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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31650
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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To Doctor Dr. Arun Phophalia only Something does not seem

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To Doctor Dr. Arun Phophalia onlySomething does not seem right with this cat scan compared to the prior one.11 September 2016 02:02
Hi Doctor,Is there some way we can have a phone conference to discuss the results of my cat scan last week compared to the one done on 6/21Thank you,Fred6/21LUNGS AND AIRWAYS: There are new linear and bandlike densities in the lower lobes bilaterally which
may represent atelectasis (collapsed lung). Short-term follow-up is recommended to ensure resolution.In the right lung upper lobe a 2 mm nodule on image #47 of series 3 is unchanged. There is also a 3
to 4 mm nodule along the minor fissure in the right lung on image #150 unchanged. In the left lung
lower lobe there is a 7 mm subpleural nodule on image 166 unchanged. A 3 mm nodule in the left lower
lobe on image 151 is also unchanged. No new suspicious nodules are seen in the lungs. Central
airways are clear.PLEURA: There is no pleural effusion.CHEST WALL: NormalLIVER: There are multiple hypodense lesions in the liver consistent with metastatic disease. These
lesions have increased in size and number from the prior study. The largest lesion is again seen in
the right lobe and now measures up to 11.8 x 10.0 cm compared to 10.2 x 8.9 cm on the previous
study. A lesion in the left lobe on image #33 now measures up to 2 cm in diameter compared to 1.1 cm
on the prior study. Several hypodense lesions measuring up to 1.1 cm in the right lobe on image #26
appear to be new from the prior exam.9/6PULMONARY PARENCHYMA: The visualized pulmonary parenchyma demonstrates underlying emphysematous
changes. A 7 mm nodule in the left lower lobe on image 183 is unchanged other tiny nodules seen for
instance on images 43, 150, and 163 are unchanged. No new nodules are found. The lung bases are
better aerated than on the previous study.PLEURA/CHEST WALL: No pleural effusion is seen.LIVER: As seen previously, there are multiple hypodense lesions in the liver compatible with
metastatic disease. These look generally smaller than on the previous exam. One in the left hepatic
lobe measures 7 mm compared to 20 mm previously. The dominant lesion in the right hepatic lobe
measures 5.0 x 5.9 cm, compared to 9.9 x 11.7 cm previously. Multiple other lesions looks smaller
also.
Submitted: 3 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 3 months ago.

Fred,

The lung nodules are insignificant as all of them are subcentimeter (less than a cm) and none of them have changed so these are likely to be benign. The lung bases too are aerated so it is an encouraging sign.

In the liver too, the nodule sizes have reduced significantly. This is very good. You are responding very well to the chemotherapy.

This CT scan is a better prognostic indicator.

Expert:  Dr. Arun Phophalia replied 2 months ago.

Fred,

An important thing with regression of the liver metastasis is consideration of other therapies by your doctor. Your doctor may consider intra arterial chemotherapy. In this, via angiography catheter, drugs can be directly delivered to the nodules, so they become more efficacious.

Expert:  Dr. Arun Phophalia replied 2 months ago.

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Customer: replied 2 months ago.
Hi Doctor,Sorry for the late response I have been away from my computer for several days.The doctor was quite surprised that after five treatments that one tumor was reduced in 1/2 and the second from 20mm to 7mm.He said this was quite unusual.I have new insurance so beginning in October I will be at the University of Chicago with a colon cancer specialist.
Expert:  Dr. Arun Phophalia replied 2 months ago.

Fred,

Yes, it is a dramatic response and very encouraging result. Only 10-15% people have this significant positive response. It is good that you have a new insurance next month and I am sure with the new specialist; you would have better therapeutic results.

Expert:  Dr. Arun Phophalia replied 2 months ago.

My goal is to provide you with the best service possible. If you feel I have done so, then an "Excellent Service" rating is greatly appreciated! If not, please click "Reply" to let me know how I can better assist you with any additional information or clarification.

Thank you very much for the opportunity to be of help!

Customer: replied 2 months ago.
Hello Doctor,My 7th chemo treatment ended today.I am told CEA levels in colon cancer are pretty accurate to measure cancer.in your system Mine have dropped fro 20 ng/ml to 10 ng/ml since August 2nd.Is this unusual?Although I was told in the beginning that liver sectioning was not possible one of the oncologists says 20mm to 7mm from one tumor on the liver and 11.5x11.5 to 5.5x5.5 is an incredible shrinkage especially after 6 treatments and did not rule out liver resection.What is your opinion based on this evaluation after my last cat scan.Could you please open the links to review blood work ups from the beginning until yesterday and give me your opinion.My medications Folfoxiri
Irinotecan
Flouorouracil
Oxaliplatin
Bevacvizumab (Avastin)
LeucovorinCEA 6/30/2016 8/2/2016 8/18/2016 8/30/2016 9/14/2016 10/4/2016
0.5-5.0 ng/mL 14.8 20.8 16.5 14.4 11.4 10.2https://mychart.dupagemedicalgroup.com/mychart/inside.asp?mode=labdetail&submode=1&orderid=2https://mychart.dupagemedicalgroup.com/mychart/inside.asp?mode=labdetail&orderid=4
Customer: replied 2 months ago.
Hi Doctor,I forgot to include description of liver before surgery against last cat scan.Does it appear that some of the smaller tumors may have been eliminated?Before chemoLIVER: There are multiple hypodense lesions in the liver consistent with metastatic disease. These
lesions have increased in size and number from the prior study. The largest lesion is again seen in
the right lobe and now measures up to 11.8 x 10.0 cm compared to 10.2 x 8.9 cm on the previous
study. A lesion in the left lobe on image #33 now measures up to 2 cm in diameter compared to 1.1 cm
on the prior study. Several hypodense lesions measuring up to 1.1 cm in the right lobe on image #26
appear to be new from the prior exam.Last cat scanLIVER: As seen previously, there are multiple hypodense lesions in the liver compatible with
metastatic disease. These look generally smaller than on the previous exam. One in the left hepatic
lobe measures 7 mm compared to 20 mm previously. The dominant lesion in the right hepatic lobe
measures 5.0 x 5.9 cm, compared to 9.9 x 11.7 cm previously. Multiple other lesions looks smaller
also.
Expert:  Dr. Arun Phophalia replied 2 months ago.

Fred,

Could you please rate this thread.

Thank you.

The drop of CEA level is not unusual and very encouraging. A significant fall indicates tumor free at this point.

A significant low tumor burden in liver, can be considered as resectable now. So surgery may be considered.

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