Sigmoid Colon Cancer

[Billyrex]

My dad just undergone laparoscopic surgery to remove the tumor in the sigmoid region. He has stage-4 colon cancer with metastases to the liver. During the surgery, the doctor could not see the back of the liver due to restrictions caused by the nature of the laparoscopy surgery - therefore could not acertain the extent of the metastasis to the liver - however it seems that surgery to the liver has been ruled out. Also we are not sure the extent of the spread to the lymph nodes and how many nodes have been affected.

I understand that striving for a cure will be difficult, and the doctor has estimated a 18 months life expectancy. The good news is that the primary tumur has been removed and he will be leaving the hospital today for recovery at home. My dad is 75 and we are not sure if Chemo is worthwhile.

I read in the forum that if liver metastases are initially unresectable, the oncologist may opt to give some chemotherapy to shrink them enough to render them resectable. How viable is this option? I have read that advances in Chemotheraphy have improved signifcantly also.

Or shall we focus on palliation treatments instead and allocate our resources to relieve his symptoms and improve the quality of what is left of his time here? Please advise as we will be making a very difficult decision in the next few weeks and mentally prepare for the next course of action. Many many thanks. -What_to_do-

[Billyrex]

Thank you for providing us with your deep understanding of the science and philosophical aspects of treatment. Over the next few days we will find out if dad can qualify as a candidate for multi-agent Chemo treatement. Please can you elaborate more on this type of Chemo treatment vs. traditional Chemo methods. We will shortlist a liver surgeon and start assessing the risk/benefit scenarios after.

Please let me know are there any other questions and relevant issues that I should raise and find out?

Many thanks

[Billyrex]

Thank you for providing us with your deep understanding of the science and philosophical aspects of treatment. Over the next few days we will find out if dad can qualify as a candidate for multi-agent Chemo treatement. Please can you elaborate more on this type of Chemo treatment vs. traditional Chemo methods. We will shortlist a liver surgeon and start assessing the risk/benefit scenarios after.

Please let me know are there any other questions and relevant issues that I should raise and find out?

Many thanks.

[HeinrikMD]

Hi,
Unfortunately, there is no clear way to predict who will indeed respond and who will only get side-effects. It is clear however, that if there is are signs that he is not doing well with the treatment - will the plan be modified or discontinued.
Regarding the success of surgery, this is best answered by the surgeon who will review the size, neighboring structures, number of involved segments of liver.
Symptoms of worsening disease in the liver would include pain on the upper right area of the abdomen. There are also signs of liver failure which would include yellowing of the whites of the eyes as well as skin tone, dark, tea colored urine, itchiness, and changes in mental status, ranging from belligerence to drowsiness.
At the end of the day, this is a catastrophic disease in which the treatment options do carry both risks and benefits. The final decision may rest on the personal philosophies or values to determine the most acceptable route. But I think everyone deserves at least a discussion about these options.
Stay positive, and God bless you and your family.

[Billyrex]

Thank you for your encouragement and suggestions, you have shed valuable insights into what we need to find out, and how to frame our questions when we meet with the doctors next week.

It sounds to me that chemotheraphy is worthwhile, and if my dad is fit enough, we should go for it.
If the probability of conversion from unresectable to resectable is around 20-30%, what is the typical probability that the surgery to the liver will be successful (i.e. in removing all the tumors). And typically what will be our best case scenario in terms of prolonging and improving the quality of his life, considering his cancer is stage-4?

Dad requires assistance in this daily life. He has been for the past 5 years. During his surgery of the colon last week, the doctors have categorised him as "medium to high risk". This is due to his heart condition as he underwent a heart bypass 10 years ago. We were so happy that he pulled through without complications.

I can anticipate that when dad exhibit signs of symptoms, the family will do whatever they can to find treatment. Symptoms will come in the form of pain, and bleeding (can you please advice more on typical symptoms)? And if this is the case, we will not be able to bear it.

To me, chemotheraphy is stigmatised as a horrendous treatment(i.e side-effects). We will be devastated if he transformed into skin and bones - post-treatment. Currently, he looks fine and in good spirits. Is this a case where he will need to become worse to get better?

Please excuse me for loading so many questions and please help us understand what we are up against.

Many thanks and God bless you.

Billy

[HeinrikMD]

Hi,
I understand the decisional conflict that you now face.
Unfortunately, your question raises a number of other questions:
First
How good is the status of the liver, and is it expected to be able to handle removing the number of segments if the chemotherapy is able to shrink it? This is best answered by the hepatologist or gastroenterologist ?
Second:
Is he a candidate for multiple agent chemotherapy? The usual parameters include how strong he is (bedridden? Requiring assistance most of the time? Independent in most daily activities?).
If the answer to both questions is that he is a candidate for both, then the known conversions of unresectable to resectable disease is around 20-30%.
From a practical viewpoint, for colon cancer – in the absence of compelling contraindications, treatment with chemotherapy is advisable as soon as possible (this leads to better outcomes compared to the scenario that treatment is initiated when there definite symptoms). So if the chemotherapy is very successful in reducing tumor volume – then the surgery can be contemplated. Be wary though, that the surgeons must follow him closely. If the chemotherapy shrinks the tumor so that the surgeons cannot see them, they may perform an inadequate resection.
Discuss your concerns with your doctors. Try to come up with a plan that is acceptable to you.
Stay positive.