What is the prognosis for peritoneal disease?

Question

Hello doctor,

Could you please review this letter and report as they seem to differ? We have been informed that the following are metastases, which we agree with one liver metastasis, one aortocaval node, and one subpleural nodule.

However, the oncologist's letter mentions possible peritoneal disease. Why did the CT (computed tomography) report not mention peritoneal disease, and why has the oncologist rated it? The metastases are under 0.787 inches. Would ablation be a better option? Irinotecan has not been effective so far—what are the next steps? What is the prognosis?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand the situation you are facing, but it is important to accept the facts about your patient. Firstly, the patient has an incurable disease and has already undergone major surgery. Despite treatment, the underlying disease is progressive, and most importantly, it is widespread in distant organs. Consequently, the treatment options are very limited. The treatments that have been tried have not been effective, and the disease is not responding to the current therapies.

Addressing your questions:

The aortocaval node has increased in size, which suggests peritoneal progression. The oncologist can observe this in the CT (computed tomography) images. It is important to note that radiologist findings are not always final. Additionally, there are adrenal metastases present.
Ablation of liver metastases alone will not cure the disease, as it is at stage 4 and has already spread to other organs. Therefore, treating metastatic lesions will not address the primary disease.
The fact that Irinotecan has not worked indicates that the malignancy is chemoresistant. As a result, any future palliative treatments may not be effective.
Regarding prognosis—your primary oncologist has already provided information on this. The disease is now at stage 4 with no response to palliative chemotherapy, which means the prognosis is very grave. Despite the progressive nature of the disease, the patient is currently asymptomatic, which is fortunate. However, it is difficult to predict when the condition will worsen or how long the patient will remain stable. It is advisable to focus on symptomatic palliative care.

I hope this information helps you.

Thanks for using icliniq, and have a nice day.