Question about CT scan results

fringetree

Hi there, I know you all have a lot of experience looking at CT scans, so I am hoping you can answer some of my questions. My dad's oncologist told us about six weeks ago there was nothing more he could do because the chemo was not working and my dad was too sick to try other regimens. The main problem is a large tumor in his liver surrounding his billary tree (he has one or two other small liver mets, but the big one is the real issue). He showed me two scans, one from two weeks before treatment and one from three weeks after. The tumor was about two centimeters larger and much darker than before.

I just picked up my dad's medical records, and I found there was a third scan that was done a few days after his very first treatment showing the tumor was 13cm. Meaning, in two weeks of treatments, the tumor had actually shrunk 1 cm! I called the oncologist about what I found, and I didn't get the best reaction. First of all, he did not even remember ordering the scan and had never even looked at it. He said it was probably not significant shrinkage and that the error of the technology is about 0.5cm (which still wouldn't mean the tumor had not shrunk, and could actually mean it had shrunk 1.5 cm if you want to get technical). I don't understand why he thought two centimeters increase in five weeks was "aggressive growth" but shrinking one cm in two weeks is meaningless. He also said he could "just tell" things were worse and that the tumor looked necrotic. I thought that was the point?? I really doubt this doctor, especially since he also never checked the pathology report showing my father had an active, identified infection (despite my arguments at the time that he had an infection, he was convinced it was "tumor fever" and started the chemo anyway). I just found that in his medical records, too. I am so angry with myself for not looking into this sooner, as my father has since declined and doesn't want to get a second opinion now. I know it doesn't make a difference, but I need to know if my instincts are right, if my doctor is just covering his a** for not looking at all the available data, or if he is right that I am just grasping at straws.

So, to summarize:

Big liver tumor
9/23 10cm and white
10/20 13 cm (haven't seen the actual scan, just the report)
10/31 12 cm and dark/splotchy

My questions are:

1. What sort of shrinkage do your oncologists seem to find encouraging?
2. Is is positive or negative for the tumor to look darker on a scan? Does this mean "necrosis"? Isn't that the point?
3. Is the doctor correct that I am obsessing and that I should just shut up?

Paula G.

Not sure
Hi,
I'm not sure but my husbands Onc thinks any shrinking is good. Is it just in his liver? Have you got a second opinion? I would do that if I were you. If his mets are just in his liver and they have removed the cancer from his colon or rectum he could be a canidate for a resection. I don't know but it is worth seeing someone else. Paula

PhillieG

Let me start with #3
Don't shut up!
I don't know all of the technical info but I would try to get your Dad to get a second opinion. His current onc seems less than totally competent. Doctors in general don't like to be second guessed, especially by regular folks like us. I have found it hard to really decipher the scans. My onc will show me them and go over things and then I see the nuances involved.
Has your Dad tried Avastin? I have large and numerous liver mets and it caused really significant shrinkage to the tumors.
-p

fringetree

Paula G. said:

Not sure
Hi,
I'm not sure but my husbands Onc thinks any shrinking is good. Is it just in his liver? Have you got a second opinion? I would do that if I were you. If his mets are just in his liver and they have removed the cancer from his colon or rectum he could be a canidate for a resection. I don't know but it is worth seeing someone else. Paula

It seems like even not
It seems like even not growing would be good! He has mets in his lung and pancreas, too, so he has never been a candidate for resection. I think we were all trying to keep him around as long as possible in hopes of new technology down the road (and because we love him, of course). I see all the stories here about people beating the odds and I want that for my father. I would like to get a second opinion, but my dad is very weak and told me he doesn't think he could do chemo again. I don't want to push him against his wishes, especially if I am being delusional about his prior results.

fringetree

PhillieG said:

Let me start with #3
Don't shut up!
I don't know all of the technical info but I would try to get your Dad to get a second opinion. His current onc seems less than totally competent. Doctors in general don't like to be second guessed, especially by regular folks like us. I have found it hard to really decipher the scans. My onc will show me them and go over things and then I see the nuances involved.
Has your Dad tried Avastin? I have large and numerous liver mets and it caused really significant shrinkage to the tumors.
-p

Ha! I have always been an
Ha! I have always been an argumentative thing, so shutting up is hard for me! I don't know why I was so quiet and accepting of this guy's opinion for so long. I do think this doctor is pissed that I second guessed him (although I tried very hard not to be accusing or anything). He has actually been pretty snotty with me. My dad was not on avastin b/c he was still bleeding a little from having stents placed, but that has cleared up and seems like it would be a reasonable option at this point. They also never did genetic testing and/or tried the other targeted drugs. Anyway my dad doesn't want any more chemo. I guess I am just looking for answers for myself. And, I suppose, in case my dad changes his mind and wants to reconsider, I would like to have as much information as possible to try to make an informed argument. I am so torn between respecting his wishes and wanting to push for every decimal point of a percent of a chance that he can be helped. Thanks for the advice.