Recurrent cancer treatments

[AGibsonFNP]

My father was dx with stage 3 colon cancer June 2002. 12 out of 18 lymph nodes were positive (mucinous adenocarcinoma).  He also had a CT and MRI which revealed two very small areas  on the liver and he was told they were cysts and too small to bx. (8/02).  12/03 he had a f/u CT and the liver lesions were not present.  He had other CTs afterwards which were also fine.  On the CT 8/02 they said there was an increase in what appeared to be fatty tissue around the surgical site in the right anterior abdomen.  In 8/03 there was an increase in soft tissue density as compared with the previous cts which was suspicious for recurrent cancer.  The areas on the liver were also seen again but remained unchanged (they said this could be technical in nature).  He then underwent a PET scan which revealed the area in the anterior mesenteric region adjacent to the surgical clips to be cancer(2X4cm) and the liver to be cancer as well.  They told us in 2002 that a PET would not be a good diagnostic tool to detect liver metz due to the increased glucose uptake in the liver.  In 8/03 after finding the recurrence he began his second round of chemo.  He first (8/02) had 5fu &leucovorin and now is having 5fu/leuc/camptosar.  After about 2mos. of chemo on the repeat CT it showed significant increase in the mass in the abdomen (now 8X5cm).  He is also having internal bleeding because his HGB continues to drop and he has had a transfusion.  They haven't found the site but I presume it is in the abdomen.  There was only one area on the liver and it remained unchanged.  No adenopathy or other areas of metz were seen.  His CEA upon starting chemo was 13 and just had it repeated but we haven't been told the results yet.  He went to SloanKettering in NY for a second opinion and they acted like they were more concerned about the liver than the abdomen and told him if they could get his CEA down and the cancer controlled they would do surgery on the abd.and liver.  Now, my question is - is surgery possible in this area?  Anterior mesentery adjacent to the large bowel and a loop of small bowel, and the radiologist said it is engulfing the colon.  If surgery isn't possible how will the bleeding be controlled and what if it completely blocks the bowel?  If the liver hasn't changed should we worry about that right now?

[Kevin Pho, MD]

Surgeon has kindly addressed your question in his comments below and I agree with his assessment.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

The hard truth is that in this situation, the best that can be hoped for is trying to moderate problems as they occur. It's not impossible that some form of drug therapy could provide control or regression of tumor for a while. As to the large mass: it's not easy to say what can be done surgically without seeing the actual images. But it's more likely than not that the area could be operated with the goal of removing all or most of the tumor, or in the worst case to bypass it if it becomes pre-obstructive. When to undertake such an operation in the face of incurable tumor is not ever a clear-cut decision, and the success or outcome is very difficult to predict with any certainty. Nevertheless, from what you describe, it seems abdominal surgery is or may become on the list of things to consider. I assume that the inclination to defer is based on the idea that if the chemo they have in mind doesn't accomplish anything, then operating might be deferred unless it becomes absolutely unavoidable. Likewise, if it helps, it might make the need for surgery less, or make it easier if needed.