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Question 1

Hi Doctor, My dad is diagnosed with stage 3, anaplastic oligodendroglioma. He got operated and he is undergoing radiotherapy. Could you please suggest me how can I save him from this cancer. Please help me.

I belive this is not stage 3 s we don't have staging for brain cancers. This should be grade-3 anaplastic oligodendroglioma. After adequate resection and completion of adjuvant radiation therapy, he needs adjuvant chemotherapy with PCV regimen which includes procarbazine + lomustine + vincristine.

Patient Info

Initials : SB

State : Indiana,

Question 1

Good Day Doc, I'm Sheira Labus 25 from Philippines. I was diagnosed stage 4 rhabdomyosarcoma that grow in my right femur it was stage 4 because its spread to my lungs. I had chemoteraphy 7 session my Chemo Drugs was Vincristine-Doctinomycin my Ct-Scan result show progression of nodules on my both lungs and the tumor on my femur become bigger that's why I decided to amputate my right leg. My amputated Leg immunochemistry result was Favor Leiomyosarcoma. The Doctor change my Chemo drugs, the drugs was Doxorubicine-Ifosfomide. I receive 4 session and the follow up CT_Scan show increase multiple nodules and size in both lungs, Lymphnodes, Metatasize to bones and thyroid. The Doctor stop my chemo and she will change the chemo drugs. Im searching for clinical trial here in our country but theres no available trial in my kind of cancer. I attached the result of my CT_Scan and pathology.PLEASE HELP ME DOC i really need your advice and sorry for my english. Sincerely, Sheira

I would recommend to switch to gemcitabine + docetaxel if you can tolerate chemotherapy. Otherwise we can try pazopanib, however it may not as effective as chemotherapy.

Patient Info

Initials : SL

State : Arizona,

Question 1

Dr. Mokhtari, My dad is 70 year old and diagnosed with extensive SCLC with metastasis to bones, thyroid, liver, brain. We are told by doctor that only option is etopaside +carboplatin and possibly we can try Chemo + I/O. Is radiation therapy ruled out because Mets? What are the options for such a case? Your suggestions would help us in discussing with our oncologist. Thank you so much

Radiation is only indicated for brain metastasis in your dad. No role for radiation therapy for other metastatic lesions. Yes. I/O (atezolizumab or durvalumab) should be added to carboplatin and etoposide for first line of treatment.

Patient Info

Initials : PV

State : Wisconsin, Switzerland

Question 1

Diagnosed with CDH1 2014. TG done 2017vwith no issues. Have been having yearly surveillance of breasts due to increased risk of breast cancer. In April 2021 I was diagnosed with hormone+ HER- Ki67 at 2 invasive lobular breast cancer. Mammo and ultrasound measured at 20mm and MRI at 10mm. May 2021 underwent lumpectomy, but got no clear margins so underwent skin sparing masectomy with tissue expander in June 2021. Met with my oncologist 5 days ago who said tumor was in fact 60mm. I will begin 5 weeks of radiation mid August 2021. I assume given that given I am 15 months post menopause that I will be put on an AI hormone blocker. My issue is when I had a CT scan to see if I will be able to use my abdomen for a DIEP reconstruction they found an issue with my uterus. I then underwent an internal ultrasound which measured my endometrial lining at 13mm. I underwent a biopsy where 2 polyps were removed and samples from lining were taken. Result was no malignancy found. Due to CDH1 I believe I am at a little bit more exposed to endometrial cancer than those who don't have the gene. My question is should I consider having a hysterectomy?

Dear Wendy, thank you for reaching out . 1- risk of breast cancer is up to 50% so I recommend you consider prophylactic mastectomy of the controlateral breast (preventively removing the other breast) 2- risk of colorectal cancer also increased, and colonoscopy every 3 to 5 years is recommended 3- I couldn’t find any official recommendation regarding endometrial cancer risk or sceeening and no recommendation for prophylactic hysterectomy. Here is what I found: a study published in the British Journal of Medicine reporting an ivreased risk of uterine cancer in the first and second degree relatives of patients who were diagnosed with gastric cancer irrelevant of the the genetic predisposition. ( those were not necessarily CDH-1 positive patients) They concluded that there may be an association between the two cancers. In addition, I Found a report regarding small nucleotide polymorphisms (SNP) within the CDH-1 gene that are associated with a higher incidence of endometrial cancer in Chinese women. Meaning some genetic variants in CDH1 may increase the susceptibility to endometrial cancer in that specific population. So if I were to advise you, my recommendation would vary depending on your other risk factors to endometrial cancer (such as overweight, diabetes, hypertension and family history). I would offer you the options of either monitoring with ultrasounds Of the uterus every 6 to 12 months or prophylactic hysterectomy. Evidently, how anxious you are about it and your wishes strongly weigh on that decision given the absence of any definitive guidelines. And if I were you, I would proceed with the hysterectomy. My philosophy with cancer predisposition genes especially in the areas that are not critical for life is : “when in doubt, take it out” This may sound overly aggressive to most other physicians. I hope this helps, attached the article that listed the SNP of the CHD -1 gene there are potentially associated with endometrial cancer if it could be of any help. Thank you so much and I Wish you the most clairvoyance in your decision making. Tlemcani

