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What Does Elevated CEA Levels Post Chemo For Liver Metastasis Indicate?

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Posted on Sat, 8 Nov 2014
Question: If a met in the liver is killed by chemo can it still appear on a pet scan as a no fdg lesion ?
doctor
Answered by Dr. Grzegorz Stanko (9 minutes later)
Brief Answer:
Detailed below.

Detailed Answer:
Hello!

Thank you for the query.

If the liver metastatic tumor is not consisted of alive cancer cells, it should not show up as a metabolically active in PET scan. It may be visible in CT images (as it is a part of PET scan) as a calcification or a kind of scar tissue but should not uptake FDG.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (5 minutes later)
Well my father had recent pet scan as his cea was rising. He had surgery in march to remove a bowel tumor and was stage 3.

16 mm liver met and 1 aortocaval node ,
I'm confussed y they are doing chemo
First and not getting rid if this by surgery or ablation and then chemo ?

He was on xeloda but only had 4 cycles . Does this mean xeloda did not work ?

Yes 1 lesion has no fdg uptake but it's a new finding as was not present on previous scans . So could it be a met that has died from the chemo ? It's the same size as the liver met that was fdg active
doctor
Answered by Dr. Grzegorz Stanko (6 minutes later)
Brief Answer:
.

Detailed Answer:
Well, single or 2 single liver tumors (meths) should be removed with the surgery. No doubt in that. Generally there is a tendency to remove colon cancer meths from the liver and lungs as well. This is proven to give more chances for complete cure.
So I suggest you to consult a surgeon with this results and consider another surgery.
Chemo is good to destroy cancer cells in lymph nodes and to decrease the size of liver meths. But complete removal of the meths should be done by surgery.
If the silent lesion in the PET is in the same location that the meth was, most likely its a remaining of this meths. Lack of FDG activity allows to suspect that there is no cancer cells inside. But still you should consider removing it by a surgeon.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (13 minutes later)
So do u mean this other lesion which is same size but no fdg uptake is a killed met ?

Do u think
Chemo is not the correct approach initially then ? There is 1 met 16 mm (small ) and 1 node so that it's not that bad right ?

Is it cuz of the node they Re doing chemo
First ?
doctor
Answered by Dr. Grzegorz Stanko (4 minutes later)
Brief Answer:
.

Detailed Answer:
Yes, the other lesion can be the killed meth indeed.
Chemo is correct approach right after the surgery. But instead of another chemo (after the first one). surgical removal of the meths should be done.
1 node and one small meth sounds optimistic, but please note that some meths can appear even few years after the surgery.
Chemo is redone because of the meths in the lymph node.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (16 minutes later)
Ok. So u think xeloda did not work then after Surgery ? But only had 4 cycles .

Or could the xeloda have killed that other met ?

Could that other lesion b a cyst ?

So u think chemo correct approach at present or should the met n node be ablated then chemo ?
doctor
Answered by Dr. Grzegorz Stanko (6 minutes later)
Brief Answer:
.

Detailed Answer:
Xeloda could not work. Not every cancer reacts for the chemo. It is individual for every person. As the mets are still present, given chemo was not enough.
It is possible that Xeloda have worked only partially and eliminated one met.
It is hardly possible for this lesion to be a cyst. Cyst is clearly visible in the CT and can not be taken by any other lesion.
Another chemo is a good approach. Please note that your doctors has great advantage that they are able to see tests results and the patient. I am not. So you should relay on theirs opinion more than on mine.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (4 minutes later)
Which chemo they likely to give ?

They I said systemic chemo . Then will re scan In 4-8 weeks .

What is survival like with this kind situation ?
doctor
Answered by Dr. Grzegorz Stanko (4 minutes later)
Brief Answer:
.

Detailed Answer:
They choose chemo basing on patient general condition, cancer type and the stage. So it is hard to tell which exactly chemo he should get.
He is stage IV. His chances of 5-years survival are from 30-6%.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (12 minutes later)
Can liver met n lymph met disappear with chemo?
doctor
Answered by Dr. Grzegorz Stanko (2 minutes later)
Brief Answer:
.

Detailed Answer:
Yes. With complete response for the chemo such mets can disappear completely. Its possible and sometimes happens.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (7 minutes later)
Should we consider immunotherapy or properly try chemo
First and then see .
doctor
Answered by Dr. Grzegorz Stanko (2 minutes later)
Brief Answer:
.

Detailed Answer:
Immunotherapy is not tested well yet. It may be effective in case of some tumors. This should be the case of discussion with his oncologist. Such problem can not be solved here in this service. Please follow his oncologist advice.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (18 minutes later)
Thx . Can
This non fdg lesion still be a met ?
doctor
Answered by Dr. Grzegorz Stanko (16 hours later)
Brief Answer:
.

Detailed Answer:
Lack of FDG absorption rather rules the meth out. So this is something else.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (24 minutes later)
Can this b a killed meth ?
doctor
Answered by Dr. Grzegorz Stanko (48 minutes later)
Brief Answer:
.

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5798 Questions

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What Does Elevated CEA Levels Post Chemo For Liver Metastasis Indicate?

Brief Answer: Detailed below. Detailed Answer: Hello! Thank you for the query. If the liver metastatic tumor is not consisted of alive cancer cells, it should not show up as a metabolically active in PET scan. It may be visible in CT images (as it is a part of PET scan) as a calcification or a kind of scar tissue but should not uptake FDG. Hope this will help. Feel free to ask further questions. Regards.