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Suggest Treatment For Peripheral Neuropathy In Feet While Treating Colon Cancer
Question: I presented with constipation, gas, and abdominal pain in January of 2102. My gp did blood tests and found that my iron had dramatically dropped and my Vit D was low. She advised me to get the tablets from a pharmacy. The young woman at the pharmacy gave me the strongest Iron tablets available (I knew nothing abt iron tablets then) and resulted in me passing a great deal of blood when I went to the toilet.
I had also been given a bowel faecal cancer test kit. On return from my week-end away I reported to the GP what had happened and she advised I do the bowel faecal test and send it away once the bleeding had stopped(I had stopped the iron tablets). Since I also have haemeroids I hate to wait for these to clear up. Once cleared and the bleeding stooped I sent the Bowel Cancer test away. It returned as positive. My doctor then booked me for a colonoscopy (waiting period 6 months for a hospital spot) but proceeded in further investigation by first ordering Abdominal X-Ray late April 2012.. which showed nothing unremarkable. We also did further faecal tests to find out that I am infected with Blastocytis Hominis . This was treated with metronidezol to no affect. I have had various other antibiotic treatment to no affect. I now teat it myself with probiotic Lactobacilus and Bifidicilus infected Yougurts and Kefirs with improved health. Next in May of 2012 I had an abdominal CT scan. The radiographer asked me for my mdical history and what was bothering me (this is the same firm that did the Abdo X-Rays) and I told him and produced the results of the Bowel Cancer Screening tests as been positive.
The CT scan was shown to be nothing unremarkable but did show some diverticula. On August 9 I had the colonoscopy and diagnosed with Apple Core carcinoma of the caecum. I was sheduled for surgery 6 weeks later so asked to have another CT scan with the same firm that had done the Abdo-X-Rays and the first CT Scan. I showed the technician the Colonscopy results and he was truly shocked and proceeded with the scan. The results showed a 4.5 cm Apple Core carcinoma in the ascending colon. However it was described in the report as been 45 cm and in the descending colon. There were no obvious lymph nodes. After my operation in September 17 my surgeon told me that I was stage 4 cancer and that the cancer had metastasized into the surrounding area and I had had a hemiolectomy.He also advised that I would need chemotherapy.
When. my oncologist with my wife for the first time he advised us that the cancer was a rapidly growing cancer and that it was probably not more than 6 months old and had spread rapidly and broken through the colon wall and infected 2 lymph nodes. I had to have chemo for 6 months.
This information concerned me and I asked my oncologist to check my CT scans as I was concerned that the first CT scans the cancer had not been detected. He agreed to have an expert radiologist in the hospital have a look.at them When I next saw him he said the cancer had been there at the first CT scan but neither he or the radiologist in the hospital wanted to give evidence because it was a small community and they could be prejudiced. I then asked a private radiologist to access the CT Scans which was done and he immediately picked up the cancer but said "they will probably argue that it could be dismissed as faecal matter.''
I then decided to seek legal advise. After one year and quite a bit of money I have been advised that the lawyers medical experts can find no evidence of malpractice and that the radiologists report was exemplary. Now suddenly I can no longer get support from any doctor. I am suffering the after affects of the chemotherapy in that I have permanent peripheral neuropathy in my feet and have lost a great deal of tactile ability in my hands and fingers. I have the CT scans available and do not know what to do as I am now quite disabled . Please advise what steps you think I should take. I am based in Australia
My attorneys have advised me that if I can get a specialist radiologist to state that the cancer was there on CT scan of early May 2012 and had that been actioned on then I would not have had to undergo chemotherapy then they will continue with the case for me. They have never lost a medico-legal case yet so it appears that they are more concerned about their reputation than they are about their client.
My surgeon prior to the operation to remove the cancer was of the opinion based on the CT scans that the cancer had not metastasized and that I would not have to undergo Chemotherapy.
My contention is that a specialist radiologist and adjunct professor) should have picked up the cancer on the first CT scan.
I had also been given a bowel faecal cancer test kit. On return from my week-end away I reported to the GP what had happened and she advised I do the bowel faecal test and send it away once the bleeding had stopped(I had stopped the iron tablets). Since I also have haemeroids I hate to wait for these to clear up. Once cleared and the bleeding stooped I sent the Bowel Cancer test away. It returned as positive. My doctor then booked me for a colonoscopy (waiting period 6 months for a hospital spot) but proceeded in further investigation by first ordering Abdominal X-Ray late April 2012.. which showed nothing unremarkable. We also did further faecal tests to find out that I am infected with Blastocytis Hominis . This was treated with metronidezol to no affect. I have had various other antibiotic treatment to no affect. I now teat it myself with probiotic Lactobacilus and Bifidicilus infected Yougurts and Kefirs with improved health. Next in May of 2012 I had an abdominal CT scan. The radiographer asked me for my mdical history and what was bothering me (this is the same firm that did the Abdo X-Rays) and I told him and produced the results of the Bowel Cancer Screening tests as been positive.
