Chemotherapy for Colorectal Cancer with Liver Metastasis - Oncology

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Chemotherapy for colorectal cancer with liver metastasis is a complex and multifaceted treatment approach that requires careful monitoring and adjustment based on individual patient responses. In your case, your husband has undergone surgery to remove the primary colorectal cancer, and he is currently receiving chemotherapy with a combination of 5-fluorouracil (5-FU), leucovorin (often referred to as "益立諾"), and oxaliplatin (known as "癌思停").

Understanding CEA Levels
Carcinoembryonic antigen (CEA) is a tumor marker often used to monitor treatment response in colorectal cancer. It is important to note that while CEA levels can provide valuable information, they are not definitive indicators of cancer progression or response to treatment. In your husband's case, the CEA level increased significantly from 300 to over 900 after the first round of chemotherapy. This rise can be concerning, but it is essential to consider several factors:
1. Timing of Blood Tests: CEA levels can fluctuate after chemotherapy. It is not uncommon for levels to rise temporarily after treatment begins due to the release of tumor antigens into the bloodstream as cancer cells are destroyed. This phenomenon is sometimes referred to as a "tumor flare."
2. Imaging Studies: Your doctor is correct that imaging studies, such as CT scans, provide a more accurate assessment of the tumor's response to treatment. These scans can help visualize changes in tumor size and the presence of new lesions, which are critical for determining the effectiveness of the chemotherapy regimen.

3. Monitoring Response: It typically takes several cycles of chemotherapy (usually 2-4) before a clear trend in CEA levels can be established. Therefore, it is essential to continue monitoring CEA levels alongside imaging studies to get a comprehensive view of your husband's treatment response.


Treatment Options for Liver Metastasis
Regarding the liver metastases, you mentioned that there are lesions measuring 1.98 cm and 2.2 cm, along with smaller lesions resembling "acne." The use of targeted therapy, such as the one you are currently using (癌思停), can be beneficial in shrinking tumors and potentially making them operable. Here are some points to consider:
1. Targeted Therapy: Targeted therapies can help to inhibit the growth of cancer cells by interfering with specific molecules involved in tumor growth and progression. If the smaller lesions respond well to the targeted therapy, there is a possibility that they could shrink enough to consider surgical options like resection or ablation.

2. Surgical Options: If the tumors shrink significantly, surgical interventions such as liver resection (removing part of the liver) or ablation (destroying tumor cells with heat or cold) may become viable options. The decision for surgery will depend on the overall health of your husband, the extent of the disease, and the response to chemotherapy.

3. Follow-Up and Adjustments: Continuous follow-up with your oncologist is crucial. They may adjust the chemotherapy regimen based on how well your husband is responding, the side effects he experiences, and the results of his imaging studies.


Conclusion
In summary, while the rise in CEA levels can be concerning, it is essential to interpret these results in the context of imaging studies and overall clinical assessment. The treatment for colorectal cancer with liver metastasis is a dynamic process that requires ongoing evaluation and potential adjustments. It is vital to maintain open communication with your healthcare team, who can provide personalized guidance based on your husband's specific situation. Regular follow-ups and imaging will help determine the best course of action moving forward.