not enlarged. Atherosclerotic vascular calcifications are present in the coronary vessels. Trace pericardial effusion extends into the superior pericardial recess.
VASCULATURE:     The thoracic aorta has unremarkable configuration without aneurysm or dissection. Atherosclerotic vascular calcifications are present about the aortic arch.
LUNGS/PLEURA:     Minimal medial left apical and medial right paramediastinal paraseptal blebs are demonstrated. There is dependent subsegmental atelectasis bilaterally. Scattered reticular opacities may also represent atelectasis. Trace peri-fissural
nodularity along the minor fissure is stable and may represent an intrapulmonary lymph node (series 3, image 62).
No airspace consolidation, pleural effusion, or pneumothorax is detected.
AIRWAYS:     The tracheobronchial tree is without central mass or obstructing lesion.
MEDIASTINUM/HILA:     No mass or lymphadenopathy.
CHEST WALL:     Bilateral symmetric gynecomastia is present. No axillary mass or lymphadenopathy.

LIVER:     Postoperative changes of hepatic wedge resection are newly evident in segments V and VI.
There are several new hypoenhancing hepatic lesions which are suspicious for metastatic disease. There is a reference segment VIII lesion measuring 1.0 x 1.1 cm (series 2, image 84). A lesion at the border of segments VII and VIII measures 1.1 x 1.4 cm
(series 2, image 92). Subcentimeter lesions are present in the left hepatic lobe (series 2, images 95 and 96).
BILIARY:     The gallbladder is surgically absent. Mild intrahepatic and borderline extrahepatic biliary dilatation.
PANCREAS:     No lesion, fluid collection, ductal dilatation, or atrophy.
SPLEEN:     Enlarged, measuring 14.8 cm craniocaudally.
ADRENALS: No defined mass or abnormal enlargement.
KIDNEYS: Symmetric enhancement is seen without evidence of hydronephrosis or underlying solid masses.
GI/MESENTERY: A small hiatal hernia is evident. Distal esophageal wall thickening may be attributable to underdistention or could reflect esophagitis. There is no evidence of bowel obstruction. Postoperative changes of right hemicolectomy are
demonstrated with an ileocolic anastomosis in the right upper quadrant. Gross patency is demonstrated. Minimal scattered colonic diverticula are present in the descending and sigmoid colon. There is no colonic wall thickening or pericolonic fat
stranding.
URINARY BLADDER:     No visible calculus or focal wall thickening.
PELVIC NODES:     No lymphadenopathy.
PELVIC ORGANS:     No visible mass. Pelvic organs appropriate for patient age. Prostatic calcifications are present.
VASCULATURE: Heavy atheromatous plaque and scattered atherosclerotic vascular calcifications of the abdominal aorta are observed. No aneurysm is detected.
RETROPERITONEUM:     No mass or lymphadenopathy is apparent.
BONES: Multiapex scoliosis of the thoracolumbar spine is demonstrated. Multilevel degenerative changes of the spine are present. There is substantial wedging of mid thoracic vertebral bodies resulting in angulation of the thoracic kyphosis. Vacuum disc
phenomenon is present.
There is a lucent lesion of the L2 vertebral segment with prominent vertical trabeculations. This appears unchanged from previous imaging and is most compatible with a hemangioma.
Degenerative changes of the shoulder joints are observed bilaterally.
ABDOMINAL WALL:     Minimal periumbilical scarring/infiltration is present.
OTHER:     No free air or fluid is seen in the abdomen or pelvis.

Dictated by (CST): XXXXXXX XXXXXXX MD on 8/08/2017 at 15:18
Approved by (CST): XXXXXXX XXXXXXX MD on 8/08/2017 at 15:39
Component Results

Thank you,
XXXXXXX
doctor
Answered by Dr. Iven Romic Rommstein 26 hours later
Brief Answer:
my recmmendations

Detailed Answer:
Hi again.

Yes, these findings suggest recurrence inside hepatic parenchyma.
These are small, especially thes eless than 1cm which cant be evaluated prperly by CT scan.
Those 2 larger than 1cm are obviously metastases,but considering that this was stage IV disease initially so this is something expected and still you are in a lucky group of colorectal cancer patients considering slow disease progression.
I think that these >1cm lesions are treatable with RFA (radiofrequency ablation) but this should also be done in highly specialized centres.

Second option is TACE (transhepatic arterial chemo-embolization) in which chemotherapy is applicated into liver artery.

True, lesions are small and these interventional procedures XXXXXXX not be successful.

Third, your liver parenchmy should be evaluated with certain test to see if there is possiblity of additional liver resection. Segments 8 and 7 can be removed if at least 40% of healthy liver is left. Of course, resection would be the best option and may bring long term survival. RFA and TACE will not be able to destroy lesions completely... as well as chemotherapy.

Wish you good health. Regards

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Iven Romic Rommstein 4 hours later
Hi Doctor,

Thank you very much for your evaluation.My daughter in law wirk for 20 radiation oncologists and suggested a procedure called cyber knife may work.Do you have any experience in this area?

Thank you,
XXXXXXX

Just got home from Geoff's.Kerstin said if I give her a brief summary of my condition she will post it to her 21 oncologists for their treatment opinions.One she thought may be an option is cyber knife

doctor
Answered by Dr. Iven Romic Rommstein 31 hours later
Brief Answer:
Cyber knife is worth of try

Detailed Answer:
Hi and welcome.
Yes,cyber knife is one if the modern options which radiates specific point in liver. This is similar to RFA,just less invasive. If you have access to this type of treatment,you should consider it as well.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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