The CT scan was shown to be nothing unremarkable but did show some diverticula. On August 9 I had the colonoscopy and diagnosed with Apple Core carcinoma of the caecum. I was sheduled for surgery 6 weeks later so asked to have another CT scan with the same firm that had done the Abdo-X-Rays and the first CT Scan. I showed the technician the Colonscopy results and he was truly shocked and proceeded with the scan. The results showed a 4.5 cm Apple Core carcinoma in the ascending colon. However it was described in the report as been 45 cm and in the descending colon. There were no obvious lymph nodes. After my operation in September 17 my surgeon told me that I was stage 4 cancer and that the cancer had metastasized into the surrounding area and I had had a hemiolectomy.He also advised that I would need chemotherapy.
When. my oncologist with my wife for the first time he advised us that the cancer was a rapidly growing cancer and that it was probably not more than 6 months old and had spread rapidly and broken through the colon wall and infected 2 lymph nodes. I had to have chemo for 6 months.
This information concerned me and I asked my oncologist to check my CT scans as I was concerned that the first CT scans the cancer had not been detected. He agreed to have an expert radiologist in the hospital have a look.at them When I next saw him he said the cancer had been there at the first CT scan but neither he or the radiologist in the hospital wanted to give evidence because it was a small community and they could be prejudiced. I then asked a private radiologist to access the CT Scans which was done and he immediately picked up the cancer but said "they will probably argue that it could be dismissed as faecal matter.''
I then decided to seek legal advise. After one year and quite a bit of money I have been advised that the lawyers medical experts can find no evidence of malpractice and that the radiologists report was exemplary. Now suddenly I can no longer get support from any doctor. I am suffering the after affects of the chemotherapy in that I have permanent peripheral neuropathy in my feet and have lost a great deal of tactile ability in my hands and fingers. I have the CT scans available and do not know what to do as I am now quite disabled . Please advise what steps you think I should take. I am based in Australia
My attorneys have advised me that if I can get a specialist radiologist to state that the cancer was there on CT scan of early May 2012 and had that been actioned on then I would not have had to undergo chemotherapy then they will continue with the case for me. They have never lost a medico-legal case yet so it appears that they are more concerned about their reputation than they are about their client.
My surgeon prior to the operation to remove the cancer was of the opinion based on the CT scans that the cancer had not metastasized and that I would not have to undergo Chemotherapy.
My contention is that a specialist radiologist and adjunct professor) should have picked up the cancer on the first CT scan.
Brief Answer:
Please upload CD containing May 2012 CT scan to Dropbox
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
This is Dr.Vivek and I am a practising faculty in Radiology. I am glad to be helping you out with your query.
1. I would like to see all the images of CT scan dated 9 May 2012 to confirm the appearance of the cancer in the first scan. The screen shot images attached do not show the caecum and ascending colon region.
Can I request you to please upload al the contents of the CD to a file sharing service like Dropbox and send me the link. I will download the images and see them at my workstation. To upload images, please sign up with www.dropbox.com and follow instructions on how to upload and generate a sharing link. You can then copy and paste the link on your follow up query to me.
2. Unfortunately nothing can be done for the peripheral neuropathy however sufficient chemotherapy had to be given to treat the cancer and this could not have been avoided as you had a 4.5 cm mass and 2 lymphnodes.
3. Regarding the contention that you have, I believe the cancer would have been slightly smaller in the May 2012 scan (I will confirm this once you have upladed the images) and has grown rapidly in the duration May to August 2012, when your colonoscopy and second CT scan were done.
4. Concerning the radiologist's interpreatation of the first scan, if they had picked up the diverticula then not visualizing the apple core at the caecum was not deliberate or negligence. The caecum is a reservoir of undigested fecal matter and at times the caecum is not completely distended making the diagnosis of an apple core a difficult one at the first look.
5. Please upload the CD containing CT scan May 2012 images and send me the download link. I will have a detailed look at my workstation and confirm your contention at the earliest.
Regards,
Dr.Vivek
Please upload CD containing May 2012 CT scan to Dropbox
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
This is Dr.Vivek and I am a practising faculty in Radiology. I am glad to be helping you out with your query.
1. I would like to see all the images of CT scan dated 9 May 2012 to confirm the appearance of the cancer in the first scan. The screen shot images attached do not show the caecum and ascending colon region.
Can I request you to please upload al the contents of the CD to a file sharing service like Dropbox and send me the link. I will download the images and see them at my workstation. To upload images, please sign up with www.dropbox.com and follow instructions on how to upload and generate a sharing link. You can then copy and paste the link on your follow up query to me.
2. Unfortunately nothing can be done for the peripheral neuropathy however sufficient chemotherapy had to be given to treat the cancer and this could not have been avoided as you had a 4.5 cm mass and 2 lymphnodes.
