Managing Advanced Colon Cancer with Liver Metastasis in Elderly Patients

Q: Managing Advanced Colon Cancer with Liver Metastasis in Elderly Patients

Hello： 1. Oral chemotherapy agents. 2. Experimental oral chemotherapy medication! 3. None. 4. Urinary issues suspected to be related to prostate problems; bilateral leg edema due to poor liver function resulting in fluid retention. Sincerely, Dr. C

Malignant colorectal tumor with liver metastasis?

Hello Dr.
Chen, my father is 83 years old and underwent surgery at the end of July for a malignant colon tumor with multiple liver metastases, during which the right side of the colon was resected.
Postoperatively, everything was normal, and he has resumed a normal diet and bowel movements; however, his weight has not returned to normal.
His preoperative CEA level was 192, and the liver tumors were distributed in a radial pattern, occupying about 1/4 to 1/3 of the liver.
As of last week's follow-up appointment, his CEA level has risen to over 270.
The attending surgeon has recommended that we consult with a hematology-oncology specialist next time.

I would like to ask the following:
1.
Given my father's advanced age, what more palliative treatment options can you suggest that would allow him to live comfortably for the remainder of his life?
2.
Is it advisable to consider forgoing treatment? What does it mean to forgo treatment?
3.
Are there any other recommendations? Additionally, my father has recently reported difficulty and pain when urinating in the early morning, and he has noticeable swelling in both legs.
Thank you!

fangjojo, 30~39 year old female. Ask Date: 2004/09/05

Dr. Chen Sirong reply Oncology

Hello: 1.
Oral chemotherapy agents.
2.
Experimental oral chemotherapy medication! 3.
None.
4.
Urinary issues suspected to be related to prostate problems; bilateral leg edema due to poor liver function resulting in fluid retention.
Sincerely, Dr.
Chen Sih-Rong, Oncology.

Reply Date: 2004/09/05

More Info

Managing advanced colon cancer with liver metastasis in elderly patients, particularly those like your father who is 83 years old, requires a careful and compassionate approach. Given his recent surgery and the complexity of his condition, it’s essential to consider both the medical and emotional aspects of his care.

1. Treatment Options for Elderly Patients
For elderly patients with advanced colon cancer and liver metastasis, treatment options should prioritize quality of life. Here are some potential approaches:
- Oral Chemotherapy: Medications such as capecitabine (Xeloda) can be administered orally and may be better tolerated than intravenous chemotherapy. This can help manage the cancer while allowing your father to remain at home.

- Targeted Therapy: Depending on the specific characteristics of the tumor, targeted therapies such as bevacizumab (Avastin) or cetuximab (Erbitux) may be options. These treatments can be less harsh than traditional chemotherapy and may improve outcomes.

- Palliative Care: Engaging a palliative care team can help manage symptoms and improve quality of life. This approach focuses on relieving symptoms such as pain, nausea, and fatigue, and can be integrated with curative treatments.

- Clinical Trials: Depending on your father's overall health and the specifics of his cancer, participating in clinical trials may provide access to new therapies that are not yet widely available.

2. Considering the Option to "Give Up" Treatment
The term "giving up" treatment can be misleading. It often refers to transitioning from aggressive curative treatment to a focus on comfort and quality of life. This does not mean abandoning care; rather, it involves prioritizing symptom management and emotional support.
- Informed Decision-Making: It’s crucial to have open discussions with your father's healthcare team about his prognosis, treatment goals, and preferences. Understanding the potential benefits and burdens of continued treatment can help guide these decisions.

- Advance Care Planning: Discussing your father's wishes regarding end-of-life care can be beneficial. This includes preferences for resuscitation, hospitalization, and other critical decisions.

3. Addressing Other Symptoms
Your father's recent symptoms, such as difficulty urinating and leg swelling, warrant further evaluation:
- Urinary Issues: Difficulty urinating and pain may indicate prostate issues or urinary tract infections, especially in older men. A urologist should evaluate these symptoms to determine the underlying cause and appropriate treatment.

- Leg Swelling: Swelling in the legs can be a sign of fluid retention, which may be related to liver function or heart issues. It’s essential to assess liver function through blood tests and possibly imaging studies to understand the cause of the edema.

Conclusion
In summary, managing advanced colon cancer with liver metastasis in elderly patients involves a multifaceted approach that prioritizes comfort and quality of life. Treatment options such as oral chemotherapy and targeted therapies can be considered, while palliative care can significantly enhance your father's quality of life. Open communication with healthcare providers about treatment goals and preferences is essential, especially when considering the transition to comfort-focused care. Additionally, addressing any new symptoms promptly will help ensure your father receives comprehensive care. Always consult with his healthcare team to tailor the approach to his specific needs and circumstances.

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