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Opinion if chemo should be given or not
The patient was diagnosed with poorly differentiated signet ring cell adenocarcinoma of the colon with lymph node and peritoneal metastasis (stage pT4aN2bM1c).
• Treatment so far: Right extended hemicolectomy (July 2024) → 12 cycles of FOLFOX + Bevacizumab (completed June 2025).
• Progression (Aug 2025): Recurrence at anastomotic site and abdominal wall, causing pancreatitis, obstruction, and severe abdominal distension. Biopsies confirmed recurrent adenocarcinoma. Multiple interventions were done including DJ stenting, sigmoidoscopic decompression, and finally emergency laparotomy with ileal resection, double-barrel ileostomy, sigmoid colostomy, and DJ stent replacement (18 Aug 2025).
• Current Status: Disease has advanced with complications.
• Surgeon’s opinion: Focus only on pain control and avoid further aggressive treatment.
• Oncologist’s opinion: Chemo can still be considered.
i need an opinion what should i do chemo can i tell doc to give or just pain killer
Thank you for sharing the case.
So in this case, since the patient had stage 4 disease at the time of diagnosis itself and since then has now progressed on 1st line FOLFOX + Bevacizumab with multiple complications and comorbidities over a period of 2 months, the focus is without a doubt to give a good quality of life. Having said that, whether to make a decision on giving the patient 2nd line chemotherapy or targeted therapy (with other Anti EGFR agents) +/- 2nd line chemotherapy or even immunotherapy, the need for mutation analysis (if not done previously) is deemed necessary so as to understand which agent will work the best in this setup and a decision can be made after reviewing the patient's general condition and performance status (ECOG criteria) whether they are fit to tolerate the planned therapy versus best supportive or palliative care only
Next Steps
1. Trace the NGS/RT-PCR report whether there is any mutation - KRAS/NRAS/BRAF/Her2neu/MMR to help decide next line of treatment
2. To review along with the patient & discuss further treatment options if the patient's general condition & performance status permits (choice of treatment shall remain at the discretion of your primary medical oncologist)
3. To meet a palliative care specialist for continuation of best palliative & supportive care
Answered
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