3. Regarding the contention that you have, I believe the cancer would have been slightly smaller in the May 2012 scan (I will confirm this once you have upladed the images) and has grown rapidly in the duration May to August 2012, when your colonoscopy and second CT scan were done.
4. Concerning the radiologist's interpreatation of the first scan, if they had picked up the diverticula then not visualizing the apple core at the caecum was not deliberate or negligence. The caecum is a reservoir of undigested fecal matter and at times the caecum is not completely distended making the diagnosis of an apple core a difficult one at the first look.
5. Please upload the CD containing CT scan May 2012 images and send me the download link. I will have a detailed look at my workstation and confirm your contention at the earliest.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hello Doctor XXXXXXX
I really appreciate your input. Since i am now quite old and not so computer savvy I have asked my young neighbour when he comes home to help me up load the Cd files onto DropBox. When that is done i shall advise you accordingly with the password.. There is something that i need to clarify with you however.
If the radiologist is supplied with the GP's notes on the condition of the patient.. such as in my case the history of stomach cramps and bleeding, bloat, constipation, etc., plus the Bowel cancer test report as positive and the drop in the Haemoglobin and Vit D then does it no follow that Specialist should be carefully looking for an obstruction or tumour?
I really appreciate your input. Since i am now quite old and not so computer savvy I have asked my young neighbour when he comes home to help me up load the Cd files onto DropBox. When that is done i shall advise you accordingly with the password.. There is something that i need to clarify with you however.
If the radiologist is supplied with the GP's notes on the condition of the patient.. such as in my case the history of stomach cramps and bleeding, bloat, constipation, etc., plus the Bowel cancer test report as positive and the drop in the Haemoglobin and Vit D then does it no follow that Specialist should be carefully looking for an obstruction or tumour?
Brief Answer:
Specialist must look carefully for findings related to symptoms
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. We can see your images once your neighbor is able to upload the same and after you share the account email and password used for creating the Dropbox account.
2. I agree to your comment that the radiologist must try and look for every possibility of a tumor should a patient have a history of stomach cramps and bleeding, bloat, constipation and reports indicate drop in hemoglobin. In my experience at a cancer research institute where I served as radiologist for few years, we were careful while reporting CT scans in patients having the symptoms listed by you.
Regards,
Dr.Vivek
Specialist must look carefully for findings related to symptoms
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. We can see your images once your neighbor is able to upload the same and after you share the account email and password used for creating the Dropbox account.
2. I agree to your comment that the radiologist must try and look for every possibility of a tumor should a patient have a history of stomach cramps and bleeding, bloat, constipation and reports indicate drop in hemoglobin. In my experience at a cancer research institute where I served as radiologist for few years, we were careful while reporting CT scans in patients having the symptoms listed by you.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. herewith the link with images on Picasa..
Kind regards, XXXXXXX
https://picasaweb.google.com/0000/CtScansMay2012?authuser=0&authkey=Gv1sRgCMmKzIOC9_ugzwE&feat=directlink
Kind regards, XXXXXXX
https://picasaweb.google.com/0000/CtScansMay2012?authuser=0&authkey=Gv1sRgCMmKzIOC9_ugzwE&feat=directlink
Brief Answer:
The cancer area pictures are not uploaded, please upload all pictures in CD
Detailed Answer:
Hi XXXX (XXXX),
Thanks for writing back with an update.
1. Thanks for sharing the link however I find only about 50 images shared on Picasa. The images you have uploaded are of the lower chest and up to the level of gall bladder while the suspected problem area is in the caecum and those pictures are not to be seen.
2. A usual CT scan abdomen contain 200 to 300 pictures and I request you to please upload all the imaged in your CD so that I can see your problem area and confirm the presence of cancer in the May 2012 scan.
3. I understand that you might have a little inconvenience in uploading the images as you are not computer savvy. Please take the help of your neighbor and get him to upload all the images on the CD. Please send in a follow up query once you are done with uploading all the images and I will reply back at the earliest.
Regards,
Dr.Vivek
The cancer area pictures are not uploaded, please upload all pictures in CD
Detailed Answer:
Hi XXXX (XXXX),
Thanks for writing back with an update.
1. Thanks for sharing the link however I find only about 50 images shared on Picasa. The images you have uploaded are of the lower chest and up to the level of gall bladder while the suspected problem area is in the caecum and those pictures are not to be seen.
2. A usual CT scan abdomen contain 200 to 300 pictures and I request you to please upload all the imaged in your CD so that I can see your problem area and confirm the presence of cancer in the May 2012 scan.
3. I understand that you might have a little inconvenience in uploading the images as you are not computer savvy. Please take the help of your neighbor and get him to upload all the images on the CD. Please send in a follow up query once you are done with uploading all the images and I will reply back at the earliest.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks! It was a very big job! I shall ask him again to help upload all the images..Oherwise the only alternative is to post you the CD's?
