f******I
发帖数: 769 | 1
鼻咽癌（晚期），end stage ENT cancer
肝转移 liver metastasis
腹水 ascites(malignant) |
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l*******n
发帖数: 68 | 2 It looks like that your friend's mother has metastatic renal carcinoma with
liver metastasis and biliary tract obstruction (primary kidney cancer and
spreaded to liver causing biliary tract obstruction). Unfortunately, the
prognosis in this situation is terminal. There is no cure. She is not a
candidate for surgery given metastatic situation. she is too ill to receive
chemotherapy. In addition, kidney cancer does not respond to chemotherapy
well. What the doctors in China have been doing are all |
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m****a
发帖数: 98 | 3 cea is a marker for colon cancer recurrence after operation. not absolute
accurate, but it is a good marker. now your mother should have a though exam
to see any metastasis. generally speaking, colon cancer has good prognosis
as compared to other GI cancers. |
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g*****j
发帖数: 1211 | 4 You will need to know what type of cancer it is and the status of metastasis
, which usually involves biopsy & PET scan.
Staging the cancer is critical for deciding the treatment plan. Don't give
up yet without knowing the beast you are dealing with. |
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g***r
发帖数: 285 | 5
metastasis
give
not very good at interpreting the chinese terms, but i assume 纵隔 is
mediatinum,
you are right in a way, that it would be important to know if this is truly
cancer(though highly likely but without tissue diagnosis it's a still a
question mark), and to know what type,
however, by the scan result, there are mediastinal involvement and thoracs
spine had shown lytic lesions, then it is at least T4, so for non-small cell
it's already stage IIIB, for small cell he could still be limite |
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m***5
发帖数: 2 | 6 Thanks a lot, gordonj. I will ask them for more info. At the same time, some
people recommend 氩氦刀治疗. Is this a more effective treatment for lung
cancer? Thanks a lot.
metastasis
give |
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g*****j
发帖数: 1211 | 7 You are right in most of the cases.
Cancer is a very complex topic, and it varies from type to type. Certain
types of cancer is still treatable after metastasis, such as testicular
cancer, hematological cancer ... |
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t*******n
发帖数: 4445 | 8 A successful surgery means the doctors had removed all the cancer tissues
they could identify. It does not guarantee against metastasis, since a
single cancer cell is enough to establish a new site.
For older people esp. those already diagnosed with cancer, it would be very
hard to find affordable insurance here. :-(
Before deciding on the next step, I'd suggest you gather as much information
as possible, about your mom's condition (i.e. more exam & testing), the
disease in general and possible |
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c********e
发帖数: 496 | 9 overall,
benign tumor: surgery only
malignancy: surgery plus radio
malignancy plus metastasis: surgery, radio, chemo.
follow up internal depends on the pathology report. |
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g*****j
发帖数: 1211 | 10 Metastasis should be suspected with positive lymph node growth after
mastectomy. It even happens after 7 years, let alone one year. I am
surprised that the doctor can draw the conclusion without biopsy.
The recommendation of thymosin peptide is suspicious to me as well.
I think you should seek a second opinion at a large trustworthy hospital. |
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l*****O
发帖数: 402 | 11 i am moved by your love for your mom. however, all her symptoms point to
bone metastais and brain metastasis. i am not against your choosing
alternative therapy for your mom, but to monitor her progress, you still
need western medecine's disgnostic techniques. go get her brain cat scan,
bone scan + abdominal ultrasound. |
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l*****O
发帖数: 402 | 12 Sorry, i am not saying she definitely has metastasis. I assume 胃癌晚期 is
terminal stage IV. I guess I am wrong. Maybe according to the definition in
China, she's at stage III which is not metastatic yet. Obviously she
responded really well to chemo therapy but poorly did she tolerate it. Maybe
she should carry on the chemo but at the same time use chinese medicine to
control the side effects and decrease her discomfort from chemo. Just my 2
cents. The ultimate outcome of giving up conventional ca |
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g*****j
发帖数: 1211 | 13 I am afraid there is no such magic drug. Appropriate treatment for primary
cancer is the best way to minimize risk of metastasis. |
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c**i
发帖数: 6973 | 14 What kind of medicine is that? In China! Whether there is metastasis to bone
is clear immediately.
Ultrasound? 骨质疏松 (osteoporosis)? Ridiculous. |
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l*****O
发帖数: 402 | 15 HER2 ++++ 应该有转移高风险。你可以试Herceptin if bone metastasis is
confirmed. |
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m********h
发帖数: 86 | 16 18F-FDG PET is the best way to tell the bone metastasis. It is highly
sensitive, less false positive. It does affected by inflammary tissue, but
it will give a global view of the disease for whole-body. It is a standard
follow up for monitoring breast cancer recurrence. Strongly recommended. |
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s*****g
发帖数: 180 | 17 ECT is sort of bone scan.Usually 99mTc-MDP would be used as a radio-tracer.
