Colorectal Cancer: A Grandfather's Journey and Treatment Options

Q: Colorectal Cancer: A Grandfather's Journey and Treatment Options

Hello： <br>1. <br>It should be either metastasis or recurrence; confirmation is necessary, and a biopsy may be required for verification. <br>However, most people accept the diagnosis and proceed with further treatment without confirmation. <br>The prognosis is quite serious, and

My grandfather has been diagnosed with colorectal cancer?

Hello, doctor.
My grandfather (80 years old this year) was diagnosed with colon cancer last year.
He underwent surgery in mainland China to remove a section of his intestine and received chemotherapy for 2-3 months.
However, he felt very uncomfortable and did not complete the treatment, opting instead for traditional Chinese medicine for recovery.
After returning to Taiwan, he was checked and found to have polyps in his intestine, which were benign and removed.
Recently, he went to the hospital for a CT scan and discovered a tumor outside the intestine, with a CEA level of over 15.
Initially, he consulted a colorectal surgeon, but the doctor referred us to an oncologist.
What is the reason for this? On the hospitalization consent form, the doctor noted that his condition is "stable." Does this indicate that there is no major issue?
Additionally, I have several questions for the doctor:
1.
Does the tumor moving from inside the intestine to outside indicate metastasis of cancer cells? How serious is this? What stage does it belong to?
2.
The doctor mentioned that chemotherapy is the only treatment needed and that surgery for removal is not necessary.
Why is that? I have read that the fundamental treatment for colon cancer is direct removal.
3.
A few years ago, during a lung examination, a scar caused by tuberculosis was found in my grandfather's lung.
Does this scar need further examination for potential changes?
4.
There is a mass on the right side of my grandfather's thyroid, but it has been confirmed to be benign.
Is there still a risk of metastasis?
5.
Is it necessary to complete the full 6-month treatment course? My grandfather has decided to undergo only 2 months of chemotherapy this time.
Will this result in ineffective treatment and unnecessary suffering?
6.
My grandfather is already 80 years old, and I am very concerned about his physical strength during chemotherapy.
Will his condition worsen with treatment? (He usually has good stamina; he can travel from Keelung to Hualien and make steamed buns by himself...
Recently, he has even gained weight.)
7.
How much longer can my grandfather expect to live? Thank you very much for taking the time to answer these questions.
Thank you!

Xiao Ban Tou, 20~29 year old female. Ask Date: 2006/05/22

Dr. Chen Sirong reply Oncology

Hello:
1.
It should be either metastasis or recurrence; confirmation is necessary, and a biopsy may be required for verification.
However, most people accept the diagnosis and proceed with further treatment without confirmation.
The prognosis is quite serious, and the current condition is stable, indicating recurrence or metastasis without staging.

2.
The physician has identified a possible tumor outside the intestine.
a.
A CT scan has shown that surgical resection is not feasible.
b.
If it is indeed metastatic, even if surgery is performed, it is likely to recur quickly, making surgery of limited utility.
c.
At over 80 years old, reoperating on the site of recurrence may not significantly extend lifespan, so the recommendation is to consult an oncologist for chemotherapy.
A stable condition means that although there is recurrence or metastasis, the patient's overall health is currently stable.

3.
An X-ray once a year is sufficient.

4.
No, it will not.

5.
Only two treatments have been administered, and both have had effects.
The patient's physical condition is the most important factor, and it cannot be forced.

6.
There are many types of chemotherapy drugs available, and it is advisable to discuss options with the physician.

7.
Not necessarily.

Respectfully, Dr.
Chen Si-Rong, Oncology.

Reply Date: 2006/05/22

More Info

Dear Patient,
Thank you for reaching out with your grandfather's medical history and concerns regarding his colorectal cancer journey. It’s understandable to have many questions during such a challenging time, and I will do my best to provide you with clear and informative answers.

1. Tumor Location and Staging: The fact that the tumor has progressed from within the intestine to the outside suggests a potential local advancement of the cancer. This could indicate that the cancer is invasive, and depending on the extent of the invasion, it may be classified as Stage II or III. The CEA (Carcinoembryonic Antigen) level of 15 is elevated, which can indicate the presence of cancer, but it’s important to interpret this in conjunction with imaging studies and clinical findings. A consultation with an oncologist will help clarify the staging and the implications for treatment.

2. Chemotherapy vs. Surgery: The decision to pursue chemotherapy without immediate surgical intervention can be based on several factors. If the cancer has spread beyond the original site, the oncologist may recommend chemotherapy to shrink the tumor or manage the disease before considering surgery. In some cases, surgery may not be feasible due to the patient's overall health or the extent of the disease. The goal of chemotherapy in this scenario is to control the cancer and potentially improve the patient's condition before any surgical options are explored.

3. Lung Scarring: The scar in the lung from previous tuberculosis (TB) is generally benign, but it’s wise to monitor it, especially given your grandfather’s cancer diagnosis. Regular follow-ups with imaging can help ensure that there are no changes indicative of malignancy. If there are any new symptoms or changes in the lung, further evaluation may be warranted.

4. Thyroid Nodule: Since the thyroid nodule has been confirmed as benign, the risk of it being cancerous is low. However, it is essential to continue monitoring it with regular check-ups, as benign nodules can sometimes change over time.

5. Chemotherapy Duration: While a typical chemotherapy regimen may last around six months, it is crucial to tailor treatment to the individual’s response and tolerance. If your grandfather feels unwell or is unable to complete the full course, it’s important to discuss this with his oncologist. Sometimes, a shorter course may still provide benefits, but this should be carefully evaluated based on his specific situation.

6. Age and Treatment Tolerance: At 80 years old, your grandfather’s ability to tolerate chemotherapy can vary significantly. While some elderly patients manage well with treatment, others may experience more severe side effects. It’s essential to monitor his health closely and adjust treatment as necessary. His current good physical condition is a positive sign, but ongoing assessments will be crucial.

7. Life Expectancy: Predicting life expectancy in cancer patients is complex and depends on various factors, including the cancer stage, response to treatment, overall health, and any comorbid conditions. It’s best to have an open discussion with his oncologist, who can provide a more personalized prognosis based on his specific circumstances.

In conclusion, your grandfather's case requires a multidisciplinary approach involving oncologists, surgeons, and possibly palliative care specialists to ensure he receives comprehensive care tailored to his needs. Open communication with his healthcare team will be vital in navigating his treatment options and addressing any concerns that arise.

Thank you for your thoughtful questions, and I wish you and your grandfather strength and support during this journey.

Best regards.

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