Brief Answer:
Please have the images uploaded at your convenience and I will wait for you
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. I am sure your young neighbor will find it an easy job to upload all the images in the CD.
2. Please do not get worried, you can take a day or two at your convenience to get help from your neighbor.
3. I have come across patients who find it difficult to get across the images in the beginning but then with the help of someone around they have been able to send the images.
4. Posting the CDs is not an easy option because we are in different locations across continents and it might be cumbersome and expensive to you.
5. It is only a matter of a few hours or days and I can wait till your images have been uploaded completely and I will wait to hear from you
Regards,
Dr.Vivek
Please have the images uploaded at your convenience and I will wait for you
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. I am sure your young neighbor will find it an easy job to upload all the images in the CD.
2. Please do not get worried, you can take a day or two at your convenience to get help from your neighbor.
3. I have come across patients who find it difficult to get across the images in the beginning but then with the help of someone around they have been able to send the images.
4. Posting the CDs is not an easy option because we are in different locations across continents and it might be cumbersome and expensive to you.
5. It is only a matter of a few hours or days and I can wait till your images have been uploaded completely and I will wait to hear from you
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Doctor. You are a very kind man! Until later then to success with the uploading all the images!
XXXX
XXXX
Brief Answer:
Hope to view all your images soon
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Thanks you for your appreciation. Looking forward to success with the uploading of your images.
Regards,
Dr.Vivek
Hope to view all your images soon
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Thanks you for your appreciation. Looking forward to success with the uploading of your images.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr
Thankfully my young neighbor has come to my rescue like a Super Hero! So please find attached the April X-Rays and the CT Scans for May and August 2012. Please when studying them look out for signs of disease that could indicate a cancer in the making as well as when the arrival of the metastases eventuated?
Thanks again for your patience!
kindest regards, XXXXXXX
X-Rays:
https://picasaweb.google.com/0000/X_Ray?authuser=0&authkey=Gv1sRgCJ2xm9LAju_m4AE&feat=directlink
12 May 2012:
https://picasaweb.google.com/0000/CtScansMay2012?authuser=0&authkey=Gv1sRgCMmKzIOC9_ugzwE&feat=directlink
21 August 2012:
https://picasaweb.google.com/0000/CTScansAugust?authuser=0&authkey=Gv1sRgCIedzoDw76HTnAE&feat=directlink
Thankfully my young neighbor has come to my rescue like a Super Hero! So please find attached the April X-Rays and the CT Scans for May and August 2012. Please when studying them look out for signs of disease that could indicate a cancer in the making as well as when the arrival of the metastases eventuated?
Thanks again for your patience!
kindest regards, XXXXXXX
X-Rays:
https://picasaweb.google.com/0000/X_Ray?authuser=0&authkey=Gv1sRgCJ2xm9LAju_m4AE&feat=directlink
12 May 2012:
https://picasaweb.google.com/0000/CtScansMay2012?authuser=0&authkey=Gv1sRgCMmKzIOC9_ugzwE&feat=directlink
21 August 2012:
https://picasaweb.google.com/0000/CTScansAugust?authuser=0&authkey=Gv1sRgCIedzoDw76HTnAE&feat=directlink
Brief Answer:
There was eccentric wall thickening of ascending colon in first CT scan
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. I have reviewed the images uploaded; X rays dated April 2012, CT scan dated May 2012 and August 2012, thanks to you and your helpful neighbour for arranging it.
2. The wall thickening in the ascending colon is seen in the CT scan abdomen dated May 2012. It is seen as an eccentric wall thickening. Minimal fat stranding is seen next to the wall thickening. However fecal matter is also present in the lumen following the wall thickening.
The wall thickening has almost doubled in the CT scan dated August 2012 with mild peripheral fat stranding.
3. Few diverticula are seen as mentioned earlier.
4. Lymphnode like structures also visualized but they are too small to confirm as disease related.
5. Your CT scan chest is normal. No lung metastasis is seen.
6. Colon cancer usually causes metastasis to lymphnodes, liver, lung and the peritoneal lining inside the abdomen. Though rarely, it can also spread to bones or other organs.
7. The rising level of Carcinoembryonic antigen (CEA) indicates the possibility of liver metastasis. Therefore serial determinations of CEA are recommended for detecting cancer spread to the liver. Regular imaging follow up by ultrasound scan is also recommended in the months following treatment.
One cannot predict that metastasis will occur in every patient operated for colon cancer but numbers show that half of the patients might show up with liver metastasis within 2 years from the date of surgery. Being cautious and monitoring closely with CEA levels and ultrasound or CT scan is advised.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
There was eccentric wall thickening of ascending colon in first CT scan
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. I have reviewed the images uploaded; X rays dated April 2012, CT scan dated May 2012 and August 2012, thanks to you and your helpful neighbour for arranging it.
