Prognosis - please help!

	Asked by tanzytanzy (Male; 47; My hubbie is 47 years old and was eventually diagnosed with Bowel Cancer in October 2006 after two yrs of abdominal pain. This is his story so far in as brief a detail as possible. [*]He had a laproscopic right hemi-colectomy in November 2006 followed by six months adjuvant chemotherapy (Capecetabine+Oxaliplatin). [*]November 2007 the cancer had returned by way of four small tumours, spread to the peritoneal cavity. [*]He had six months further chemotherapy (FOLFIRI+Avastin) follwed by an operation in July to remove the peritoneal mets by removing his omentum and gall bladder [*]Then put on more chemotherapy (Tegafur+Avastin) from August [*] He was then re-diagnosed December 2008 with further tumours - 5cm in porta hepatis, gastro-epicloic region, splenic hilum [*] Told he was inoperable but wasn't prepared to accept that lying down! He was tested to see if he could have Erbitux but the result showed that this drug would not be effective. [*] He had Cyberknife treatment Feb 09 which worked on the 5cm tumour in the porta hepatis only [*] Then had surgery May 2009 to have his spleen removed, the tail of pancreas removed and section 3 of the liver resected also. Unfortunately the couple of mets that were found in the liver hadn't shown on any scan. [*] Ended up with pancreatitis and he was extremely unwell and ended up spending about 6 weeks in hospital having several drains inserted and his lungs collapsed; [*] After getting over the operation, in July 2009 tumour markers (CEA level) went down from 22 to their lowest ever level of 1.5 [*] In Jan 2010, tumour markers reached 300 for CEA and 8250 for CA-199 [*] The March scan showed that an area thought to be a haematoma was a cm larger than the previous scan, which was strange as post-operative fluid should diminish NOT increase. A biopsy was done which showed the area to be a solid mass of tumour nearly 8cm in size plus there are other suspicious areas in the abdomen. [*] Then had FOLFIRI + Avastin regime again for 3 months which was awful [*] He was then told in June 2010 that he is now definitely inoperable next scan in September; Relevant drugs:lisinopril, bisoprolol, lantus, novorapide, metformin, penicillin v, omprezole ) on Tue 20, Jul 2010 01:53am :
	NO-ONE has given us ANY idea of prognosis. Now he is inoperable we need to have some idea how long he's got. For the record, everyone says how well he looks - although I tend to think that's standard speak! Are the 5 year stats applicable in my husband's case as he has had cancer for nearly 4 years now and been stage 4 since Nov 2007? Up until now he has undergone op after op and chemo after chemo which has obviously extended his life. But now he is inoperable surely it is fairly evident to someone with a fair amount of experience in this field so say what sort of life expectancy he has - even if a range of best case, worse case is provided which would be sufficient? He has also decided that he doesn't want any more chemotherapy because he would rather have quality of life and, let's face it, he's had enoughof it. I saw that someone who was diagnosed with stage 4 + inoperable was told about 30 months but surely someone like my hubby who has already gone through so much would have less than that? We would really, really appreciate some "educated" views taking into account his personal situation because it will enable us to plan certain things, for me to decide whether to continue working or not (as if it is 6 months to a year I would rather not continue but if it's 3 or 4 years I'll carry on for the time being as it's paying bills!) - Incidentally, we can "take" whatever the bottom line is and do not intend to "hold" anyone to anything!!!! Thank you so much for spending the time to read this and for your response. Incidentally, he has moderately differentiated mucinous adenocarcinoma
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	Answer by bobby s, md (oncologist) on Tue 20, Jul 2010 01:02pm: Hello, I am sorry to hear of your husbands problems over the last few years. The prognosis/survival figures that you have mentioned are fair estimates. I am afraid that I cannot give you a more accurate number, without the benefit of examining him nor reviewing his reports. You may like to meet the treating doctors to specifically discuss this issue. Some patients with a good performance status have prolonged survival. Cyberknife for symptomatic mets may still be an option for your husband. Be positive, and continue to explore all reasonable options. All the best, and God Bless! . Response to your follow-up comment: I am sorry that you are not satisfied with my answer. I have never examined your husband, nor seen his reports. In fact, even if I had, it would be impossible for me to predict his survival accurately. It is very well to say that with experience etc, one does know the "expected" survival in a particular disease. Unfortunately, such population-based statistics can rarely be applied to individual patients. I would hesitate to pronounce any such judgment, especially because I have never seen the patient. All the best, and God Bless! . Response to your next clarification: We have decided to reimburse your money since you do not seem satisfied. Please allow 3 weeks for completion of transfer. We apologize that we are unable to answer your question to your satisfaction because of the reasons mentioned above. All the best, and God Bless! Please rate my answer (select the stars below, no need to log in.)
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	Follow up: Clarification / Comment by tanzytanzy on Tue 20, Jul 2010 01:24pm: You didn't answer my question at all. I am really unhappy with your response. Clarification / Comment by tanzytanzy on Tue 20, Jul 2010 01:31pm: Also, Cyberknife is not an option as his tumour is 8cm which is too large for this treatment.
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