Brief Answer:
Cannot see the attached file sir, pls reattach or email

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us sir.

I have gone through your query with diligence and would like you to know that I am here to help. I understand your anxiety and would be more than happy to be of assistance, but unfortunately I do not see the attached CT scan of your liver to be able to answer your question sir.

Please try to re-attach it to our discussion or email it to

YYYY@YYYY

with "ATTN: Dr. Shoaib Khan" mentioned in the address line. I shall provide my input as soon as I examine the CT scan sir.

Best wishes.

---

Brief Answer:
Sadly all the lesions do not match the description of simple liver cysts :(

Detailed Answer:
Hello once again sir.

The new and multiple liver lesions seen are unfortunately not liver cysts sir as they:

+Have enhanced after the CT scan (but with liver cysts enhancement does not take place)
+The borders of a simple liver cyst are clear and are denoted by a black line around the cyst (no clear borders, and no black line around the lesions)
+The cysts appear to be round or oval with clear margins (wheres in the CT scan, none of the lesions are clearly round or oval)

Sadly sir, the lesions are more in accordance with metastasis. I am really very sorry to inform you about the same. Please feel free to write back to me for any further clarifications, I am always here to help sir.

Best wishes.

---

Brief Answer:
I see the confusion sir, but the cysts should have resolved, now only mets

Detailed Answer:
Hi sir.

Thank you so much for the information provided, and the reports attached.

Yes, I do see why there is a confusion. But the first time around when you attached two images, I did not go through the report and just saw the CT image attached, and from my experience the lesions looked like mets (metastasis), which is what I reported to in my response.

Going through the attached reports provided on different occasions, does raise confusion for the patient especially, but in my opinion from the image of the liver CT attached, the lesions do resemble mets sir.

Simple liver cysts are self-limiting (resolve without treatment most times), and it is quite possible that they must have self-resolved, now leaving only the mets to be viewed through the scans. So in response to your last question, yes sir, the cysts could have possibly gone or resolved.

Best wishes sir.

---

Brief Answer:
Possibly he just wanted to report those nodes that have increased in size

Detailed Answer:
Hi sir.

May be Dr. Tyagi XXXXXXX was paying special emphasis to the lesions which he found were enlarged on comparison with the last scan, as quoted 'there is increase in the previously noted aortocaval as well as in the subcapsular hypodense liver lesions'.

Although he has not reported anything on the other seen liver lesions, possibly he was just speaking about those nodes which have increased in size. But this is indeed an incomplete report, I believe.

What do you think sir? Please share your thoughts with me, so I can comment on whether you could be right or not.

Best wishes.

---

Brief Answer:
i understand

Detailed Answer:
Hi sir.

With the advancement in medicine, we cannot quote 'chemo failed and ineffective' without trying out all the regimens and drugs available to treat a particular type of cancer. So I concur with the doctor who provided the second opinion in saying that may be you were not given the right combination, single drug or a different regimen altogether.

If chemo works, and ablation can be performed, then chances of survival rise significantly, yes, most certainly.

If different types of drugs have been tried and failed, only then can we assume the individual to be chemo-resistant sir.

Best wishes. :)

---

Brief Answer:
Slow, but promising rise in survival rate

Detailed Answer:
Hello sir.

The blood reports do not raise any significant cause for concern, yes a few fluctuations but nothing really that serious and is more than fine for an individual who has gone through so much.

As for survival rate, it all depends on when we find lesions, mets, response to chemo, etc. But there are numerous drugs in the pipeline, all proving to be better than the previous one, although the truth is that they will all take several years till they can actually be released into the market. But yes, there has shown to be great promise than there was a decade ago.

I wish you lots of luck sir. I understand my responses were quite basic, and I am sorry I could not help you get rid of your condition, and only contributed to clearing a few minor doubts. I wish I could have done more, and I really hope and pray I hear from you a few years down the line telling me how great you feel.

Best wishes and God bless sir.

---

Brief Answer:
There is a variation of course, but liver failure not an issue right now

Detailed Answer:
Hello.

As mentioned sir, there is of course variation, but liver failure should not be an issue anytime in the near future. Plus, with your new doctor initiation new chemo, the liver enzyme levels should change for the better soon.

As for the other parameters, there may be quite a bit of fluctuation once the chemo is initiated, but it will only be temporary (i.e. as long as the chemo lasts).

Best wishes.

---

Brief Answer:
It was my pleasure entirely

Detailed Answer:
:)

Best wishes sir.

---