2. The wall thickening in the ascending colon is seen in the CT scan abdomen dated May 2012. It is seen as an eccentric wall thickening. Minimal fat stranding is seen next to the wall thickening. However fecal matter is also present in the lumen following the wall thickening.
The wall thickening has almost doubled in the CT scan dated August 2012 with mild peripheral fat stranding.
3. Few diverticula are seen as mentioned earlier.
4. Lymphnode like structures also visualized but they are too small to confirm as disease related.
5. Your CT scan chest is normal. No lung metastasis is seen.
6. Colon cancer usually causes metastasis to lymphnodes, liver, lung and the peritoneal lining inside the abdomen. Though rarely, it can also spread to bones or other organs.
7. The rising level of Carcinoembryonic antigen (CEA) indicates the possibility of liver metastasis. Therefore serial determinations of CEA are recommended for detecting cancer spread to the liver. Regular imaging follow up by ultrasound scan is also recommended in the months following treatment.
One cannot predict that metastasis will occur in every patient operated for colon cancer but numbers show that half of the patients might show up with liver metastasis within 2 years from the date of surgery. Being cautious and monitoring closely with CEA levels and ultrasound or CT scan is advised.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Doctor... I need to sleep on this and absorb more of it and I hope to write back to you soon with some questions so that I can put your responses in ''Bullets'' so as to be present the disease spread and progression as you have found on step by step basis.
Thanking you for your expertise and kindness.
XXXXXXX R. XXXXXXX
Canberra. Australia.
Thanking you for your expertise and kindness.
XXXXXXX R. XXXXXXX
Canberra. Australia.
Brief Answer:
Wondering if you are on treatment with medicines for peripheral neuropathy
Detailed Answer:
Hi XXXX,
Welcome and thanks for writing back with an update.
1. I was wondering if you have consulted a neurologist and are under treatment for peripheral neuropathy and taking medicines for it.
2. The chemotherapy which you took has suppressed the cancer cells left over after the surgery and I believe that has worked in preventing any metastasis to the other organs after surgery.
3. Colon cancer is not an easy condition to get treated for and you have won the battle against cancer which is an achievement in itself, though unfortunately you have to deal with peripheral neuropathy.
4. Please do write in with questions that you might have and we can discuss in detail.
Regards,
Dr.Vivek
Wondering if you are on treatment with medicines for peripheral neuropathy
Detailed Answer:
Hi XXXX,
Welcome and thanks for writing back with an update.
1. I was wondering if you have consulted a neurologist and are under treatment for peripheral neuropathy and taking medicines for it.
2. The chemotherapy which you took has suppressed the cancer cells left over after the surgery and I believe that has worked in preventing any metastasis to the other organs after surgery.
3. Colon cancer is not an easy condition to get treated for and you have won the battle against cancer which is an achievement in itself, though unfortunately you have to deal with peripheral neuropathy.
4. Please do write in with questions that you might have and we can discuss in detail.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dar Dr, XXXXXXX Thank you for your advice regarding the peripheral neuropathy. I have tried many different drugs and the side affects such as depression, anxiety, suicidal tendencies, insomnia and then not able to stay awake I decided to stop them all and now take only Panado. I also try to swim 3 times a week. I am getting some relief through this and positive thinking . Dr Please have a look at the questions that I posted in your reply of Sunday. I would be most grateful if you could respond accordingly. I have also uploaded more information for you. My very kind regards, XXXXXXX R. XXXXXXX My question are in Blue XXXXXXX XXXXXXX
Attachments1:15 PM (21 hours ago)
to customercare, bcc: XXXXXXX
Brief Answer:
There was eccentric wall thickening of ascending colon in first CT scan
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Dear Dr.
Thank you for this report. I have highlighted in RED your comments I would like answers to with my questions in Blue
1. I have reviewed the images uploaded; X rays dated April 2012, CT scan dated May 2012 and August 2012, thanks to you and your helpful neighbour for arranging it.
2. The wall thickening in the ascending colon is seen in the CT scan abdomen dated May 2012. It is seen as an eccentric wall thickening. Minimal fat stranding is seen next to the wall thickening. What does the wall thickening indicate? However faecal matter is also present in the lumen following the wall thickening. Does the faecal matter presence detract from the fact of the eccentric wall thickening? Should the radiologist been able to see the wall thickening albeit of the presence of faecal matter? Can you please identify the numbers of the images where you see the wall thickening and if so do they per chance coincide with the first image I emailed you Image 140- jpg.? These are written in long hand.
The wall thickening has almost doubled in the CT scan dated August 2012 with mild peripheral fat stranding.
So this indicates a rapid growing cancer?
Are you able to measure the wall thickening of the May 2012 CT scan? Are you able to measure the August 2012 Ct Scan?
3. Few diverticula are seen as mentioned earlier.
What is the significance of the diverticula in terms of the diagnosis?
4. Lymph node like structures also visualized but they are too small to confirm as disease related. Are you referring to the May 2012 CT scan here or the later one?
