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Suggest Treatment For Liver Metastasis

Posted on Sat, 31 Jan 2015

Question: If october pet scan showed a liver met snd 1 node . Primary was removed last year march. Can the next scan in january show
More mets ?

Patient on irinotecan

Answered by Dr. dr. Jawahar Ticku (1 hour later)

Brief Answer:
Liver metastasis, primary Colon

Detailed Answer:
Dear XXXXXXX
Thank you for quiry throug healthcare magic.
After removal of the primary and the nodes, but PET scan positive for liver metastasis suggests that it is stage IV of the disease
It is treated by chemotherapy for which there are multiple regimes which I hope you have already undergone. Following chemotherapy there must be some growth restraint of the metastatic deposits. As per my experience the metastasis does not disappear completely after chemotherapy. Either they get reduced in size or they are restrained from further progression.
Hence if you repeat the scan of the abdomen most likely it will show the spots. if the earlier spots were very small they may not be seen but in case they were big at the initial stage you will find the spots there with some moderate change.
There is nothing to worry. If you are emotionally up you will conquer the disease.
Truly,
Dr. J. Ticku

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. dr. Jawahar Ticku (18 minutes later)

Very helpful reply . Ok liver met was 16 mm and aortocaval node 10 mm. Started irinotcan in october , every 2 weeks .

But im
Worried the chemo not working as cea rising :

August cea was 9.8
Oct cea was 8
Dec cea was 9 XXXXXXX cea was 10

Does this mean more mets are occuring ?

Also can these 2 be ablated so atleast they are out
the way ?

Answered by Dr. dr. Jawahar Ticku (1 hour later)

Brief Answer:
liver metastasis

Detailed Answer:
Dear XXXXXXX

Thanks for quick revert.

As explained in my earlier reply that as per my experience the metastasis are likely to show up in the next scan.
Chemotherapy works as a growth restraining procedure. It may ablate the tumor when there are micrometastasis.

CEA levels have not much bearing but definitely tells about the progression of disease in case the levels go very high. When there is a solitary or even two focci they can be ablated by other measures like chemoembolisation or radiosurgery. Large number of metastasis can not be ablated. Only systemic chemotherapy with altered regimens can keep them under check to some extent.

Truly,
Dr. J. Ticku

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. dr. Jawahar Ticku (29 minutes later)

In the last scan ther were these 2, liver met and 1 aorticaval node . Cn these both b ablated ?

What u think re the rising cea each month in this case ?

Are these both small in ur view? 16 mm and 10 mm

Answered by Dr. dr. Jawahar Ticku (3 hours later)

Brief Answer:
Liver mets suggest other micro mets elsewhere. Repeat scanning will determine growth rate.

Detailed Answer:
Dear XXXXXXX
If there is metastasis in the liver and in view of the rising Cea there must be some micro-metastasis elsewhere in the body. As such these spots are not alarming but their rising size if determined on repeat USG or CT abdomen will be a matter of concern.
As I told you radio surgery or chemo-embolisation can be tried. Then there is also targeted chemotherapy which would be of some help. Your Oncologist will determine what can be the best option.
Truly,
Dr. J. Ticku

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. dr. Jawahar Ticku (1 hour later)

Can the chemo cause cea to rise. ?

Answered by Dr. dr. Jawahar Ticku (12 hours later)

Brief Answer:
Liver mets

Detailed Answer:
Dear XXXXXXX
Normally with chemo the CEA level should fall but if chemo is ineffective the the CEA level will show no change rather the trend will be upward.
Truly,
Dr. Ticku

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju