Doctor Q&A

My wife is 54 years old and in good spirits. She underwent a second stage rectal tumor resection in June 2019 without follow-up treatment. After the surgery, her CEA index was 3.2; In June 2020, the CEA index rose to 10, and it was discovered that colorectal cancer had metastasized to the liver. The first course of treatment (injection of Oxaliplatin plus oral Xeloda for two weeks) began on June 26, and then the patient was transferred to a public hospital for targeted therapy and chemotherapy. The patient completed the first targeted therapy with Cetuximab and the second chemotherapy with Oxaliplatin (Eloxatin), Fluorouracil (5FU), and Folinic Acid on 15/7. I should be readmitted for further treatment in two weeks. On July 27th, a blood test was taken. Due to low platelet count and high liver enzymes, another blood test was needed on August 3rd, one week later, to determine whether I could continue chemotherapy. Unfortunately, on August 4th, I saw a doctor who said that the blood test results showed a platelet index of 0.8 and liver enzymes were three times normal. Therefore, I have not been able to start the second targeted therapy and the third chemotherapy. It depends on the blood test results on August 10th to know whether I can start the next course of treatment. That is, the third chemotherapy has been delayed for three weeks. The current question is that my wife's CEA index of 3.3 has decreased compared to before chemotherapy. However, if the blood test results continue to be unsatisfactory and treatment is delayed, will it have an impact on her condition and drug resistance? Also, may I ask how to increase platelets and decrease liver enzyme index during this period? Teach with effort!

October 23, 2024

Oxaliplatin chemotherapy drugs often cause low platelets. If you want to maintain the dosage without affecting its efficacy, you can consider switching from once every three weeks chemotherapy drugs to once every two weeks (retaining Oxaliplatin and replacing Xeloda with 5FU). If combined with artificial blood vessels, even three days and two nights of hospitalization can be avoided, and chemotherapy can be performed in the outpatient department. There is also a drug called eltrombopag, which has been found to accelerate platelet recovery. You can inquire with a doctor. By contrast, more importantly, I suggest that your wife conduct a large-scale genetic test on previous tumor tissues. Your wife does not have a K/N ras gene mutation on her tumor, so she is suitable for using cetuximab. Therefore, there is a high chance of introducing other druggable gene mutations (known as "feasible gene mutations"), and testing may also include a very specific gene mutation called "microsatellite instability". If the tumor carries this gene mutation, immunotherapy is suitable, and even a considerable number of patients can ultimately use it to cure diffuse colon cancer! We also need to distinguish whether her liver tumor has spread to the only location and whether it can be completely removed. If it is marginally resectable, it is advisable to re evaluate it using computer sketching as soon as possible, which may allow for earlier surgical resection.

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I was diagnosed with stage III nasopharyngeal carcinoma in mid March this year. After more than 30 rounds of electrotherapy and five rounds of chemotherapy, I completed the course of treatment on June 11th. But at the end of July, I did a PET scan and found a tumor in the third section above the caudal keel. When arranging for electrotherapy, I asked the doctor why only palliative electrotherapy was used. He told me that because my cancer had spread into the bone, there was no chance of cure! Is that the case? Also, I saw another private doctor who told me that currently only immunotherapy can be tried, but due to the high cost of medical treatment, he is unsure if he can help me with the treatment. May I ask if this is the only method that can be tried in this situation? Please note that I am 52 years old

2024 年 10 月 22 日

Thirty plus sessions of electrotherapy and five sessions of chemotherapy are curative treatment options. If positron emission tomography (PET-CT) only detects one diffusion site, we call it 'oligometastasis'. This may just be the only place where it spreads. If we treat the location of this' oligometastasis' with surgery or high-dose radiation therapy, some patients can be cured of cancer without recurrence. According to your description, the spread of the lumbar spine is suitable for treatment with high-dose "stereotactic radiotherapy". Unlike general palliative radiotherapy, stereotactic radiotherapy has a higher dose. Although it requires a large amount of technology, it is more effective in completely eliminating the tumor at the spreading site and is an inevitable choice for treating "oligometastases". In terms of drug therapy, there are many drugs that can be used, and chemotherapy regimens including carboplatin or cisplatin and gemcitabine are usually preferred, as well as oral chemotherapy drugs (TS-1 or capcitabine). Immunotherapy is also one of the available (but not the only) options. You can inquire about the details with your attending physician.

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I am a triple negative breast cancer patient who underwent chemotherapy, electrotherapy, and surgery to remove breast and axillary lymph tissue a year ago. Recently, during a follow-up visit, I discovered a recurrence of breast cancer and am currently undergoing chemotherapy with Gemcitabine and Carboplatin. May I ask what factors caused my recurrence in a short period of time? Can electrotherapy be used to prevent recurrence?

2024 年 9 月 13 日

The recurrence factors of triple negative breast cancer are mainly determined by the number of stages of the tumor and whether the adjuvant therapy performed is sufficient. At present, most triple negative breast cancers undergo preoperative chemotherapy and immunotherapy, and then complete remission (pCR) is determined based on the pathological report after surgery. If the effect is ideal, only one year of immunotherapy is needed, otherwise additional chemotherapy drugs need to be added to further reduce recurrence. In addition, many triple negative breast cancers are hereditary. Once confirmed to be hereditary, there is a targeted drug (PARPi) that can be taken to further reduce recurrence. Whether electrotherapy can prevent recurrence depends on the current situation of recurrence. If it is a local recurrence and the breast or chest has never received electrotherapy, surgery can be performed first before electrotherapy. If one has previously undergone electrotherapy, the likelihood of being suitable for further electrotherapy will be reduced, and the complications of further electrotherapy will also be significantly increased, so it will only be suitable for a very small number of patients. If tumor recurrence is already a diffuse condition, treatment aims to control the tumor. In some cases, local electrotherapy can prolong the time for the tumor to be controlled, but cannot completely prevent recurrence.

