Hi,
Welcome back to icliniq.com.
Thanks a lot for providing this information, and attaching the PET, CT, and MRI reports (attachments removed to protect patient identity). It does make me more aware of the original disease, treatment given, and progress of the disease as well. However, my interpretation of the pathological report stays more or less the same. But, now I can explain that better to you. This is rare cancer, and the five years survival for such a patient treated at best center in the worls is around 40 %. That means out of 100 patients with this cancer only 40 will be alive, five years after the diagnosis. Most likely, it was advanced cancer at the time of diagnosis, and it had invaded surrounding structures. I say most likely as none of the imaging reports mentioned at what stage the cancer treatment was started, and none of the MRI or PET scan attached is before the first surgery, and pathological report of the first surgery and the intraoperative details of the surgery are missing. Depending on the stage of the disease, for this cancer the possibility of surviving five years without the disease coming back ranges from less than 25 % to a maximum of 70 %. These surgery details and previous imaging will not change anything now at this stage, so if you do not have them, never mind. The cancer is a type of squamous cell carcinoma, for which chemotherapy alone usually does not help much after the surgery. Unless combined with radiation for some tumors that could not be removed completely. That is why alternative chemotherapy was given, and surgery was done for recurrence. In the MRI reports, there is no indication of cancer reaching the bone, but in the surgical specimen taken out, bone of the pelvis was found to be invaded by cancer. It is important to note that it was not a direct invasion like an army invading a border. It was more like some tumor cells slipped out of the tumor into the blood vessels and made a nest in the bone nearby (this is called metastasis).This situation was taken care by removal of the bone, but what about the other cancer cell that went beyond this very bone? Those cannot be managed by any more surgery, and this a danger sign. They will make trouble some day if not taken care by chemotherapy. Now the question is, what chemotherapy? The simple answer is whatever the patient can tolerate because anyways it is not going to help much. These cancer cells that survived the previous courses of chemotherapy are going to be resistant to many drugs and are very difficult to control. So, it is a lost battle that we have to fight, just because we have to do something to prolong the fight. But to win it will be a miracle. So most likely, after discharge from the hospital, there will be repeat tests and maybe some chemotherapy with uncertain benefit, but only if the patient can tolerate. In my opinion, he is too week by his given weight and height. I wish I could have been in a position to help. But hope you understood the above. Talk to your doctor about the information mentioned above. Follow-up if you want any clarification after you discuss the plan with your doctor.