Patient Info

Initials : WB

Primary Cancer : Breast

State : Victoria, Australia

Question 1

I have breast cancer stage 3 surgery done 4 AC done now on 12 cycle of which 5 r done suffering from sever mouth ulcers and stomach pain and discomfort and then passing stools

Hi Maia, thank you for contacting me. From what you describe, it appears like you are on weekly Paclitaxel. Gastrointestinal side effects and mouth sores are a common occurrence with chemotherapy. Please make sure you discuss with your oncologist so they will prescribe you supportive care medications. If you are having diarrhea, you may be prescribed loperamide or diphenoxylate. For mouth sores, they may give you some numbing solution/ lidocaine and potentially, nystatin if there’s superimposed thrush. Please let your care team know so they can evaluate and prescribe necessary supportive care. With good supportive care, you will be able to complete all 12 treatments as previously planned. Wish you all the best!

Patient Info

Initials : MS

State : Texas,

Question 1

I was diagnosed adénocarcinomes sigmoid ( colorectal) moderately differentiated stage T3N2 M1, at age of 64, 4 nodules are involved with metastasis to both lungs micromodules on mai 2020, FOLFOX was started then surgery on august 2020, then FOLFOX again for 4 months. They added vectibix 6mg/kg for 2 times only. I was KRAS wild type with MMR normal I don’t have any marker all normal, they did another PET scan on June and the nodules now are doubled in my lungs, 4 in each inferior lobe, one in each middle lobe and one every lingula do total are 12. They are all less than 9 mm. No surgery indicated neither SABR radiotherapy. They want yo restart vectibix at 5 mg / kg plus FOLFOX at 70% to be well tolerated not like last time. My question is do I have another choice or another procedure or any treatment anywhere in the world or trial treatment to follow. Thank you for your help and suggestions.

Hi Assad, Thank you for contacting me. To summarize, you have a KRAS wild type, MMR proficient, stage 4 colon cancer with lung metastases. From what you described, it appears like the lung nodules were initially being observed because they probably were not sure if those were true metastases. You were treated with FOLFOX preoperatively and then again post-op. You were only given 2 cycles of Vectibix - potentially, this was added when they were more concerned about lung metastases. From what you described, your last FOLFOX was in October or November 2020. Now, multiple lung nodules are increasing in size. In the case of multiple nodules, local therapies ( SBRT, surgery) are not right away recommended. It’s better to treat with systemic chemotherapy along with Vectibix or Erbitux. Since your last oxaliplatin was in October/ November and the progression of metastases is just within 1 year of last oxaliplatin, one could switch over to FOLFIRI ( 5FU plus irinotecan) plus Vectibix/ Erbitux. However, your oncologist may have more specific information about your cancer why a certain regimen is chosen. You may certainly discuss the above option during your next visit. Wish you all the best.

Patient Info

Initials : AS

Primary Cancer : Colon

State : California, Canada

Question 1

Hi, Doc. I just want to ask regarding my hubbys chest ctscan with contrast report and whats the treatment for his case now, since he has stage 3b colon adenocarcinoma, waiting for your reply Doc., thanks

Hi Genreb, thank you for contacting. The CT chest report that you sent mentions lung metastases in history. Does he have a previous history of cancer spreading to lungs? In that case, it would be considered a stage 4 colon cancer where treatment approaches are diverse. I see that pulmonary Tuberculosis is mentioned in CT chest report. Cystic lung lesions can sometimes be seen with metastasis in colon cancer, not just pulmonary TB. I would recommend consulting a pulmonologist ( lung doctor) and get an opinion. He may need a bronchoscope if that has not been done yet. Further recommendations will depend on what they find in the lungs. Once you have those details, please feel free to contact us again. I wish you all the best.

