Expert: Claes-Gustaf Nordquist, M.D. - 12/22/2007

Question
QUESTION: Hi,  I emailed you back in June to ask about my friend who had a large colon cancer with mets to the liver (8 in all) and a met on the omentum.  The colon tumor was successfully removed along with the one on the omentum and a number of affected lymph nodes and it was eventually decided that the liver would be operated on (Which for a long period of time was not going to be possible.)  One lobe of the liver was removed and small wedges of the other lobe (I believe it was the maximum amount of liver that could have been removed) and this was also deemed to have been successful although a week later she did get a liver infection but then got through it.  Now a few weeks ago she noticed bleeding coming from her vagina and had an appointment with a gynecologist who discovered along with a large amount of blood a growth in her vagina.  Biopsy has now shown that this indeed another secondary from her bowel cancer and is now waiting for some new scans.  

My friend was told that this is very rare for it to spread to such place and info on the net about it is very limited indeed.  What do you think may be the likely procedures and outcomes now - will they try to treat it even if it is an isolated secondary. How could it have spread to there?  Is it more likely to have through the abdomen directly or via the lymphatic system???  The gynecologist and her colleague looked very shocked at what they had found.


Thanks for your time

ANSWER: Any kind of radical hopefully curative treatment - if indeed possible - must be surgical including the removal of at least a part of her vagina. What is possible to do must be decided by her gynecologist. How it got there is impossible to say with any certainty. A spread of cancer cells via the fluid in the abdominal cavity is possible, but so is the spread via the lymphatic vessels or even via the blood stream. Which one it actually is is anybody's guess! It is however very rare but not unheard of. I personally have no experience of this particular situation.


---------- FOLLOW-UP ----------

QUESTION: Hi,

I emailed you late in november about my friend who had a primary colon cancer removed in march along with a secondary that was found on her Omentum following 8 courses of intravenous chemo and xeloda which was deemed to be very successful. Then in August she had her Liver resected (almost 3/4 of it as she had had 8 lesions in the liver) and in October she was given the all clear and a 55% 5 year survival rate.  She then went back to the doctors in november as she experienced bleeding from her vagina and generally felt very weak muscle and joint wise.  A biopsy confirmed a colon secondary in her vagina and she had a CT scan last week.  Well the CT scan came back and didn't show a thing up on it but the docs said clearly there is something there and her CEA which was well below ten in June was showing up as 30.  The doctor spoke of its rarity and said they'd had a meeting about what they should do.  They have said they aren't really sure but they will send her for a PET scan and then if it is an isolated secondary then they will most likely give her a high intensity course of radiotherapy. My friend asked if she will get an operation and the doctor seemed to think not.  I wonder if I could ask you a couple of questions about all this,

Firstly , Is it possible that radiotherapy alone could cure the secondary tumour?  I thought that radiotherapy and chemo couldn't cure colon cancers, but am I wrong and radiotherapy be curative?

Secondly, I have heard that colon cancers are not usually responsive to radiotherapy.  Is this because of the cell structure or is it that when in the colon it is too deep in the body.  So is it the case that because its in the vagina near the outside of the body its more likely to respond.

Thirdly,  Is it unusual that my friend is putting on weight. We were under the impression that when you have cancer you start to lose weight.  Is it likely to be a build up of fluids thats causing it or is it that the cancers not that bad?

Thankyou for all your replies to date,  Although my friends doctors have been fantastic she has sometimes not always felt clear on things and your answers have been of great help,  In conclusion what do you feel is my friends prognosis,

Thanks

Answer
Unfortunately I do think that her prognosis is bad! If it has spread to somewhere - as it has here among other places to her liver & to her vagina - it usually also has spread to other places though not yet detected (maybe not even detectable yet)! If a cancer has spread it usually ends badly unfortunately!