5. Your CT scan chest is normal. No lung metastasis is seen. I assume that this is the August CT Scan you are referring to?
That is indeed good news!
6. Colon cancer usually causes metastasis to lymph nodes, liver, lung and the peritoneal lining inside the abdomen. Though rarely, it can also spread to bones or other organs.
7. The rising level of Carcinoembryonic antigen (CEA) indicates the possibility of liver metastasis. Therefore serial determinations of CEA are recommended for detecting cancer spread to the liver. Regular imaging follow up by ultrasound scan is also recommended in the months following treatment.
One cannot predict that metastasis will occur in every patient operated for colon cancer but numbers show that half of the patients might show up with liver metastasis within 2 years from the date of surgery. Being cautious and monitoring closely with CEA levels and ultrasound or CT scan is advised.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr XXXXXXX
Replied by Dr. XXXXXXX Chail
, 16 hours ago
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Notes: Please confirm that you do or do not find evidence of metastasis in both the May 2012 and or August 2012 CT scans? Please see Histopathology report attached for your reference.
Please also confirm that when you mention the wall thickening that this is an indication of an adeno carcinoma or Apple Core Carcinoma?
To sum up: I need to know whether any reasonably trained and experienced radiologist would have picked up from the evidence of the May 2012 CT scans sufficient information to alert them of an existing cancer(albeit that there was a faecal matter?) based on the medical evidence provided and available to both the Radiologist and his Technician by the referring GP & during the prior procedure interview of the patience e.g.: myself?
I look forward to your answers Doctor and thank you for your responses to date.
My very kind regards,
XXXXXXX R. XXXXXXX
Attachments1:15 PM (21 hours ago)
to customercare, bcc: XXXXXXX
Brief Answer:
There was eccentric wall thickening of ascending colon in first CT scan
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Dear Dr.
Thank you for this report. I have highlighted in RED your comments I would like answers to with my questions in Blue
1. I have reviewed the images uploaded; X rays dated April 2012, CT scan dated May 2012 and August 2012, thanks to you and your helpful neighbour for arranging it.
2. The wall thickening in the ascending colon is seen in the CT scan abdomen dated May 2012. It is seen as an eccentric wall thickening. Minimal fat stranding is seen next to the wall thickening. What does the wall thickening indicate? However faecal matter is also present in the lumen following the wall thickening. Does the faecal matter presence detract from the fact of the eccentric wall thickening? Should the radiologist been able to see the wall thickening albeit of the presence of faecal matter? Can you please identify the numbers of the images where you see the wall thickening and if so do they per chance coincide with the first image I emailed you Image 140- jpg.? These are written in long hand.
The wall thickening has almost doubled in the CT scan dated August 2012 with mild peripheral fat stranding.
So this indicates a rapid growing cancer?
Are you able to measure the wall thickening of the May 2012 CT scan? Are you able to measure the August 2012 Ct Scan?
3. Few diverticula are seen as mentioned earlier.
What is the significance of the diverticula in terms of the diagnosis?
4. Lymph node like structures also visualized but they are too small to confirm as disease related. Are you referring to the May 2012 CT scan here or the later one?
5. Your CT scan chest is normal. No lung metastasis is seen. I assume that this is the August CT Scan you are referring to?
That is indeed good news!
6. Colon cancer usually causes metastasis to lymph nodes, liver, lung and the peritoneal lining inside the abdomen. Though rarely, it can also spread to bones or other organs.
7. The rising level of Carcinoembryonic antigen (CEA) indicates the possibility of liver metastasis. Therefore serial determinations of CEA are recommended for detecting cancer spread to the liver. Regular imaging follow up by ultrasound scan is also recommended in the months following treatment.
One cannot predict that metastasis will occur in every patient operated for colon cancer but numbers show that half of the patients might show up with liver metastasis within 2 years from the date of surgery. Being cautious and monitoring closely with CEA levels and ultrasound or CT scan is advised.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr XXXXXXX
Replied by Dr. XXXXXXX Chail
, 16 hours ago
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Notes: Please confirm that you do or do not find evidence of metastasis in both the May 2012 and or August 2012 CT scans? Please see Histopathology report attached for your reference.
Please also confirm that when you mention the wall thickening that this is an indication of an adeno carcinoma or Apple Core Carcinoma?
To sum up: I need to know whether any reasonably trained and experienced radiologist would have picked up from the evidence of the May 2012 CT scans sufficient information to alert them of an existing cancer(albeit that there was a faecal matter?) based on the medical evidence provided and available to both the Radiologist and his Technician by the referring GP & during the prior procedure interview of the patience e.g.: myself?
I look forward to your answers Doctor and thank you for your responses to date.
My very kind regards,
XXXXXXX R. XXXXXXX
Brief Answer:
Please find detailed explanation below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my answers below
1. What does the wall thickening indicate?
The eccentric wall thickening indicates a high suspicion of disease process which might be benign or malignant.
