GI Cancer Archive Questions

Below are Dr. Pandya’s answers to GI Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 8 of 8.

1

---

Q : 1 08/05/2009	My mother has been diagnosed with stage 3 colon cancer. She is receiving chemotherapy and seems to be reacting positively. However, her hemoglobin and white cells blood counts are low and she is experiencing major weakness in her arms and legs. The last time she went for chemotherapy, she was given a double dose, should that help? It is common to have low blood counts (white blood cells, red cells (hemoglobin), and platelets) when receiving chemotherapy. The levels should recover prior to the next treatment. Based on the information you provided, I am unable to comment on why her chemotherapy treatments were adjusted. However, they are usually at the discretion of the oncologist and dependent on the underlying cancer and response to chemotherapy treatments.
Q : 2 06/24/2009	I have a gastric adenocarcinoma with a possible small metastatic lesion in the liver. The biopsy of the lesion was ruled inconclusive. I am in the middle of the third cycle of ECF chemotherapy and am waiting to find out if a 4th cycle will be indicated. I would like to have a second opinion about the duration/number of rounds of chemotherapy that have been advised as well as a post surgical treatment plan. The MAGIC trial used 3 cycles of ECF chemotherapy after surgery for patients with non-metastatic gastric cancer. However, they also used 3 cycles of ECF pre-surgery. Other trials included 3 or 4 cycles of various chemotherapy regimens in the adjuvant setting. The most important aspect of your case is to determine if the liver lesion had any metastatic foci of cancer. If so, then, unfortunately, it would be considered metastatic gastric cancer, which requires indefinite chemotherapy treatments. I would be happy to provide additional, more specific, review of your case in consultation, if you choose. Please contact our referral office at 410.328.7904 to set up an appointment.
Q : 3 06/08/2009	How effective are Sorafenib pills for HCC? My husband has been diagnosed with HCC and has been taking the pills for a little over a month. No one seems to be able to tell me how he got this cancer since he has never been a drinker. I've been told by his doctors that by taking the pills he can live for maybe 12 months. Because of his underlying conditions, he is only taking half of the standard dose. Sorafenib is used for HCC patients and there has been an increased rate of survival shown in patients who received it as a treatment in recent studies. However, its main benefit is that it stabilizes the disease and keeps the cancer from progressing. Generally, HCC presents in patients who have had cirrhosis or hepatitis. Survival among these patients is dictated by how dysfunctional the liver is as a result of the damage caused by cirrhosis. Dose adjustments are commonly made for cancer treatments, due to either risk of toxicity or other comorbidities involved.
Q : 4 05/23/2009	In May 2008, my father was diagnosed with stage 4 stomach cancer and a tumor that measured 4cm in size. He eats well, walks, and does go out and socialize. He was given 2 cycles of Xeloda and Oxaliplatin last June. He started feeling really sick and due to those complications, he stopped chemotherapy. Since then, we have been giving him agaric mushrooms, but lately he has seemed more lethargic. What are your thoughts? Should we consider any other treatments? I can only recommend specifics regarding chemotherapy. Though alternative medicines and herbal treatments may help, there is no randomized study that helps us figure out if such treatments improve overall survival among metastatic gastric cancer (stage IV) patients. Regarding chemotherapy, re-challenging him to 5-flurouracil and Oxaliplatin may be an option, both in a dose reduced fashion and with the IV 5-FU formulation (Xeloda is the oral form of 5-FU). Other chemotherapy options can include Cisplatin, Irinotecan, or Docetaxel. Certain biologic drugs, such as Bevacizumab and Cetuximab, also have shown to be effective for this condition. It would be good to discuss with your father's medical oncologist which options are best based on his current condition and his ability to tolerate further chemotherapy treatments.
Q : 5 04/21/2009	My father is 68 years young. He just recently had CT scan due to kidney stones; he was found to have an area of concern on his pancreas. He is now have a test to see if the cancer is contained to the pancreas or is any where else. His mass is 5cm located in the center of the pancreas and is said to be the non-aggressive type. Can a tumor of the size and location be removed? If it has not spread to any other location, would any other type of treatment need to be done? What is the likelihood it would come back? Surgery for a pancreatic mass is simply not based on size. Location relative to other structures, such as blood vessels and nerves, does matter. But in general, if operable, your father should have surgery. However, a full multi-discliplinary evaluation would be best, as it involves surgeons, radiation oncologists, gastroenterologists, radiologists, and medical oncologists. He may need further tests done prior to surgery, such as blood work, endoscopy, and biopsy. Evaluation by a team of physicians specializing in GI cancer/masses would be best, as a proper diagnostic and treatment strategy can be developed from the beginning. There may be a role for other treatment prior to surgical resection, depending on how extensive the mass is and what the mass is. So, if feasible, I would recommend that you have your father's case evaluated by a multidisclipinary team. Good luck!
Q : 6 04/17/2009	I had the Whipple procedure done in April 2008 for ampullary cancer. My latest CT scan showed no recurrence. What are the chances that my cancer could return? My oncologist said if it comes back there will be no way to cure the cancer again. What are your thoughts? While it's great that you have made it out one year without a recurrence, statistics show that Whipple patients have about 25%-30% 5-year survival among lymph node negative patients and 10% among those whose lymph nodes were positive. Furthermore, it is generally true that once recurrence does occur, it usually is metastatic at that time, rendering it incurable. Chemotherapy is definitely an option and effective at the time of recurrence, however other options may be feasible depending on site of recurrence.
Q : 7 03/31/2009	My mother is 72 years old and has recently been diagnosed with stage IV, poorly-differentiated adenocarcinoma of the gallbladder with liver metastasis. She is currently receiving systemic chemotherapy treatment with Gemcitabine and Capecitabine (oral Xeloda), which she is tolerating very well. She is healthy otherwise. Although everyone speaks in terms of palliative care rather than curative, I am curious about the advisability of more aggressive liver-directed therapies, particularly radiofrequency ablation, TheraSpheres or SIR-Spheres, and percutaneous hepatic perfusion. Are these options? Depending on the burden her tumor has placed on the liver, she may be a candidate for such liver-directed therapies. We would be happy to evaluate her case within our GI multi-disciplinary conferences.
Q : 8 12/24/2008	Does your facility treat advanced bile duct cancer cases with vascular involvement/encroachment (portal vein and associated arteries)? Yes, we do treat these advanced bile duct cancers. I would be happy to review the particulars of your case. Please call our referral office at 410-328-7904.

1