Patient Info

Initials : RS

Primary Cancer : Colon

State : Texas, United States

Question 1

Dr. Tlemcani, I am stage 4 adenocarcinoma lung patient diagnosed in Sept 2019 with an exon 20 insertion. I have survived this long but developed brain Mets ( 2 tiny lesions) last month and did cyber knife treatment. I am currently on Docetaxel chemo and my pet scan this week revealed same response as before ( no progression other than brain ) so my doctor has put me on the same chemo as of now. He thinks this chemo is controlling my cancer and will monitor brain. He is not keen on starting Tagrisso or any other chemo that crosses blood brain barrier. My doctor wants to keep other drugs in reserve as i have a rare mutation ( s768 d770 sub mutation) and my options are limited. I trust my doctor completely and I finished my 7th cycle of chemo today. I am looking to take some suggestions. My question is do oncologists normally change chemotherapy when we have spread to the brain or is it on a case to case basis?

Dear Joe, thank you for reaching out Exon 20 insertion isn’t sensitive to Tagrisso Good News: A new drug called Amivantamab is active specifically against exon 20 insertion. However this is an antibody and is thought NOT to cross the blood brain barrier (BBB) Docetaxel also does not cross the BBB. So in my opinion, as long as you are tolerating docetaxel and the systemic disease is at least stable, it’s reasonable to continue, if you start having too many side effects, or if there is progression I suggest to discuss Amivantamab with your DR. For the brain, we try whenever available to use drugs that are effective and cross BBB but when not available- as in your situation- we depend heavily on our neurosurgeons and radiation oncology colleagues. Thank you Dr. Tlemcani

Question 2

Any info on clinical options for person in my situation would be appreciated. I understand you can't give me specific recommendation to my case

Please confirm that you read my reply and feel free to reach out anytime Dr T

Patient Info

Initials : JM

State : Illinois,

Question 1

Dr. Agarwal, I am 26 year old male diagnosed with HL in August 2020. I was told it was curable at the beginning of treatment. I had 6 cycles of ABVD followed by 4 cycles of BEACOPP because of progression. The PET/CT scans showed cancer continued to progress. My doctor tried adding Adcetris but no result. Because of this series of intensive treatment, my bone marrow required stem cell treatment from my sister. My tests show no change. It is likely my oncologist , who is very puzzled, would try adding Opdivo with RT. I am now really very worried what is my fate. I read the prognosis is bad for cases like mine. What are my next options? I am thankful in advance your response.

Hi. Seems like you have a pretty refractory HL, having failed ABVD, followed by BEACOPP, followed by Brentuximab, followed by Allotransplant from your sister Immunotherapy alone or with Radiation is a reasonable choice. Similarly, ICE chemo with/out radiation. Or, just Generating Hope you have a Tertiary Cancer Center close to you, because the options would be limited, but with trying CAR-T cells cells would be a great new option in specialised centres. Also, they may have some relevant clinical trials for this scenario. Wish you the very best

Patient Info

Initials : BC

State : California,

Question 1

Is there a good cream for chemo rash. Specifically Avastin and Doxil.

Hi I usually recommend Aquaphor. Sometime lidocaine cream helps. But I also recommend really avoiding heat, Saunas, hot showers, Sun, Recommend ice, cold showers, don’t rub your hands too hard, friction makes it worse. Avoid using harsh chemicals especially cleaning agents without gloves. Wear comfortable shoes.

Patient Info

Initials : MF

State : Florida,

Question 1

Hey how are you today? I really just have an inquiry. Recently, a loved one of mine received a stage 4 diagnosis based on purely CT. After a second opinion, we learned that it was not stage 4, but stage 2-3 and the spots they saw on her liver were actually fatty liver and the nodules on her lungs were common benign nodules. She did have one lymph node that was localized and positive (small intestine cancer), but everywhere else they scanned showed no signs of inflammation. Is this normal? Is stage 4 usually diagnosed based on CT scans only? Has anyone ever been staged incorrectly? A loved one of mine received a stage 4 diagnosis based on purely CT. After a second opinion, we learned that it was not stage 4, but stage 2-3 and the spots they saw on her liver were actually fatty liver and the nodules on her lungs were common benign nodules. She did have one lymph node that was localized and positive (small intestine cancer), but everywhere else they scanned showed no signs of inflammation. Is this normal? Is stage 4 usually diagnosed based on CT scans only? Would a definite diagnosis be given purely off imaging or would a biopsy be necessary? Her primary tumor is 4cm. She is currently on Folfox. Her CEA levels were first reported at a 12. I know CEA levels aren't cut and dry. We are still considering getting a third opinion since we jumped from such a dire diagnosis to a not so bad one in a month. The second opinion came off of CT scam imaging as well. No biopsy has been done on any of the other suspicious spots and no symptoms from the lung mets that was originally diagnosed as well as the spot on her liver. Thanks! I'm waiting on my dad to send CT scans so I can also submit through here.

