Oncologist Update

Friday afternoon we went to the caravan at Glentunnel, we could only stay one night due to baby sitting duties, but we really needed to check that all was OK with the caravan as it had been 6 weeks since we were there last.  No problems with the caravan as such, but we got a frost of -2 C and the 1Kw oil heater inside did not cope well.

On returning home I spent about one hour water blasting 1/3 of our drive, I now feel like I have done the Coast to Coast race. The chemo is clearly having an inpact on my energy level.

On getting home there was a note from the oncologist, recording our last meeting.  Here is the relevant content:

Diagnosis:
13.10.06 Anterior resection for sigmoid carcinoma — T2NO (0/16) Dukes A adenocarcinoma.

26.05.10 Hepatic wedge resection segment 5 for CEA secreting solitary liver metastasis
Consideration adjuvant therapy, declined. For watchful monitoring with 3-monthly CEA and imaging on CEA rise.

Apr2011 Rising CEA. CT documents new right pulmonary 1.1cm nodule plus further 2cm segment border liver metastasis.

May2011 PET-CT confirms right middle lobe pulmonary lesion and FDG avid segment 8 hepatic metastasis, along with several subcentimetre foci specific for additional hepatic metastases
MRI liver confirms segment 8 35mm metastasis, however no clear evidence of metastases at the two other FDG avid areas 

ECOG performance status: 0 

I saw Tony today in outpatient clinic. He had seen my registrar the week earlier, but had some questions regarding the longer term management. His MRI scan has not demonstrated two of the small liver lesions emphasised on the PET. The feeling of the imaging border is that this may represent a false positive PET as MRI liver tends to be a more gold standard investigation.

I discussed with Tony that I envision that we would continue to manage him relatively aggressively. I would plan for him to proceed on with 3 cycles of FOLFOX, of which he has completed one. At this time, we would perform imaging with a CT scan of the chest, abdomen and pelvis to identify any evidence of response in the lesions. I would be hopeful that we would see a response given the slow disease growth pattern and recurrence, and the fact that he is chemo naive. His CEA is also a good marker of disease and, he believes, it is down as he relates the CEA also with a pattern of itch, which he feels has resolved since commencing the chemotherapy.

I’ve recommended that we reimage him after 3 cycles and assess the lung lesion, along with the liver lesion. The liver lesion, I believe, is resectable and we will give further thought to the merits of whether or not to investigate the PET areas with intraoperative ultrasound or other possibilities. With regards to the pulmonary lesion, we will base our decision making on if it responds to chemotherapy or not. Thought could be given to RFA or a lobectomy were an aggressive surgical path to be taken, but this would require control of his systemic disease with response in the liver and other sites.