CancerWarrior_23 wrote:.
Here is a summary of the [April 10th] scan results:
Clinical Indication: New diagnosis of colon cancer with liver and possible [lung] mets
Technique.Postcontrast enhanced CT of the [chest], abdomen and pelvis at the portal venous phase.
Comparison: No previous exams for comparison.
Findings:
Chest: No pathologically enlarged axillary, mediastinal, or hilar lymph nodes. The mediastinal vessels are unremarkable. There is no evidence of pleural or pericardial effusion. The cardiac chambers are normal in size. The trachea and main bronchi are patent. No pulmonary parenchymal airway process is present. Multiple lung micronodules are seen considered nonspecific for follow-up. The largest is seen at the right upper lobe measuring 6 mm (image 52). No aggressive bone lesions.
Abdomen and pelvis: The liver is enlarged measuring 22.9 cm in height at the mid clavicular line. Multiple large innumerable hypodense liver lesions are seen compatible with metastasis. For example at hepatic segment II. There is a hypodense lesion measuring 7.1 cm. Another example, there is a hypodense liver lesion at hepatic segment III measuring 6.8 cm. Patent portal and hepatic veins. The gallbladder is not seen. No intra or extrahepatic biliary ductal dilatation. The spleen is normal in size. No focal splenic lesions. The pancreas is normal. The pancreatic duct is not dilated. No adrenal masses. Both kidneys are normal in size. No focal lesions. No hydronephrosis. The the abdominal aorta is normal in calibre. No pathologically enlarged mesenteric, retroperitoneal, or pelvic lymph nodes. Mild amount of free fluid in the pelvis. The small bowel is not dilated. There is circumferential wall thickening involving the mid part of the sigmoid colon measuring up to 10 mm in thickness and spanning approximately a segment that measures 6 cm in length, probably corresponding to the known colon cancer. Multiple regional lymph nodes are seen. The largest measures 6 mm in short axis. Multiple mesenteric lymph nodes are also seen. The largest measures 50 mm in short axis (image 242). The remaining parts of the colon appear grossly unremarkable within the limits of the lack of bowel preparation and opacification. No pathologically enlarged retroperitoneal or pelvic lymph nodes. The urinary bladder is unremarkable. No signs of peritoneal carcinomatosis. No aggressive bone lesions.
Conclusions:
- Multiple lung micro nodules considered nonspecific for follow-up.
- Sigmoid colon mass with multiple pathologically enlarged regional and mesenteric lymph nodes.
. - Hepatomegaly with innumerable large size liver metastases.
"
I wanted to ask for your thoughts on these recent scan result, please... CancerWarrior_23."
==============
CancerWarrior_23 -
My thoughts on this scan are as follows:
- This was the first CT scan at your brother's new hospital. It basically confirmed the conclusions of the earlier CT and MRI scans done at the original hospital, namely that there are two main points of concern: (1) the sigmoid colon primary tumor along with its enlarged regional lymph nodes, and (2) the enlarged liver with innumerable mets scattered throughout. Both of these problem areas are still active in your brother's body and need to be dealt with in an effective manner, whatever that might be.
- This scan found that there are no other organs/structures invaded by cancer in the chest-abdomen-pelvis area -- which is a very encouraging finding.
- This was not a full-body scan, so no information was captured about possible mets in the throat, esophagus, thyroid, brain areas, on the one hand, or possible mets in the reproductive organs, or thigh bones, etc. Also, this scan didn't mention anything about possible hepatic cysts or hepatic hemangiomas likely to be found in fatty liver patients. Also, no mention of the appendix or the prostate gland.
- This scan will have to be used as the baseline scan for comparison in any future scans, instead of the real baseline CT scan that was done at a different hospital on a different scanner machine, because the earlier March 2nd initial scan is not available for use by your brother's new hospital.
- This scan will be the first in a series of on-treatment scans to determine the effectiveness and safety of the current "FOLFOX+Avastin" regimen. If any of the future scans find that this regimen is either
ineffective (i.e., no reduction in overall tumor burden) or
unsafe (i.e., presence of Grade 3 ("serious") or Grade 4 ("life threatening") adverse events, then it will either be suspended or be replaced by another chemo regimen
- At this point in time it appears that the medical team at the new hospital is simply continuing with the earlier "treatment with palliative intent" plan until some future scans show substantial tumor reduction that might suggest that an implementation of a "treatment with curative intent" regimen could be possible.
- If the medical team starts to get serious about exploring "curative intent" options, they may need to use more advanced kinds of scanning, such as PET/CT scans for identifying active mets, special MRI scans that mimic angiograms for visualizing blood flow in the liver, or special MRIs designed for primary liver tumor analysis, such as
LI-RADS. Of course, these advanced kinds of imaging usually cost more and are often available only at major cancer centers.
- If your brother wishes to switch the treatment focus from "palliative treatment intent" to "treatment with curative intent" then he could read [a translation of] the first article below and study the decision diagram in
Figure 1 of that article so that he can have productive discussions on this topic with his medical team at the new hospital.