Hi there, So sorry to hear about your loved one with a cancer diagnosis. Prayers coming your way from me. From a medical perspective any imaging is just pictures at the end of the day. To go from a locally advanced cancer that is node positive and curable to stage IV is indeed a big leap. Locally advanced with node positive disease can be potentially cured. Treatment would be surgery and 6 months of chemotherapy with FOLFOX as it appears she is on. In order to make a diagnosis of stage IV truly they need to biopsy a suspicious lesion. If radiographically there is no suspicion then there is nothing to biopsy. I cant be sure but it seems to me that someone drew early conclusions that the suspicious lesions were metastatic cancer. As oncologist, truly, the words that come out of her mouth and how we say things has a huge impact on perceptions and emotions. It is not uncommon, to answer your question, for further imaging to show that suspicious lesions are not suspicious. So, there is hope that this is a locally advanced potentially curable situation. CEA levels do not definitively diagnose any cancer. They can go up with inflammation and smoking. Not all small bowel tumors will secrete a CEA. However, it can correlate with disease. A CEA level of 12 is probably from the tumor. It would be important to keep an eye on it during and after treatment. Good luck!

Patient Info

Initials : BJ

State : Alabama,

Question 1

I was operated in 9/19 full hysterectomy etc for 12.4 cm tumor in left ovary. Then a one carbo/ taxol another With taxtere another then nothing because I’m very mal nourished. Also have IBS. Had right hip replacement 9/2020. In Jan-Feb 2021 had one carbo one gemzar one Avastin and another carbo each a week apart. Don’t tolerate chemo well at all. Changed oncs. Second one gave one carboplatin even though I know I’m resistant. Wound up in ER. Changed oncs. Third one gave Doxil:Avastin in April. Haven’t felt well one day since. Had second Doxil/Avastin again 3 weeks ago then Avastin alone two weeks later. Can’t get out of bed. Can’t breathe. Can’t eat. No energy. Abdominal pain so I take Percocet morning and evening. Completely miserable. Diverticulitis possible? Weigh 95 lbs at 5’4”. Am 75 years old. Was very active before cancer. Don’t want more chemo. What to do?

Hi Mariana, thank you for contacting. To summarize, it appears like you have a recurrent platinum resistant ovarian cancer. Since you are unable to tolerate chemotherapy, you would like to know if any non-chemotherapy options exist. It’s important to have further information about ( BRCA genetic testing, HRD/Genomic instability status, Microsatellite Instability/ MSI, Tumor Mutation Burden/ TMB) to give specific treatment recommendations. There are certainly some non-chemotherapy options provided your cancer fits the criteria. If you have positive BRCA mutation or HRD positive, you may be placed on a PARP inhibitor such as Olaparib. If you have MSI-high or TMB-high, you may be able to receive immunotherapy ( pemrolizumab). Your abdominal pain may be related to the cancer itself or there could be another cause. This can be determined with a CT scan. If you intend to pursue chemotherapy once your performance status recovers, you could consider dose reduced topotecan, pemetrexed, or salvage option with oxaliplatin. Your oncologist should have information regarding the above to make specific treatment recommendations. Please reach out to us if you need any further questions answered. Wish you the best.

Question 2

What to do?

As above

Question 3

Help

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Question 4

Please answer

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Patient Info

Initials : MF

State : Florida,

Question 1

I have: cancer that has metastasized to my left this is metastasized to my liver it's a small 6MM lesion. I had a CT scan, MRI and then PET, results attached. My doctor wants to do 6 rounds of FOLFOX6 (every 14 days)chemotherapy before they do surgery to remove the lesion, then do another 6 rounds of chemo after my surgery. My question is since my lesion is so small and the PET scan says concerning for metastasize do I need chemotherapy first before surgery? Why can we just either do surgery first then do chemotherapy or watch the lesion to see if it grows before doing anything? My blood work is great my CEA is 2.4. When i6 had my colon cancer surgery in June 2020. My CEA was 15. After my surgery I elected not to do chemotherapy at that time. Thank you

Yes, if your CEA is 2.4 and your new liver lesion size is 6 mm and you don’t have any other concerning lesions in your CT scan (except 2 small stable unchanged lung nodules), then I agree with you to monitor without any intervention and repeat the CT in 2 months. I personally prefer to biopsy that liver lesion before starting any chemotherapy, however with that small liver lesion the likelihood of getting non diagnostic biopsy result is very high.

