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This question was answered on Fri 30, May 2008 12:53am by Dr Paul S, MD

Colon Cancer, Duke's Stage C, FOLFOX4 treatment - PET Scan shows clear


    
Asked by phill86518 (Female; 64; Colon cancer, Duke's Stage C, 4 out of 21 lymph nodes impacted ) on Thu 29, May 2008 03:08pm

My mother underwent colon resection that removed the tumor. 4 out of 21 lymph nodes were impacted and therefore the diagnosis was Duke's Stage C. My mother started the FOLFOX4 regimen and has just completed her 3rd cycle (out of 12). She had a PET scan just prior to 3rd chemo and it shows everything to be clear (no evidence of metastasis to another organ). Her liver is showing hemangiomas which are now larger than they were about 2 months ago as seen in the ultra-sound. However, her CEA levels have been Negative (prior to surgery), 1.3 (post surgery), 1.6 (prior to first chemo) and 1.9 (after second chemo treatment). They are all below 2.5 but the trend is concerning us. Can you advise what further study should be done on the liver hemangiomas to make sure that the chemotherapy is working and where we stand? Thanks for your advice.
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Answer by Dr Paul S, MD  on Fri 30, May 2008 12:53am:

Hi there. Presently, your mother is receiving chemotherapy as an "adjuvant" to the operation. This means that the chemotherapy is being given to clean up microscopic cancer cells called "micrometastasis" which is a common premise in cancer treatment. Adjuvant chemotherapy has been shown to increase survival and decrease the chance of the tumor recurring or spreading. The normal PET scan is reassuring, and this should have accurately differentiated hemangioma from a malignant tumor spread. Hemangiomas can be treated with embolization or surgery but I would be hesitant to recommend such at this point. Your mother's CEA is normal even before operation. This means that the tumor may be non-CEA secreting, and therefore the CEA test may not be a good indicator of disease recurrence whatever the value, and the results should not be taken at face value. I hope that your mother's remaining chemotherapy sessions will be as uneventful as possible. Regards and God bless.

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