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Hello doctor, my brother is 55 years old and just had an X-ray. We found a 3-4 centimeter shadow and emphysema in his right lung. The hospital doctor suggested that a computer scan and bronchoscopy should be performed. I would like to ask if it is necessary to undergo bronchoscopy after completing the computer scan? Because of concerns that bronchoscopy is an invasive examination, there are risks involved

2024 年 8 月 24 日

If your brother has a smoking habit (as emphysema is often associated with smoking), then there is a high chance of developing lung cancer.
Instead of doing computer sketching, I suggest doing positron emission tomography (PET-CT) directly, because after the final diagnosis of lung cancer, more accurate positron emission tomography (PET) scans are needed for detection, and surgery or radical radiation therapy can only be considered after ruling out spread.
Positron scanning can also more accurately identify the location of diffusion. Unfortunately, some diffusion sites can be easily detected by taking tumor tissue, such as lymph node metastasis in the clavicle. Therefore, bronchoscopy is not necessary, and simple ultrasound-guided needle aspiration can be performed.

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My husband was diagnosed with stage IV lung adenocarcinoma in March 2019. At the end of February, a positron emission tomography scan showed a 7.9cm lung tumor, with tumor spread in the surrounding lymph nodes and metastasis to the spine. At QE Oncology, using electrotherapy 5 times to relieve pain in the spine can stop the pain. Due to the absence of genetic mutations in the extracted lung tissue test results (he is a smoker), targeted drugs cannot be used. He wants to try immunotherapy, but the test result is less than 1%, so he cannot use this treatment and can only use chemotherapy with the chemotherapy drug Alimta+Carbonation After four rounds of chemotherapy, the cancer cell index in the blood test dropped from around 18:00 to around 8:00. However, after the second round of chemotherapy, the cancer cell index in the blood test increased again to around 12:00. Unfortunately, the tumor has metastasized to the cervical lymph nodes. The doctor's advice is that first-line drugs are already the best drugs. To switch drugs, only one drug can be switched, and the medication needs to be administered once a week. There are also more side effects than before, and steroids are needed, which can affect the stomach and may lead to gastric ulcers (my husband currently has gastric ulcers and trigeminal neuralgia, so he needs to take these drugs again). The doctor's suggestion is that second-line treatment is effective for only 1 or 2 out of 10 people. The proportion of second-line immunotherapy is around the same, and it is relatively expensive. It is estimated that self funded medication costs about 50000 yuan per month. In addition, he often has a fever and anemia, and needs to be hospitalized for blood transfusion. The hospital has a fever, and the doctor does not approve his discharge. There is currently no treatment plan. May I ask the doctor: What treatment can be given to my husband in this situation? Can cervical lymph nodes be treated with electrotherapy? What suggestions or opinions can you give us? Thank you!

2024 年 8 月 11 日

According to the latest medical research data, patients with stage IV lung adenocarcinoma can receive first-line treatment using chemotherapy drugs in combination with immunotherapy, regardless of the level of PDL-1 protein. The level of protein only reflects the extent of benefit from immunotherapy, but regardless of the level, it is still more effective than using chemotherapy drugs alone. If the first-line treatment does not use immunotherapy drugs, then the most effective second-line treatment is immunotherapy drugs. The probability of tumor shrinkage is at most only 20%, but immunotherapy will ultimately enable 10% to 15% of patients to control their tumors for more than five years, and it is believed that many of these patients have already been cured. Immunotherapy drugs for second-line treatment can be calculated based on body weight, and some patients only need half of the medication cost. If there are financial difficulties, regardless of weight, using half of the dosage, I believe that 90% of the efficacy will be preserved. Details can be consulted with a doctor. In addition, traditional second-line chemotherapy drugs, if permitted by the body, should be treated and have a certain effect on tumor treatment and soothing the condition. Chemotherapy or immunotherapy drugs are generally not accepted when there is a fever. It is necessary to treat the relevant infections before further treatment can be carried out. However, some patients' fever is related to the inflammatory response caused by tumor spread. In this case, anti-inflammatory and antipyretic drugs can be used, and chemotherapy or immunotherapy can be used as usual.

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Hello doctor, my mother is 70 years old and needs to undergo chemotherapy for lung cancer. We just discovered that she is allergic to the steroids she takes before chemotherapy, experiencing rapid heartbeat, skin irritation, numbness in her legs, anxiety, and confusion. Now the doctor will not prescribe steroids for chemotherapy. Are there any other medications that can help reduce the side effects of chemotherapy?

2024 年 8 月 11 日

The steroids commonly used before chemotherapy have several effects. Firstly, it can reduce drug sensitivity reactions. Secondly, it has a antiemetic effect. Thirdly, reduce the occurrence of edema caused by certain types of chemotherapy drugs.
As for the first efficacy, other drugs can be used, such as Benadryl Go replace it. However, if the original drug has a low chance of sensitization, there is no need for additional medication.
As for the second effect, there are many very powerful antiemetic drugs available, which can be taken orally and have strong antiemetic effects. They are even more effective than injectable antiemetic drugs, so even without taking steroids, there may not be symptoms of vomiting, so you don't have to worry too much.
Finally, there is the issue of edema. The chemotherapy medication used by your mother may not necessarily cause edema. If it occurs, it is usually treated with oral water removal pills, such as furosemide(lasix) They can all soothe.

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