Hello doctor, Please can you look at this letter and report as they differ. We have been told the following are metastases which we agree with: 1 liver met, 1 aortocaval node, 1 sub pleural nodule. But the oncologist letter says possible peritoneal disease? Why did the CT report not state peritoneal disease and onco has rated this? Mets are under 2 cm, if they are ablated is this better? So far irinotecan not worked, what to do? Prognosis?
Hello. I can understand your situation at the moment. But you have to accept the facts about your patient. First thing is he has incurable disease, he has undergone a major surgery, in spite of treatment underlying disease is progressive, and most important the disease is wide spread in the body in distant organs. So the treatment options are very limited which have been tried already and beyond that the disease is not responding to the treatment given. Coming to your questions. 1. The aortocaval node is increased in size this is suggestive of peritoneal progression. So oncologist can see it in CT films. It is not necessary that only radiologist findings to be final. Also there are adrenal metastasis. 2. Only ablation of liver mets will not cure the disease as it is stage 4 that means it is spread to other organs already. So treatment of metastatic lesions will not cure primary disease. 3. Irinotecan not worked suggests that it is chemoresistant malignancy. So any palliative treatment will not work in future. 4. Last thing about prognosis---you have already been told by your primary oncophysician about it. It is stage 4 disease now with no response to palliative chemotherapy. So prognosis is very grave. He is so lucky that in spite of such progressive disease he is asymptomatic at present. But we cannot predict exactly when the things will go wrong and the period he will be alright. So better to continue only symptomatic palliative care.