Colon Cancer

Question

Respected Sir,
                     My younger brother having a mass in Ascending colon and colonoscopy done.on biopsy poorly differentiated adenocarcinoma of colon.then Rt extended Hemicolectomy done. Chemo therapy starts with Injection Avestin Inj CPT and Inj 5FU.9 cycles done in september 2018.through out chemo courses CEA leavel was with in range .now in April he felt pain in Abdomen and CT scan done .report of CT scan showing left Para aortic Lymphadenopathy. after that we did PET can from Inmol.
Pet scan conclusion is.  Metabolically Active Nodal disease in Abdomen consistent with viable metastatic disease .FDG AVID Multiple sites in transverse colona and splenic flexure, Neoplastic ?
now BINO (Atomic energy hospital Bahawalpur Started Chemo again with ERBITUX 640 stat and 400 mg weekly
Inj irinitcan 280 mg
and inj 5FU
please guide me what should i do continue this or should go towards surgery..
Regards

Dr. Muhammad Arif · Answer

Please send me pathology report including mutation analysis ,kras ,egfr etc. Thanks

Dr. Abdul Qayyum · Answer

Why FOLFOX ( Oxaliplatin + 5Fu ) was not given initially. Was it metastatic disease at the time of diagnosis. Another question is that why Avastin was used initially.  Recent PET Scan revealed metastatic disease. Is this the 1st PET or it was also done before, and if done before, what was the findings at that time. Regarding re-surgery, it will not be helpful at this stage.

Dr. Rana Atique Anwar Khan · Answer

surgery is not possible at this stage due to extensive disease. did BINO doctor check KRAS mutation before prescribing ERBITUX?? if not then it should be done if mutation is wild type then ERBITUX is not indicated. I think XELIRI chemo is better option
you initial treatment is not started as per protocol

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Dr. Muhammad Arif - Cancer Specialist / Oncologist

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