Expert: Claes-Gustaf Nordquist, M.D. - 9/17/2007

Question
QUESTION: My father is 72 yo, had a resection in 11/2006.  Stage II, no lymph node involvement.  First CT scan and PET scan showed a 1 cm tumor in the lung and a lesion on the liver.  I know this moves him to stage iv and I know the prognosis is grim.

He begins Folfox soon--why is RAF not being mentioned as a possibility if there are only two tumors?  He feels fine and is in no pain.  His doctor apparently said they can't operate because the operation would spread the cancer.  That doesn't seem right to me.  Am    I mistaken?  I'm getting info second hand from my parents.

ANSWER: Dear Susan, I'm a Swede living in Sweden and English is NOT my first language. Americans are VERY fond of acronyms which will drive the rest of us crazy! Please write out fully what you mean! If I have to guess I may make mistakes. What do YOU mean by RAF (certainly not Royal Air Force)?! The rest of your question is easier. I'm sure your parents have misunderstood the reply they received. They do not operate because his cancer has spread. If it has spread to 2 different sites it is VERY probable that it also has spread to other sites though not detected - perhaps not even detectable - yet. In fact that MAY also be the reply to your first question but that is not certain so please clarify!


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

QUESTION: Sorry, my Swedish is weak . . . *grin*

I meant RFA--Radio Frequency Ablation.

Am I correct in assuming that he may get about one "good" year before he takes a bad turn?  I know that all cases are different.

Dad is healthy and strong, never sick before, asymptomatic with two small tumors.  Colon tumor removed.

My parents unfortunately believe it is a good thing that he doesn't "need" surgery.  There is quite a bit of denial going on.  Normal, I suppose.

Answer
RFA is a possibility but only together with chemo therapy -for the very reason I mentioned! It is unfortunately impossible to predict survival times, too many and too big individual variations. But I think about one fairly good year would be a reasonable assumption. Swedish is actually VERY close to English AND to German & Dutch but closest of course to Danish, Norwegian & Icelandic (Finnish is another matter that would be like English & Japanese, but Finland is officially bilingual with both Finnish and Swedish as official languages and the same thing is under consideration here since there are about as many Finns in Sweden as Swedes in Finland). Swedish and the other Scandinavian languages are more like dialects of one single language. I will write a few English words on the left and the Swedish translation to the right so you can compare.
Mother    moder
father    fader
daughter  dotter (Icelandic: dottir)
son       son (Finnish: poikka)
sister    syster
brother   broder
blood     blod (Finnish: veri)
hand      hand (Finnish: kesi)
not very different! Right? But Finnish is VERY different! Even more so grammatically. It has more in common with Hungarian, Turkish, Mongolian, Korean & Japanese!