It is actually sensitive to bone metastasis. Sometime a PET scan using 18F-
sodium fluoride could also be helpful.
Clear about the diagnosis (the staging of the cancer) is the first step!
Herceptin is an anti-HER2 monoclonal antibody. SERM will be applied to deal
with ER + tumors. |
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I****a
发帖数: 407 | 18 If she really is proved having bone metastasis, she should continue be
treated with hormonal therapy although through different drugs with
different mechanism. Just to list a few: she can try steroidal aramatase inactivator Exemestane or estrogen antagonist Fulvestrant or even Megestral acetate. If disease strikes through above treatment and I think sooner or later it is going to, then Her2 targeted therapy coupled with chemotherapy.
Above information is based on if your mom's menstruation had s... 阅读全帖 |
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s*****g
发帖数: 180 | 19 ECT uses single photon emitter such as 99mTc; PET uses positron emitter such
as 18F. The mechanism is different. PET/CT is the fusion of PET and CT.
Usually PET is more sensitive but it is more expensive. As I mentioned, for
bone metastasis, 99mTc-MDP scan (one sort of ECT) is good enough, 18F-FDG/
NaF scan may or may not add value to it. |
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c******1
发帖数: 191 | 20 四五天前，靠近鼻子和嘴巴区间，鼓起了一个黄豆大小的小包，不是豆豆，表面看不到
，用手摸可以摸到，不痒不疼～ 【附件一：箭头蓝色圈圈那个位置】
我查了下脸部淋巴系统分布图【附件二】，好像那个位置有一个淋巴结：怀疑是淋巴结
肿起，服了两天抗生素不见消退。
本来想等等再看几天，可是昨天和朋友聊起cancer，查了下：wiki的“cancer”词条，
发现症状的三条其中两条都和某部位肿起有关：
“Roughly, cancer symptoms can be divided into three groups:
1. Local symptoms: unusual lumps or swelling (tumor)
2. Symptoms of metastasis (spreading): enlarged lymph nodes..."
我顿时有些紧张，查了下Merk 默克诊疗手册，有关于cancer的症状，我都排除了：比
如疲劳、疼痛、咳嗽等，就剩最后一个淋巴肿大。【见附件三】
到NIH网站去查了下facial swelling，好像和cancer没有太大关系：
http://www.n... 阅读全帖 |
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j****d
发帖数: 123 | 21 请给建议
12-29-2010 male 55, surgery to remove gallbladder and right-side liver with
5x6 primary tumor (location section VII). Adenocarcinoma, moderately
differentiated. Pathology confirms cholangiocarcinoma, intrahepatic origin.
No post-op chemotherapy
12-02-2011 multiple density-contrasted foci in liver, enlarged lymph node at
liver portal and veins, enlarged spleen. Multiple small cysts in liver,
with calcification. Small cysts on both kidneys. Small nodules in upper left
lung lobe. Expansion of ... 阅读全帖 |
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I****a
发帖数: 407 | 23 I would suggest to continue Tarceva and Zometa and if your father has only
localized bone metastasis. If the new scan shows more progressive findings,
I would suggest to add Alimta in addition. Alimta is a fairly benign
chemotherapy and the side effects are minimal. If that fails I would then
consider Avastin combination. At any time, he could try Afatinib (an
more potent form of Tarceva) if it is available. This drug likely will be
approved in US by the end of this year.
I am against what so ca... 阅读全帖 |
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l*h
发帖数: 4124 | 24 apparently your dad has metastasis to multiple organs/sites. there are two
options:
1. go aggressive with conventional chemo regimens
2. change to mainly palliative care
to be honest, waiting for a "new" drug is not a viable option. inclusion of
such patients usually occurs quite some time after the drug is approved in
the specific jurisdiction. the abuse of "new" drugs in China is just
astounding.
and |
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l*h
发帖数: 4124 | 25 to be more specific, at this time, if you don't want to go the palliative
path, you should urge your dad's oncologist to consider the following
regimens:
1. a microtubule inhibitor + a platinum derivative or
2. a microtubule inhibitor + a platinum derivative + a conventional
alkylating agent
folate antimetabolites can also be considered but I would not place them
ahead of the above two options.
you should be very cautious to consider bevacizumab. remember, your dad is ~
65 yo. bevacizumab just c... 阅读全帖 |
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i*****y
发帖数: 19 | 26 Hello icetea, lmh, & others who emailed me with useful information,
Thanks to you all for spending your time to offer valuable inputs. I will
take those into considerations and talk to my father's oncologist.
