Oncology (General Cancer)/Sigmoid colon cancer with uncontroled metastasis with urinary bladder invasion
QUESTION: My grandfather had surgery to remove mass from sigmoid colon in 8/2013. Biopsy report like this- moderately differentiated adenocarcinoma, TNM stage- pT3N1Mx, Separate lymph nodes- no metastasis seen. After that surgery he had blood in urine. Then urinary bladder invasion was diagnosed. Then chemotherapy was started with FOLFOX. But he is 72 years old and right kidney was removed 15 years ago because of damage by stone. His left kidney has slightly enlarged. In addition he has diabetes and moderated high blood pressure. Doctor giving chemotherapy with low dose of FOLFOX, like this, 1.5 mg 5-FU (D1+D2), 100 mg oxaliplatin (D1), 150 mg lucoverin (D1+D2). Two pulses of chemotherapy have already been completed. But his condition is not improving. Still blood is going through stool and urine. Excessive blood loss is being stopped with taxanemic acid. I think such a low dose of FOLFOX is not sufficient for him. What do you think? He had to take blood for several times in last six months because of blood loss. In addition, since last month he has burning sensation in the urinary tract for all the times with stub like pain in lower abdomen and fever. Antibiotics like cefuroxime, gemifloxacine, nitrofurantoin courses have already been completed but symptoms are not removing. Still nitrofurantoin is being continued. Do we stop nitrofurantoin? I think he might encounter with UTI. How could we stop burning sensation of UT? Because of vomiting and sore in mouth he is unable to take full meal and he is becoming weak day by day. Antiemetic drug is being administered. He has some black skin rash or spots in several body parts. Is this side effects? Is the doctor prescribing performing chemotherapy with the right medication with right dose? What should be the best treatment approach? How much possibility to stop his cancer progression? How many days he cold survive? Do we contact new physician for better treatment? Please help with your suggestions.
ANSWER: My suggestion is to stop chemotherapy now, and do one of four things: remove the bladder (drastic, but sometimes necessary); emobolize the part of the bladder that is bleeding (an interventional radiologist can do this); radiate the bladder; or try intravesical(into the bladder) formaldehyde which can stop bleeding. All of these have their problems, but your grandfather isn't getting better and won't until this problem is controlled. All that exposure to antibiotics isn't good either, as he is probably developing resistnat infections. And the chemotherapy is, as you suggest, probably not strong enough to do any good. (I never give more than two cycles of chemotherapy if the patient is not getting better) The black skin rash may be from one of the antibiotics, or possibly from infection.
If he gets better, there are some second line chemotherapy regimens that might be useful, but I wouldn't give any more chemotherapy until the bladder is taken care of. His survival without treatment, assuming you can control the bladder problem, is probably on the order of a few months, but if the bladder invasion is the only place he has tumor, he could do a lot better. Right now he is more likely to die from infection or bleeding than from the cancer.
Hope this helps.
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QUESTION: Thanks for your answer. Yesterday he had to defecate 5-6 times with huge amount of fresh blood and black blood clot in stool. The amount of blood is huge than previous time. Has fever of 101 degree Celsius. Now more blood is going through stool than urine. We are administering high does of taxanemic acid. He is now so much week. What can we do to stop blood in stool? Most probably his colon cancer is spreading so quickly. Please suggest.
As I mentioned before, to stop the bleeding (in the stool, in the bladder) you have to stop the flow of blood. This can be done surgically, or by "embolization. In the bladder you can do a couple of other things (see previous answer). Something needs to be done if he is going to survive this, but it sounds like he may be in no condition for surgery. Hope this helps.