Expert: Claes-Gustaf Nordquist, M.D. - 3/5/2004

Question
My father (age 63) was diagnosed with colon cancer about 3 years ago. He had surgery, which successfully removed the cancer from his colon, but two tumors were found to be unresectable in his liver. Since then he's had embolization, radiation, and low dose oral chemotherapy. He's also been on a strict no sugar/low animal fat diet and taking nutritional supplements. Recent scans show no cancer elsewhere, but his liver tumors have dramatically increased in size and he's having a lot of pain. He also complains of low energy. He's decided to try standard chemotherapy as a chance at decreasing the size of  the tumors, and has an appointment to start Oxaliplatin with an angiogenesis inhibitor next week. If successful, he hopes to try to enter a vaccine trial. I'm wondering if there is now a realistic chance for the chemotherapy to reduce the tumors in size and improve liver function or if it will just comprise his liver further? Can chemotherapy at this point actually precipitate liver failure? Is there a better option of treatment for him at this point? Lastly, is it likely that his condition will worsen rapidly over the next several weeks? He has been so active and well until the last month or so, I just don't know what to expect. I live outside the United States, and I'm trying to arrange a visit, but I wonder if I need to rush back immediately.
Thank you!

Answer
I'm sorry to read about your father! First of all the treatments he is considering are all experimental, so it is impossible to predict how it is going to turn out in his case. Generally speaking when a tumour illness has reached this stage the prognosis is in most cases very bad and the best you most often can hope for is an extention of survival time and hopefully a decrease of symptoms. With this level of liver involvement treatment is always tricky but you can be assured his drs. are aware of that. Sorry, I can not predict any time table but I do suggest that you visit your father ASAP! Sorry I have no better treatment to offer him. I'm sorry I have nothing better to tell you!