Another question: if there are appropriate medications that are available in
U.S. but not in China, is there any way for my father to purchase them from
U.S.? Meanwhile, If his new scan ( in a month) shows further metastasis (
hope not!), we will also consider the chemo option(s).
Thanks, |
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l*h
发帖数: 4124 | 27 请问你说的tki中文是什么？
TKIs are tyrosine kinase inhibitors. Imatinib is one of them.
药是格格列位吗？
yes.
请问如果复发还可以再切除吗？
these patients have close followup after the initial surgery. recurrence
would be caught when it's still small and amenable to removal.
癌变和转移的机率大吗？
GISTs are 癌 by behavior. metastasis is mainly short range ones.
谢谢 |
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l*h
发帖数: 4124 | 28 because of the location, it is unlikely a metastasis. however, to be safe,
some exams can be done if they don't delay the treatment.
i don't think the description of 脑干 is accurate, but rather in front of or
behind it, ie, pituitary/supersellar or pineal region.
there are numerous types of non-germinoma germ cell tumors. choriocarcinoma
is so special that it responds to methotrexate extremely well, with >90%
cure rate if treatment is done early.
primary intracranial germinoma has a long-term rem... 阅读全帖 |
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l*h
发帖数: 4124 | 29 如果没有扩散，手术是否是最好的方法。
it is correct. if there is no sign of metastasis from preoperative tests,
consider resection first.
还有其它方法吗？
there are other options if the patient cannot tolerate surgery or the tumor
is at some special locations.
家人说只有动了手术才能知道有无扩散。正确吗？
it is correct. only after surgery you can inspect lymph nodes in detail.
问： |
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l*h
发帖数: 4124 | 30 如果没有扩散，手术是否是最好的方法。
it is correct. if there is no sign of metastasis from preoperative tests,
consider resection first.
还有其它方法吗？
there are other options if the patient cannot tolerate surgery or the tumor
is at some special locations.
家人说只有动了手术才能知道有无扩散。正确吗？
it is correct. only after surgery you can inspect lymph nodes in detail.
问： |
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a**********2
发帖数: 3726 | 31 Sad but have to be realistic, even in the US, there is nothing much
oncologists can do for him (considering the metastasis). Poor prognosis,
surppotive treatment and pain management. No need to come to the US. |
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a**********2
发帖数: 3726 | 32 Hard to say. The diagnosis of bone tumor is sometimes very tough to make. X
ray, bone scan, only provides possibility, even pathology (biopsy) sometimes
can not confirm the diagnosis.
Lets say if it is, with current 2 year of survival without obvious
metastasis or local invasion, it sounds benign or low grade malignancy.
As for the anti inflammatory meds (NSAIDS), it helps for some patients
Or early stage of pain management, but you can't judge that it is not bone
tumor because the pain can be c... 阅读全帖 |
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a**********2
发帖数: 3726 | 33 Tamsulosin is used to treat BPH, it should relieve the symptoms, but not
stop the progression of BPH. It doesn't help prostate cancer caused urinary
retention.
As for annual screening, there is no consensus about that. It's fine to do
yearly PSA. Ultrasound or CT? I don't think it's necessary.
I should not say 10 is low according to current cutoff which is 4. But this
mild elevation can be caused by many things (a marker far from specific),
BPH is one of them. Especially both last year and this ... 阅读全帖 |
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a**********2
发帖数: 3726 | 34 For your grandfather, definitely the surgery was not necessary for his age.
Many doctors may still recommend surgery, I don't. I am very conservative
when I give medical advice to my family members since I definitely will
weigh the risks and benefits. But to patients, I will not discourage them in
order to avoid unnecessary troubles.
Prostate cancer surgery has too many complications, plus adjuvant therapy
simply lower the quality of life for a 80s or 90s. If that happened to my
family member wh... 阅读全帖 |
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R****y
发帖数: 411 | 35 看中文ct 报告费劲， pet looks negative for distant metastasis. |
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l*h
发帖数: 4124 | 36 "未找到原发灶"
was there any reason they were thought as metastatic? why cannot the "
pathologist" do a morphology description? multiple location itself does NOT
equal to metastasis. |
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l*h
发帖数: 4124 | 37 choosing a treatment for SCLC requires relatively complete staging
information. i suggest you to ask an oncologist subspecializing in SCLC
whether the treatment response is good, whether radiation therapy should be
considered etc.
for SCLC, dealing with metastasis early is key to a longer survival. |
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l*h
发帖数: 4124 | 38 I don't question the diagnosis of HCC, but the pathology report is of very
low quality, and I don't understand the treatment strategy either.
