This is for my father, who is a patient of Colorectal Liver Metastases since 4 years.
He has a metastatic tumor in right lobe of liver which is right now in necrosis stage after Y-90 radioembolization and multiple TACE procedures and.
But about two months ago tumor thrombus developed in IVC that caused obstruction and eventually pedal edema, for which a stent was placed in IVC. The conditions became normal after that but since about a week he has again developed pedal edema. PET-CT and ultrasound confirmed obstruction in IVC due to tumor thrombus.
Doctor has again advised for putting another stent in IVC but is not very confident whether it will eliminate the problem or not as thrombus tends to intervene inside the stent.
Please advice what other treatment options are there to eliminate tumor thrombus in IVC.
From the history provided, it seems that your father has advanced Colon cancer, with metastatic lesions within the liver along with infiltration of the Inferior venacava (IVC) which is a large vein, that returns blood from lower part of the human body to the heart. The cancer in question has a rapid growth rate and since vascular invasion has already occured, spread to other unaffected structures occurs at a rapid rate.
Presence of tumor deposits within the wall of the IVC is termed as tumor thrombus. The chances of the tumor spreading to the heart and to the lungs is high. Complete cure in such advanced cancers is not possible. Since the cancer involved many important and highly vascular structures in the liver, and further extension of tumor cells is possible, the prognosis is poor.
In selected cases, survival can be extended to certain extent via combination of treatment measures including hepatectomy and transcatheter arterial chemoembolization (TACE), Intra arterial chemotherapy or internal radiation.
The stent placed are meant to keep the lumen of the affected vein patent (clear of obstruction). Recurrent growth of tumor cells at the site causes reocclusion and need for re-stenting. Due to the nature of the metastatic cancer, current treatment measures are not efficient enough to clear the whole Unless the whole segment of the affected vein can be resected and synthetic grafts can be used to recreate the structures, the issue cannot be completely solved.
You may consult with the treating oncologist and surgeons, who can help provide you more information regarding further management and treatment.
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