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What Do U Mean By Tiny Subpleural Nodules?

Posted on Thu, 9 Apr 2015

Question: Person with colorectal cancer now
Has mets to liver and 1 node. Was initially stage 3.

Radiologist in ct report states .... Sub pleural nodule but does not say size and if metastic. Does this mean its not a met?

Usually he says metastases when the liver mets were found first time

Answered by Dr. Grzegorz Stanko (33 minutes later)

Brief Answer:
It can be metastasis or bening lesion.

Detailed Answer:
Hello!

Thank you for the query.

Subpleural nodule can be metastatic or not. Radiologist can see only an image on computer screen. He may only suspect cancer. But he can not see tumor cells. That is why he did not mention either its a cancerous or not.
It may be a metastasis. It may also be some other benign lump. As long as biopsy wont be done, you can not be sure.

Hope this will help. Feel free to ask further questions.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (5 minutes later)

I spoke to u i think early on. Please see attached.

The sub pleural and adrenal just says nodules.

So is this he not sure? Are mets called nodules?

Answered by Dr. Grzegorz Stanko (3 minutes later)

Brief Answer:
All this nodes in recent CT are most likley metastases.

Detailed Answer:
It seems that radiologist mentioned "disease progression". This means that all this described nodes are most likely metastases. Some are new, some has gotten bigger, some remain unchanged. But general image is that the disease is going forward.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (19 minutes later)

Is there any way to tackle chemo resistalncy?

The onco has suggested oxyplatin and raltitrexed and we r pushing for avastin. Is this good chemo?

Answered by Dr. Grzegorz Stanko (8 minutes later)

Brief Answer:
Nothing can be done with chemo resistance.

Detailed Answer:
You can not do anything with chemo resistance. This is a huge problem for every cancer patient. More chemo you give, greater chances to have chemo resistance.
Oxyplatin and Raltitrex is a good chemo. Avastin, like we discussed earlier is a big chance.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (3 minutes later)

As my dad does
Not have bp, diabetes etc they done seem to think avastin would be bad for him. We can get it private as not on nhs. U think we should go for avastin right?

Is it good his liver functions are ok?

Answered by Dr. Grzegorz Stanko (2 minutes later)

Brief Answer:
Ye should try Avastin.

Detailed Answer:
His liver function is fine. He should get through chemo. Yes, he should try Avastin for sure. It is not contraindicated in his case.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (11 minutes later)

But if oxy avastin nothing works nothing we can do right?
Is stem cell anygood at all . We are so worried with this dreadful disease

Answered by Dr. Grzegorz Stanko (33 minutes later)

Brief Answer:
Stage IV colon cancer can not be cured.

Detailed Answer:
You need to know that this disease in IV stage is incurable. You can not save his life. You can only make it longer than without treatment.
If chemo wont work, not much can be done.
I`m not sure what do you mean by stem cell. Stem cells are kind of first cancerous cells. There is a theory which says that destroying stem cells can cure the cancer. Leaving stem cells can cause cancer regrow.
Chemo is generally to eradicate stem cells. But in stage IV it is impossible.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (6 minutes later)

Okay so do u think we should def do SIRT if appropriate ?

Answered by Dr. Grzegorz Stanko (1 minute later)

Brief Answer:
All mentioned methods should be tried.

Detailed Answer:
You should try all methods we have discussed. Chemo, Avastin and SIRT. All this things can make his life longer. All should be tried. No doubt in that.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (5 minutes later)

Yes i agree. We have read that sirt has some very good survival
Time with some ppl
Tumors have all gone.

U think his cancer is aggressive ? As in XXXXXXX there were 2 mets only in liver and now 10 in 6 weeks !

It was a dukes c1 initially and moderatley differentiated.

Do u think alchohol
And smoke not helping matters as he does the above?

Answered by Dr. Grzegorz Stanko (6 minutes later)

Brief Answer:
This cancer is aggressive.

Detailed Answer:
Destroying liver mets can prolong his life for sure. Just note that you can not see all cancer cells. This cells are most likely all over his body. So sooner or later, new mets will appear.

Moderately advanced means G2. It is aggressive. This mets in liver were there 6 weeks ago. Just they were too small to see them in CT.

Alcohol is not the best idea as it worsen liver condition. Smoking does not affect his current condition. Actually, he does not have to avoid either alcohol or cigarettes. In stage IV he should live his life as much as he is able to.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (12 minutes later)

Im
Hoping this new chemo works n he suitable for sirt . But some ppl live many many years right with even stage 4 cancers ?

Is chemoembolization better than sirt?

Answered by Dr. Grzegorz Stanko (1 minute later)

Brief Answer:
He may live many years.

Detailed Answer:
Chemoebolisation, thermoablation or SIRT are similar methods. Hard to say which is better.
Yeas even stage IV person can live years.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (4 minutes later)

Its hard to say hey , luck plays a part too. . Uk has a new pricedure called chemo saturation therapy and apparantly increases survival by 5 times but its a very intense procedure . We looking into that too

But thank u for all your help and advice u r a great dr.

Answered by Dr. Grzegorz Stanko (3 minutes later)

Brief Answer:
Hope he will react for chemo.

Detailed Answer:
Every cancer case is very different. So you never know how he will react to treatment. But its always worth to try as he has nothis to loose.
Hope he will react for chemo and have at least few more years to live.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar