Expert: Claes-Gustaf Nordquist, M.D. - 11/23/2007

Question
QUESTION: My dad , 63 , has surgery to remove cancer of the colon approx 24 months ago. He has been left with a colostomy but had for the next 12 - 18 months led a normal (for him) life.6 months ago a scan identified potential cancer sites within the bowel area and also on his lung. They have advised against a lobectomy as this will likely expedite the spread of the cancer. A few days ago my dad complained of neck pain and stiffness, and headaches(my dad does not normally suffer from headaches). At his consultant appointment after assessing a 'gait' if that is the correct term - a list in his walk anyway - he got scanned and has been advised that he has a 26mm tumor towards the base of his brain/neck. I understand this is secondary cancer but would appreciate any clarity you can give to my Dad's prognosis. Your previous replies suggest 1 year life span on average with radiotherapy a treatment to improve life quality not a solution.He has been told that there are chemo treatment that might be possible. Can you advise if the information given permits - what difference if any , chemo is likely to make and as with so many others what can i expect in terms of symptoms and and timescales. I appreciate any time you give this and think that your replies have probably answered many questions already..... Thanks

ANSWER: Yes chemo therapy is available that may slow the process down but it will unfortunately not be able to cure him. Colon cancer is not usually very sensitive to radiation so I do not expect much help from radiation therapy to his head unfortunately even if given as a last resort.I think under these circumstances that his survival time - even with therapy - can be measured in months - at best. I'm sorry I have nothing better to tell you!


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QUESTION: thank you for your reply we have been waiting for some more information to again ask your expertise.  Dad is going to receive steriotactic radiosurgery this week can you tell me how this differs from normal radiotherapy and if this will give him a better long term prognosis.  We know that it is not considered for tumours larger than 4cm in size and the aim is to shrink not cure the tumour, however any additional information would be gratefully appreciated. He also tells me today that his headaches have now gone which i guess means the dexamethasone is doing its job although he does still have a gait when he walks and is guarding (i.e. walking with his hand out ready to break his fall)as old people do when they get unsteady on their feet. It also appears that it is taking more effort for him to concentrate when writing or form filling out buy i assume this is all part of the process? many thanks again

Answer
Yes, his corticosteroid medication seems to be working and yes unfortunately that is part of the process! Well if you imagine normal radiation therapy as ordinary strong sunshine that may give you a sunburn but not really give you real burn wounds, then you can consider this stereotactic radiation surgery - if I have understood your question correctly - as a kind of "burning glass", a lens, that concentrates the sunlight (the radiation) to almost a point (its small area is the reason why not larger lesions can be treated). Within that small area or rather volume all living tissue - in this case the tumor - will be destroyed. The reason this is not a cure is the simple fact that if his cancer has spread to there it is probable that it also has spread to other places though not detected - or even detectable - yet. Probably to many such places in fact. But with a size of 26 mm - around one inch - this lesion is of ideal size for this kind of treatment so it will probably work very well. But unfortunately due to what I wrote it is not a cure probably!