Question concerns Merkel Cell Carcinoma and CLL. Patient is 63 yo male, dx'd with prostate cancer '95 and treated with seeds. PCa metastatic to bone in '99. PCa controlled with double dose Casodex. Patient dx'd with CLL '99-no treatment given. WBC mostly 35-45K asymptomatic except slow wound healing. Patient dx'd with Merkel Cell Carcinoma '07. Merkel cell treated unsuccessfully with chemo and successfully with radiation. Primary cancer site cancer free, but cancer metastasized to midgut. CT-guided biopsy reveals mixed composition tumor 90/10 CLL and Merkel cell, respectively. The doctor now characterizes the metastasis as a neuroendocrine tumor. It has been treated with radiation but response minimal shrinkage.
Question: I understood CLL to be a cancer of the blood. How could it have "morphed" into a midgut tumor? What is the best treatment for a tumor that has characteristics of two cancers, one of which seems to have changed from a blood cancer to "something else"?
CLL as you rightly mentioned is a cancer of blood cells. It usually involves the lymph nodes and liver and spleen at a later stage. Merkel cell carcinoma on the other hand is a neuroendocrine cancer of the skin. There is a possibility that the lymph nodes in the midgut are involved as both these cancers can spread to lymph nodes.
The treatment of this type of tumor will also be by chemotherapy and radiation. If it has not responded to one course of radiotherapy it is quite possible another round of radiotherapy may be required.
Thank you for input. Since my post, patient consulted a specialist at Duke who has no clear idea about the tumor's makeup. Patient has already had 21 radiation treatments to gut. Consensus seems to be that risk of CT-guided biopsy (a second one) outweighs the benefits of identifying the makeup of the tumor mass since we understand that no more radiation can be given and chemo is ineffective on Merkel cells. Plan is 6-week monitoring of the Merkel tumor and the Merkel/CLL tumor mass. To date, after 2 scan sets at 6 week intervals, the Merkel tumor has experienced significant reduction (ie approx 50% scan-to-scan) without treatment. The mixed tumor is very slightly enlarged. Docs do not know why Merkel tumor is shrinking as it is a very aggressive cancer.
Patient remains symptomatic but docs are not certain what is producing symptoms. Worst symptoms are spontaneous, unprovoked profuse sweats, shaking chills not related to environment, morning nausea w/ occ vomiting. Any thoughts?
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