Brain Mets--Tell Me What You Know

[fritts44]

Hopkins, your story is just amazing! I hope radiation works it's magic on you again!

[prtza]

you will never find a colon cancer pt getting radiation, because it can damage other structures and the colon is constantly undergoing perastalsis (movements in the bowel that aide in digestion).

Well, not never. I received 30 treatments of chemoradiation and I am being treated for colon cancer (descending/sigmoid).

But that was due to tumour invasion of the abdominal sidewall. And bone apparently.

EDIT:

From http://www.cancer.org/Cancer/ColonandRe ... -radiation

"The main use for radiation treatment in people with colon cancer is when the cancer has attached to an internal organ or the lining of the belly (abdomen). If this happens, the doctor can't be sure that all the cancer has been removed, and radiation is used to kill the cancer cells left behind after surgery"

[chessamay]

Catherine,
I'm well aware of the differences between colon and rectal cancer as well as the differences/similarities in their treatments.
I do think that saying that colon cancer doesn't generally metastize first to the brain is a more appropriate statement because of the handful of people on this board that I know have/had definitive brain mets, half are colon cancer and half are rectal cancer patients.
I would also say that NONE of the rectal cancer patients (that I know of) with brain mets had those mets before mets to either the liver, lungs, bones or some combination of those places. I think it's fair to say that IF a colorectal cancer patient has brain mets, they've almost exclusively had mets first to some other location

I also think it's a fair statement to say that once the cancer is pretty much all over your body (i.e. in multiple sites such as lung, liver, lymph nodes, bones, etc), it's not a stretch to believe that brain mets couldn't easily be next. Over the years, I've known eight members of this board who have had confirmed brain mets and they've all had the cancer spread throughout their body first so it really was no surprise that the cancer eventually reached the brain.

That was my point! I agree with you! But I was stating where it will most likely head first if the ca were to metastasize....
Our oncologist is constantly scanning Ivan's liver because he knows that is most likely where it will go-
his CEA's are like a yo yo. He just recently received an MRI of his liver only because of it. (didn't want too much radiation).

[chessamay]

you will never find a colon cancer pt getting radiation, because it can damage other structures and the colon is constantly undergoing perastalsis (movements in the bowel that aide in digestion).

Well, not never. I received 30 treatments of chemoradiation and I am being treated for colon cancer (descending/sigmoid).

But that was due to tumour invasion of the abdominal sidewall. And bone apparently.

EDIT:

From http://www.cancer.org/Cancer/ColonandRe ... -radiation

"The main use for radiation treatment in people with colon cancer is when the cancer has attached to an internal organ or the lining of the belly (abdomen). If this happens, the doctor can't be sure that all the cancer has been removed, and radiation is used to kill the cancer cells left behind after surgery"

I meant initial treatment of colon cancer. Of course if it mets to other areas radiation is prudent....I am so sorry what you are going through......
Catherine

[prtza]

I would quote but I font know how to cut text on my cell phone... thanks Catherine for the sentiment but I am really fine for now. Xelox is no walk in the park but I am halfway. My tumor markers are excellent do it is looking quite good at this stage. Ciao Paul

[frances]

Colorectal cancer CAN give rise to single site metastasis in the brain.

A very very small percentage of patients but when I need to find out the answer, I will be going to an academic source.

I recently saw a colorectal cancer study (2012) that looked at single site metastasis (ie the first location of metastasis) to brain, bones, lymph nodes, pelvis and liver - and lung. **The sample showed most were liver, more than half, then PELVIC, then lung, then lymph node (lung and lymph node almost same), then bones, then brain. The brain was a tiny fraction of the overall number of the sample. Lung showed the best survival.

The sample, is different from a study that sought to find out the site that had the most metastatic spread. But it probably reflected reality in its own data spread.

Frances
**EDITED info - I apologize that I had the line-up wrong here - it was liver, pelvis, lung then lymph nodes, then bones then brain.

[Laurettas]

Interestingly, the only place that hasn't been mentioned on Jake for mets has been the liver. Go figure!

[weisssoccermom]

point is - cancer doesn't follow any rules. Look at breast cancer patients - for example, of all the friends that I have or had with this type of cancer not one of them was told that the cancer mets to the brain but.....only TWO out of 10 have NOT had brain mets. Totally opposite of what the oncs said. Are these just 'rare' cases - I doubt it. The two that don't have brain mets are still fine - all the others have died from the disease with very real brain mets. Again, I believe that because all cancer patients are generally surviving longer, what used to appear to be a rare occurence - in this case brain mets, probably isn't as 'rare' as we used to believe. Oncs are able to keep patients alive longer with ACTIVE cancer cells and even though those cells appear to only be in the liver, lungs, nodes, etc. isn't it just as likely that the cancer itself is spreading all the while?

As for colon cancer patients not getting radiation until a met occurs - sorry that isn't always the case. I understand your point, Catherine, but tell that to the colon cancer patients whose margins were not clean and, although no mets, did have radiation after their surgery. Now, I'll agree that most of those that I know of (on this board and on the others I am a member of) had colon cancer in their sigmoid region but they were classified as COLON cancer and not rectal and yep, they did have radiation specifically because their margins weren't clean.

