Question: Dear Dr. Indranil
Greetings . I have been diagnosed with Colerectal cancer and before starting the treatment , I have sought second opinion from your side. Thank you for assuring me that in my case it is treatable. I went thru four sessions of Chemo with Avastin Folifiri+IINOtecan+Levcovorin+5FV .Yesterday I had second PET CT for further course of action . Fortunately PET CT conveys
"This is a patient of carcinoma rectum with lymph nodal and hepatic metastases, post chemotherapy, now for response evaluation; current PET CT study demonstrates significant interval regression of the primary lesion th lymph nodes and hepatic metastases with smaller residual lesions as described above repreenting response to therapy. Interval resolution of most of the ung nodules as described above. . NO new lesions .
As follow-up treatment . Oncologist suggested that no surgery for liver lesions, surgery of ulcer (Lymph) near rectum could be planned after 6 weeks of stopping avastin. Currently another four sessions Lecoveorin +5FU will be going thru. The idea is to avoid Coloctomy bag since the ulcer is in the edge of the rectum, they have suggested to go for Radiation therapy (IMRT) for 5 weeks for the lymph node so that they can avoid surgery+Colectomy bag if possible.
Is this a good option to try out since I responded well to the medication? They say chances are bright. Will this be effective and what are the chances of completely killing the cancer cells thru radio therapy? Have you seen any cases like this kind?
What will be the side effect and how I need to manage?
Stopping avastin - will there any chances of cancer cells metastases /new lesion showing up in the liver and other organs?
Would like to have expert opinion and suggestion .
With warm regards. XXXXXXX N

Thanks for your immediate response. Oncologist conveyed me that let us wait and watch on the few spots which are not active . Kindly go thru the enclosed PET reports which will give you more clarity. I will again ask him this question.
Do you think liver lesions are still there and potential threat to life. My Onco clarified that it will vanish in the coming Chemo sessions with Radio therapy to rectal lumph. On IRINITECAN - Onco conveyed that Radio therapy will take care and thus stopping IRINItecan.
I requested them to avoid Colostomy if feasible? Pl see the image which I have shared. They cannot do surgery since there need to be 6 weeks gaps after stopping avastin. This is to avoid bleeding after surgery. That may be reasons stopping Avastin.
Radio therapy is to check whether we can avoid colostomy if the ulcer (Lymph) gets treated thru radio therapy. Onco feels that going thru Radio therapy , it will check spreading to liver or other organs. Also it will facilitate the surgery, I am not sure on complexity & impact, I will get clarified with my Onco. Looking forward to your input.
Have I on half the battle? Am I on the path of recovery. Thks & Rgds. XXXXXXX N