instruction: hello doctor please can you look at this letter and report as they differ we have been told the following are metastases which we agree with liver met aortocaval node sub pleural nodule but the oncologist letter says possible peritoneal disease why did the it report not state peritoneal disease and once has rated this mets are under am if they are abated is this better so far irinotecan not worked what to do prognosis
output: hello I can understand your situation at the moment but you have to accept the facts about your patient first thing is he has incurable disease he has undergone a major surgery in spite of treatment underlying disease is progressive and most important the disease is wide spread in the body in distant organs so the treatment options are very limited which have been tried already and beyond that the disease is not responding to the treatment given coming to your questions the aortocaval node is increased in size this is suggestive of peritoneal progression so oncologist can see it in it films it is not necessary that only radiologist findings to be final also there are adrenal metastasis only ablation of liver mets will not cure the disease as it is stage that means it is spread to other organs already so treatment of metastatic lesions will not cure primary disease irinotecan not worked suggests that it is chemoresistant malignancy so any palliative treatment will not work in future last thing about prognosis you have already been told by your primary oncophysician about it is stage disease now with no response to palliative chemotherapy so prognosis is very grave he is so lucky that in spite of such progressive disease he is asymptomatic at present but we cannot predict exactly when the things will go wrong and the period he will be alright so better to continue only symptomatic palliative care