Advice: metastatic ca colon - Forum

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Critical

Advice: metastatic ca colon - Ärzteforum

Post#1 »

Let me share with you a plea for advice from my friend.

His father, now 85 YO underwent about 6 years ago a subtotal colectomy for DUKE B obstructing ca of sigmoid.

A year ago a small lesion was seen on CXR and was "observed"; now he has another small lesion in the same lung- FNA shows metastatic disease from the colon.

CT abdomen and LFT -normal. His general health status is very good. Lung functions- OK.

The lung lesions would require PNEUMONECTOMY for radical removal.


What would you advice?


User avatar
Surgeon

Re: Advice: metastatic ca colon - Ärzteforum

Post#2 »

You must be kidding (although I am just giving an opinion without
knowledge of the literature). Give him one of your boxes of cigars and a
bottle of sherry.

Unless he is symptomatic (Coughing up blood), I would leave it alone.

Grandpa Phil

Re: Advice: metastatic ca colon - Ärzteforum

Post#3 »

Very unlikely these are solitary lesions--look what happened just during the
period of observation, If one had removed the first lesion it clearly would
have been futile, as another showed up--removing these will not prevent others
in the lung or liver from showing up--the standard advice in this case is to
wait and do nothing, and chances are overwhelming that more will appear in
time--i.e. they are already there! Better to encourage your friend to plan
quality time and quality of life with his father--a pneumonectomy which
accomplishes nothing does not constitute quality time!

User avatar
الجراح

Re: Advice: metastatic ca colon - Ärzteforum

Post#4 »

It is very odd presentation, CRC usually recur in the liver,
recurrence after 6 years is unusual but it is in favor of the patient. What is
his serum carcinoembryonic antigen levels ??.

I think a course of a combination chemotherapy and observation for
3-4 months, then full assessment for the liver for any metastases and the lung
for the progress in the size of lesions. If there is no liver metastases and
the lung lesions are stationary or smaller in size then pneumonectomy can be
considered if the patient is fit for this type of surgery.

Jorjo

Re: Advice: metastatic ca colon - Ärzteforum

Post#5 »

It is very odd presentation, CRC usually recur in the liver,
recurrence after 6 years is unusual but it is in favor of the patient. What is
his serum carcinoembryonic antigen levels ??.

I think a course of a combination chemotherapy and observation for
3-4 months, then full assessment for the liver for any metastases and the lung
for the progress in the size of lesions. If there is no liver metastases and
the lung lesions are stationary or smaller in size then pneumonectomy can be
considered if the patient is fit for this type of surgery.

User avatar
Resident

Re: Advice: metastatic ca colon - Ärzteforum

Post#6 »

I do have a reverance for life, but if and when I come to be 85 yrs old, I would like to have the final input into this situation. Life should be cherished when an objective is in view, but not to be pursued for its own sake like the Holy Grail. My folks @ 77 have come to the point when philosophy and common sense overtakes our day to day concerns. I would submit that a minority of us Surgeons will attain this age with reasonable faculties. If your buddy's dad has a wish to find out "what's going on tomorrow?"...so be it. It is his choice. He is healthy today and may not be tomorrow, but what about the rest of us. At 86, my parents shouldn't be submitting to pneumonectomy unless there's an overpowering reason to do so. Why should we celebrate our lives in longevity as a quantifier. Our parents will live long in our souls whatever their age. ...Whew, I should have had a malt, philosophy not my forte.

User avatar
Lady Surgeon

Re: Advice: metastatic ca colon - Ärzteforum

Post#7 »

The REGIMEN [box of cigars and a bottle of sherry] is certainly fully indicated here. In fact, it has been indicated, but ignored, in many recent cases reviewed.

forceps

Re: Advice: metastatic ca colon - Ärzteforum

Post#8 »

Sometimes I think it is dangerous to even offer a patient a treatment
that has little hope for success. You are dangling before them a
poisoned carrot. They are, of course, unaware of that fact, and
begin to feel guilty that they are turning down their only hope of
cure. This is the trap that the medical oncologists routinely set
when they offer useless chemotherapy to their patients. Better to
just say that we have nothing to offer

User avatar
Treatment guru

Re: Advice: metastatic ca colon - Ärzteforum

Post#9 »

We used to call this "6PFP" therapy in Texas - "six pack and a fishing pole." Sherry and cigars is quite a bit more upscale!

Critical

Re: Advice: metastatic ca colon - Ärzteforum

Post#10 »

In Germany such a list ("The 1000 best doctors") was published a few
years ago in the newsmagazine "FOCUS". When they tried to printe an
updated version of it last year they were prohibited from doing so by
court order. The judges viewed the list as an advertisement for the
named doctors. Advertising is forbidden for doctors in Germany.

The editor who was responsible for the list told our chief of surgery
(who was not on it) about some doctors who tried to bribe her to get on
the list.

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