Expert: Claes-Gustaf Nordquist, M.D. - 11/2/2009

Question
My 71 year old mother recently entered hospital due to severe pain. Colonoscopy was performed but could not be totally completed due to blockage. 2 days later surgery was performed to remove the blockage which was diagnosed as colon cancer - along with cancerous lymph nodes in 3 of the 12 removed. CT scan did not show cancer in other parts of body. Treatment plan of radiation and chemo was planned but before this was started, pet scan was performed that showed something in another section of colon. Colonoscopy was performed and 2 additional tumors too large to remove via colonoscopy along with several polyps were found.  At this point colonscopy doctor recommends removing entire colon, surgeon recommends removing the 2 tumors and then continue with Chemo/Radiation. My questions are: 1) should pet scan have been performed before 1st surgery was performed to determine if additional tumors existed and could then have been removed without a 2nd surgery; 2) why would surgeon suggest another surgery before radiation/chemo start - is there a chance additional cancers will form after 2nd surgery and prior to the radiation/chemo getting started? 3) should the polyps at least have been removed during the full colonoscopy - he only took biopsy's but didn't remove anything and I'm not clear as to why these would be left 4)if my mother starts chemo/radiation - is there a chance the others tumors will be eliminated and no additional surgery needed or reduced to where laparoscopic type surgery can be performed? Sorry for so many questions but logic of events and recommendations of another surgery concerns me...thanks for your help.

Answer
Well this was a hard one, but I'll try to do my very best! Yes, in my opinion a PET scan would probably have shown the true picture of the situation before initial surgery. BUT PET scans are not (yet) usually a presurgical procedure (why?, well cost). Well in my opinion all polyps should have been removed, BUT since that particular doctor did suggest a total surgical removal of her colon logic did not enforce a total polyp removal before such surgery.  Where in her colon were her cancers located (important to know in order to understand why radiation therapy was included and WHEN best to give such therapy - if in her rectum radiation therapy SHOULD be given and SHOULD best be given BEFORE surgery)? Surgery IS needed regardless of other therapies. I agree that in this situation a combination of surgery, chemotherapy and maybe radiation therapy is best. I have to agree with her colonoscopy doctor in view of the fact that she has several polyps and multiple cancers of her colon and therefore a high risk of MORE future colon cancers that a total surgical removal of her colon probably is best.  I think that I have answered all your questions here. If not, sorry, but just ask again.