Hi doctor, The patient has stage 3 rectal cancer. He had brachytherapy radiation last summer. Through surgery, they removed the rectum, surrounding mesorectal fat and involved lymph nodes. Pathology declared radiation to be a complete response and no cancer found. FOLFOX chemo has begun before 14 months for every two weeks to prevent metastatic cancer. Patient also has an aneurysm in his ascending aorta of 5.3 cm which was initially found on a CT scan due to the cancer. Plan is for repair of the aorta. A chest CT scan with contrast was conducted last week in order to follow the growth of the aneurysm that left the following impression. Multiple bilateral pulmonary emboli involving the left lower lobar pulmonary artery, multiple bilateral segmental and subsegmental pulmonary arteries. Patient has no history of emboli. Multiple scans prior to surgery did not reveal such, so these seem to be the result of either the surgery or the chemotherapy itself or a combination. Patient has since been put on 1 mL injections of Lovenox, morning and night. He has infusion of FOLFOX scheduled for this week. This will be round 11 of 12 in total. Patient has two upcoming surgeries planned for this summer. The ileostomy reversal and the repair of his 5.3 cm thoracic ascending aorta. We were hoping to hear the recommendations in regards to proceeding with the infusion as a result of the most recent finding. Will further infusions slow the reabsorption of the emboli and thus delay necessary surgeries? Thank you for your help, expertise and insight.
Hi. Based on your query, my opinion is as follows: Chemotherapy and bed rest. Can continue chemotherapy along with Lovenox. 1. Continuing Lovenox is essential. Watching for any bleeding is necessary. 2. Regularly evaluate respiratory function along with patients PTT (partial thromboplastin time) and APTT (activated partial thromboplastin time) or INR (international normalized ratio) to avoid risk of bleeding due to anticoagulant therapy. For further information consult a hematologist online.--->