1. there is no description of microscopic findings, there is no way to tell
if the histological grading is correct or wrong. it seems almost all
pathologists in China have the magic power to give an unequivocal diagnosis
on everything.
2. stomach stromal tumor is rare, spleen stromal tumor is extremely rare. i
simply cannot believe all three tumors occur a... 阅读全帖 |
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j****d
发帖数: 123 | 39 so, mind me asking: Dr LMH, what DO you prescribe for your HCC patients with
distant metastasis? |
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l*h
发帖数: 4124 | 40 this begs the question why he was operated on. there is no indication for
surgery if sclc is metastasized to the pleura. pleural metastasis is not
hard to see on CT.
the traditional view was surgery had no roles in the management of sclc.
with the improvement in early diagnosis and of surgical techniques, some
sclc can be operated on, which results in some improvement in outcomes. in
the US, fewer than 5% sclc patients are eligible for surgery.
i heard many late stage sclc patients are operated ... 阅读全帖 |
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l*h
发帖数: 4124 | 41 since it's adenocarcinoma, it appears there was a justification to have
surgery, if it was to reduce tumor burden without much adverse effects on
lung functions.
the pleural invasion itself is sufficient to put it into stage IV, M1a. in
the US, about 40% non-small cell patients are at stage IV at the time of
diagnosis. the 5-yr survival is around 2%.
future treatment depends on various factors. generally speaking, it should
center on improving the quality of life unless the patient him/herself
s... 阅读全帖 |
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f****o
发帖数: 2770 | 42 the information you provided is useless
pathology report?
what kind of lung cancer?
metastasis?
smoking history?
symptoms?
what treatment plan doctor give? |
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W********r
发帖数: 158 | 43 It depends on the stage. Overall, the cure rate for Wilm's tumor is 90%. You
need to find a good surgeon do a complete gross total resection,
immediately followed by radiation, then a few months chemotherapy. Most kids
will be cured with almost no long term side effect. If there is pulmonary
metastasis, will need whole lung radiation and the outcome is still
excellent. The tough ones are the ones with bilateral wilm's tumor. |
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W********r
发帖数: 158 | 44 50% neuroblastoma is stage 4 (with distant metastasis including bone marrow)
at diagnosis. For stage 4 disease, 5 year overall survival is 50% in US.
Survival is probably much worse in China because it requires very intensive
chemotherapy, aggressive surgery, immune therapy, autologous stem cell
transplant. If the patient wants to be treated at US, I recommend you to go
to Memorial Sloan-Kettering Cancer Center. All the chemotherapy used to
treat neuroblastoma was developed from there. The surge... 阅读全帖 |
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l*h
发帖数: 4124 | 45 metastasis qualifies for stage IV.
positive |
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l*h
发帖数: 4124 | 46 T0 means it is considered a metastasis, but primary site cannot be found. |
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f****o
发帖数: 2770 | 47 what stage is her melanoma now?
any metastasis? |
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q****d
发帖数: 535 | 48 Sorry to hear that but metastasis cancer is not curable, and eventually lead
to terminal stage. Pain control and palliative care is more important at
terminal stage. |
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E*********a
发帖数: 88 | 49 Suggest to remove the affected ovary - no need to wait. Granulosa cell tumor
often found low grade, but have tendency to recur many years later. The
probablity of metastasis is much smaller when the tumor is small |
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l**x
发帖数: 110 | 50 下面这个患者希望能得到版上医生专家的指导意见，危险多大，如何治疗，预后如何？
患者44岁，男，6年前因为肝癌做了肝移植 （符合米兰标准），之后无灾无病好几年。
去年2016年初发现轻微贫血，血色素12，因为当时在服小剂量阿司匹林，于是停服，看
看有没好转。托托拉拉到了年底，还是贫血，血色素10.5。医生说做个内镜。于是在胃
内发现一个肿瘤，内镜医生直觉是GIST。随后CT，但CT却没有异常。4月初第二次胃镜
，GIST依然还在，取样活检表明可能肝癌转移或者是非常罕见的HAC。第二次CT 报告大
小46x35mm，说比较第一次32mm变大了。可能第一次看片医生那天喝多了？肿瘤位置在
Fundus，非常接近GOJ。
AFP好久没有查了，因为肝上的情况一直很好，肝移植前AFP 100多，移植后AFP一直小
于2。上一次至少是2，3年前。也是疏忽了。现在AFP 254. 显然胃上这个要么是转移，
要么是HAC。
下周二医生还要安排一次PETCT，周三见外科医生，估计排除转移外就安排切除了。 求
这里的专家教授指点，这个情况如何是好？下面我贴上最近几个报告。
个人感觉肝移植后5，6年转移到胃实在... 阅读全帖 |
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