2. Does the faecal matter presence detract from the fact of the eccentric wall thickening?
I must admit that most radiologists will have a dilemma in giving it as a confirmed eccentric wall thickening due to the presence of fecal matter.
3. Should the radiologist been able to see the wall thickening albeit of the presence of faecal matter?
The location of the wall thickening is an area which is close to the transition from the small bowel to the large bowel. At this point, visualizing the eccentric bowel thickening in the presence of fecal matter is difficult and most radiologists prefer to play it defensive and try not to make an overdiagnosis.
4. Can you please identify the numbers of the images where you see the wall thickening and if so do they per chance coincide with the first image I emailed you Image 140- jpg.?
The image which shows the suspicious bowel wall thickening are numbered 80159 and 80160 in picassa download which correspond to images numbered 31/ 95 and 32/ 95 in the coronal series 80414/ 7 of images in CT scan dated May 2012
5. So this indicates a rapid growing cancer?
Your cancer has shown significant growth in three months from May 2012 through August 2012 confirming it to be rapidly growing.
6. Are you able to measure the wall thickening of the May 2012 CT scan? Are you able to measure the August 2012 Ct Scan?
No I am unable to measure the wall thickening, my observation is subjective and based on visual estimation of size of the tumor area.
7. What is the significance of the diverticula in terms of the diagnosis?
Diverticula are not related to the cancer in your case, they are benign outpouchings from the bowel and might be seen in the elderly.
8. Lymph node like structures also visualized but they are too small to confirm as disease related. Are you referring to the May 2012 CT scan here or the later one?
The lymphnodes I have referred to is from what is seen in the August 2012 CT scan. Most cancer affected lymphnodes are large and multiple but this is not seen in your case. It might have just been the beginning of lymph nodal spread as two small nodes were only positive for metastasis as per the histopathology report.
9. I assume that this is the August CT Scan you are referring to?
Yes, the chest is scan is dated August 2012
10. Please confirm that you do or do not find evidence of metastasis in both the May 2012 and or August 2012 CT scans? Please see Histopathology report attached for your reference.
It is confirmed that there is no metastasis in both the scans.
11. Please also confirm that when you mention the wall thickening that this is an indication of an adeno carcinoma or Apple Core Carcinoma?
Adenocarcinoma is a pathological classification of the colon cancer and apple core is the gross appearance showing luminal narrowing.
12. To sum up: I need to know whether any reasonably trained and experienced radiologist would have picked up from the evidence of the May 2012 CT scans sufficient information to alert them of an existing cancer(albeit that there was a faecal matter?) based on the medical evidence provided and available to both the Radiologist and his Technician by the referring GP & during the prior procedure interview of the patience e.g.: myself?
If the CT scan was done at a cancer hospital with a dedicated team of radiologists who have had sufficient experience with working on cancer patients then probably this piece of evidence would have been picked up. In the general radiology practice, such errors of judgement are pardonable.
In conclusion, I would certainly like to know if you were recommended any bowel preparation, told to follow any set of instructions and given a rectal enema before commencing the CT scan as these are the ways by which false interpretation due to fecal matter can be avoided.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find detailed explanation below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my answers below
1. What does the wall thickening indicate?
The eccentric wall thickening indicates a high suspicion of disease process which might be benign or malignant.
2. Does the faecal matter presence detract from the fact of the eccentric wall thickening?
I must admit that most radiologists will have a dilemma in giving it as a confirmed eccentric wall thickening due to the presence of fecal matter.
3. Should the radiologist been able to see the wall thickening albeit of the presence of faecal matter?
The location of the wall thickening is an area which is close to the transition from the small bowel to the large bowel. At this point, visualizing the eccentric bowel thickening in the presence of fecal matter is difficult and most radiologists prefer to play it defensive and try not to make an overdiagnosis.
4. Can you please identify the numbers of the images where you see the wall thickening and if so do they per chance coincide with the first image I emailed you Image 140- jpg.?
The image which shows the suspicious bowel wall thickening are numbered 80159 and 80160 in picassa download which correspond to images numbered 31/ 95 and 32/ 95 in the coronal series 80414/ 7 of images in CT scan dated May 2012
5. So this indicates a rapid growing cancer?
Your cancer has shown significant growth in three months from May 2012 through August 2012 confirming it to be rapidly growing.
6. Are you able to measure the wall thickening of the May 2012 CT scan? Are you able to measure the August 2012 Ct Scan?
No I am unable to measure the wall thickening, my observation is subjective and based on visual estimation of size of the tumor area.
7. What is the significance of the diverticula in terms of the diagnosis?
Diverticula are not related to the cancer in your case, they are benign outpouchings from the bowel and might be seen in the elderly.
8. Lymph node like structures also visualized but they are too small to confirm as disease related. Are you referring to the May 2012 CT scan here or the later one?