Patient Info

Initials : DB

State : California,

Question 1

I was diagnosed with Lymphocytic colitis about a month ago after three months of severe diarrhea and two weeks of rectal Bleeding. After my diagnosis I stopped bleeding for about a month and started to have non watery diarrhea only 1-2 times a day. I’ve had a total of 3 semi normal soft formed stools and I started bleeding again yesterday this time with more clotting. I’m wondering if I should get a second opinion or just consider this normal. Other symptoms include : exhaustion, light abdominal cramping , on and off lower right back cramping, headache.

Hello Ms. Crabtree, There are a number of questions to ask in order for a practitioner to help point you in the best direction. However, the most important aspect of your summary above to address first is whether you should have a second opinion. Diagnosis is usually made by colonoscopy and taking a biopsy of at least two separate portions of the colon, one each in the ascending (right) and descending (left) portions. If this has been done and the pathology from the biopsy conclusively states lymphocytic colitis, it is unlikely that a second opinion would be useful for identifying a different or alternative condition. Whether another opinion would lead to different treatment recommendations on the other hand is another line of inquiry altogether. * Have you started on any medications for this condition? * Have you been recommended to use loperamide (Imodium) if needed for reducing the amount of bowel movements, as well as fluid loss? There are of course stronger medications, but this would typically be a starting point. * Have you been counseled to avoid any specific medications, such as nonsteroidal anti-inflammatories, anti-cholesterol (statin) medications, or antacid drugs (proton pump inhibitors)? * Have you been counseled to not smoke cigarettes, as this may likely worsen the condition? * Have you had any blood tests to determine associated complications, such as mild anemia, elevated inflammatory markers (ESR, CRP) or rheumatoid evaluation, such as RF, ANA testing or specific autoantibody testing? * Additionally, has there been any stool analysis to determine any specific irregularities that might be addressed to improve your symptoms? * Have you had a diet analysis and been recommended to modify toward a more anti-inflammatory diet? There are a number of steps, as demonstrated above, that can help both reduce the severity of the colitis, and address complications resulting from lymphocytic colitis, which may help improve overall daily quality of life. I recommend that let your gastroenterologist know about the changes in your stool that you've detailed above, as well as the associated symptoms that you've listed. She or he may want to reevaluate and possibly take another course for your treatment. Additionally, and simultaneously, you may want to identify a licensed naturopathic physician who is conveniently available to you, either geographically or by telemedicine, for an appointment to begin to address a number of the elements mentioned above, and likely more. The American Association of Naturopathic Physicians has a website feature on their site (www.naturopathic.org) to 'Find an Doctor'. Please let me know if you have additional questions following this reply, or if there is any other way that I or one of my naturopathic physician colleagues may be helpful. Wishing you the very best, Chad Aschtgen, ND, FABNO Seattle Integrative Oncology

Patient Info

Initials : KC

State : Washington,

Question 1

My husband has glioblastoma multiform. Should he be on a low carb diet

Hello GB, Unfortunately there is not enough information or detail provided in your question for us to respond with certainty about what your husband's diet should reflect. However, I can tell you that there is ample evidence that supports a ketogenic or even a ketogenic-like diet in the context of glioblastoma. This would of course be an integrative approach and should be utilized in tandem, or along with the most appropriate standard of care therapeutic measures, which typically entail surgical resection of the brain primary tumor, subsequent radiation to the tumor bed, which is usually complimented with oral temozolomide, and then followed by ongoing temozolomide at a different dosing schedule. In addition to this, there are numerous other strategies that can include the Optune device, other pharmaceutical agents, as well as integrative therapies. A great introduction to the concept is in the first addition of Anticancer: A New Way of Life by David Servan-Schreiber, MD. Although he has since passed, he wrote this book both a medical doctor and a patient with recurrent glioblastoma. He brought the very best science to-date, which of course has advanced since, to the service of complimenting conventional therapies as noted above. Although this resource provides numerous strategies that a person might be tempted to put in to place themselves, I would strongly recommend that you work with an integrative medicine expert, such as a naturopathic oncologist. One resource for identifying such a specialist is the www.FABNO.org website. If you are unable to find a practitioner near to you, it is possible that one or another might be available for telemedicine consults. I and my team here at Seattle Integrative Oncology would be happy to help you to find additional resources for you and your husband in what I imagine is a very difficult time. Please feel free to direct message us at info@seattlend.com and we will do our best to point your toward colleagues in your geographical area. Wishing you the very best, Chad Aschtgen, ND, FABNO Seattle Integrative Oncology

Patient Info

Initials : GB

State : Texas,

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