The lymphnodes I have referred to is from what is seen in the August 2012 CT scan. Most cancer affected lymphnodes are large and multiple but this is not seen in your case. It might have just been the beginning of lymph nodal spread as two small nodes were only positive for metastasis as per the histopathology report.
9. I assume that this is the August CT Scan you are referring to?
Yes, the chest is scan is dated August 2012
10. Please confirm that you do or do not find evidence of metastasis in both the May 2012 and or August 2012 CT scans? Please see Histopathology report attached for your reference.
It is confirmed that there is no metastasis in both the scans.
11. Please also confirm that when you mention the wall thickening that this is an indication of an adeno carcinoma or Apple Core Carcinoma?
Adenocarcinoma is a pathological classification of the colon cancer and apple core is the gross appearance showing luminal narrowing.
12. To sum up: I need to know whether any reasonably trained and experienced radiologist would have picked up from the evidence of the May 2012 CT scans sufficient information to alert them of an existing cancer(albeit that there was a faecal matter?) based on the medical evidence provided and available to both the Radiologist and his Technician by the referring GP & during the prior procedure interview of the patience e.g.: myself?
If the CT scan was done at a cancer hospital with a dedicated team of radiologists who have had sufficient experience with working on cancer patients then probably this piece of evidence would have been picked up. In the general radiology practice, such errors of judgement are pardonable.
In conclusion, I would certainly like to know if you were recommended any bowel preparation, told to follow any set of instructions and given a rectal enema before commencing the CT scan as these are the ways by which false interpretation due to fecal matter can be avoided.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr XXXXXXX
Thank you for your comprehensive report.and answer to my questions.
Re Point 12. above.. Although the CT scans were not done at a dedicated cancer radiology department, the radiologist (owner of business )who checked the CT was and still is a Professor of Radiology at a local University Medical School. I think it therefore fair to assume that he should be ''top of his game'' regardless of the discipline ?Re your question that I should have an enema to be able to differentiate faecal matter from other .. the answer is no that was never requested or advised to do this. I did however have to do this for the two colonoscopys I have had.
Kindest regards
XXXXXXX
Thank you for your comprehensive report.and answer to my questions.
Re Point 12. above.. Although the CT scans were not done at a dedicated cancer radiology department, the radiologist (owner of business )who checked the CT was and still is a Professor of Radiology at a local University Medical School. I think it therefore fair to assume that he should be ''top of his game'' regardless of the discipline ?Re your question that I should have an enema to be able to differentiate faecal matter from other .. the answer is no that was never requested or advised to do this. I did however have to do this for the two colonoscopys I have had.
Kindest regards
XXXXXXX
Brief Answer:
Not advising enema and not giving rectal contrast was the turning point
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my answers below
1. I agree that a Professor of Radiology must be having the experience by which he might have been able to draw suspicion and ring the bell. Unfortunately the feces literally ccame in the way and an error of judgement happened.
2. The turning point in your CT scan is not advising enema and not giving any rectal contrast. This little but important detail would have made a lot of difference.
3. Since you confirm that enema was advised during colonoscopies then it was certainly required when doing an investigation like a CT scan on a patient who is passing blood in stools.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Not advising enema and not giving rectal contrast was the turning point
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
Please find my answers below
1. I agree that a Professor of Radiology must be having the experience by which he might have been able to draw suspicion and ring the bell. Unfortunately the feces literally ccame in the way and an error of judgement happened.
2. The turning point in your CT scan is not advising enema and not giving any rectal contrast. This little but important detail would have made a lot of difference.
3. Since you confirm that enema was advised during colonoscopies then it was certainly required when doing an investigation like a CT scan on a patient who is passing blood in stools.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thank you for your kindness and patience in answering a multiple number of my concerns. My very best regards to you and your success in your chosen field of medicine.
XXXXXXX R. XXXXXXX
Thank you for your kindness and patience in answering a multiple number of my concerns. My very best regards to you and your success in your chosen field of medicine.
XXXXXXX R. XXXXXXX
Brief Answer:
Welcome and thanks for sending in your query
Detailed Answer:
Hi XXXX,
Thanks for your feedback and good wishes, I am really touched by your kind words.
Thanks for accepting my replies and I am glad to get an opportunity to help you out with your queries.
I pray for your healthy and long life.
If you have any health related queries and wish to have it answered by me then please quote "query Id 188328 Kind attn Dr.Vivek Chail" in your query and the moderators will direct the query to me. I will reply back at the earliest.
Regards,
Dr.Vivek
Welcome and thanks for sending in your query
Detailed Answer:
Hi XXXX,
Thanks for your feedback and good wishes, I am really touched by your kind words.
Thanks for accepting my replies and I am glad to get an opportunity to help you out with your queries.
I pray for your healthy and long life.
If you have any health related queries and wish to have it answered by me then please quote "query Id 188328 Kind attn Dr.Vivek Chail" in your query and the moderators will direct the query to me. I will reply back at the earliest.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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