While there are standards throughout cancer treatments, nothing is written in stone.

[Laurettas]

I have heard from two sources that the platinum drugs can foster mets to the brain somehow. Don't know if it is true because I haven't been able to find it in a study but that could explain the rise in incidence of brain mets.

[juliej]

Interesting discussion!

A 2012 study says that brain metastases from colorectal cancer are rare, with an incidence of 0.6–4%. Our numbers on this forum seem much higher to me.

However, I would caution about drawing conclusions based on the experiences of people here. As my science teacher often said, "correlation does not imply causation." The people on this forum are a select group of individuals and certainly don't represent a complete spectrum of all CRC patients.

I also found a study that analyzed the incidence of brain mets in cancer patients (lung, melanoma, breast, renal, and colorectal) in the metropolitan Detroit area from 1973 to 2001 (so a big study involving many patients over a long period of time). In the notes below "IP" refers to "incidence proportions."

The IP% of brain metastases for African Americans was significantly higher compared with the IP% for white patients, for lung, melanoma, and breast cancers, and was significantly lower for renal cancer (similar IP% seen by race for colorectal cancer). Men had similar or higher IP% of brain metastases compared with women, except for those individuals with primary lung cancer, for which the IP% was significantly higher for women. IP% of brain metastases was highest for those diagnosed at age 40 to 49 years with primary lung cancer; age 50 to 59 years with primary melanoma, renal, or colorectal cancers; and age 20 to 39 with primary breast cancer. The trends by age showed that the absolute frequency of brain metastases increased to a certain age and then decreased, although the age at which the absolute frequency peak occurred did not directly correlate with the age at which the peak in IP% occurred (Fig 1A and B). Individuals diagnosed with primary lung cancer at age 60 to 69 years showed the highest absolute frequency of brain metastases, but the peak IP% of brain metastases was seen for those diagnosed at age 40 to 49 years with primary lung cancer. Individuals diagnosed with primary melanoma at age 50 to 59 years had the highest absolute frequency and highest IP% of brain metastases, as did individuals in the same age range diagnosed with primary renal cancer. Individuals diagnosed with primary colorectal cancer at age 60 years and older had the highest absolute frequency of brain metastases, but individuals diagnosed at age 50 to 59 years had the highest IP%. Most surprising were the results for primary breast cancer, which showed that early-onset breast cancer cases (individuals diagnosed at age 20 to 39 years) had the highest IP% of brain metastasis, though the absolute frequency of breast cancer resulting in brain metastases was low in this group compared with other groups.

A statistically significant trend of increased IP% of brain metastases as SEER stage of primary cancer became more severe was seen for all primary sites; in other words, for all primary sites, those individuals with distant-stage primary cancer had the highest IP% of brain metastases. Of all individuals with distant-stage primary disease, those individuals with primary melanoma showed the highest IP% for brain metastases, which corroborates with previously reported data about the propensity of this disease to migrate to the brain. Peak absolute frequency of brain metastases and peak IP% of brain metastases perfectly correlated for patients with primary lung or renal cancer and distant-stage disease. Individuals with primary colorectal cancer had the lowest IP% of brain metastases for all stages of disease compared with the other primary sites studied.

[Mojo]

My husband had a tumor size of a small apple in back side of brain, removed march 2010 . History is stage 3 in may 2002 folfiri and 5 fu, no return til march 2010 . Then the brain tumor, adrenal mass, lung involvement with nodes. He has 5stereotactic radiation treatments prior to chemo , he died november 21 , 2011 . They had given him 3 month to one year to live, he got 18 months. He was going to have clinical trial in aug but the brain tumor started growing again and excluded him. Prayers for you!

[chessamay]

As someone mentioned, probably best to consult your Surgeons, oncologists,etc..........
Catherine

[Kathryn in MN]

point is - cancer doesn't follow any rules. While there are standards throughout cancer treatments, nothing is written in stone.

I am a prime example that cancer doesn't follow rules and doesn't always follow the "path" that is expected. I had a huge tumor in the sigmoid colon - not near the rectum - definitely colon cancer and not rectal. At dx (2 years after continued misdiagnosis) I had distant lymph node mets in one region (plus the localized lymph nodes with cancer). I NEVER had any liver or lung involvement. The lymph mets spread to other regions over time - first to periaortic, which is also not common. Currently I have several bone mets and several distant lymph node mets in many different regions (all within the trunk of my body, and all well above the pelvic region). I still have no liver or lung involvement. I have no brain involvement as of March 2012. I had a brain MRI due to issues going on - but it turns out those issues were probably from the tumors on my spine which were not picked up by CT scan - only finally dx'd by PET/CT in August.

So far I have not found another patient with no organ involvement ever, with mets to bones. There has to be someone else out there, but this is not common. It is hard to find others with mets only to lymph nodes without ever having had any mets to organs at any point. I've had both happen now. The biggest mistake we can make (or our doctors can make) is to overlook the fact that cancer doesn't play fair, and doesn't always follow a specific path. My oncologist told me my collarbone pain was probably scar tissue from a prior port, and my severe shoulder pain and trouble couldn't be cancer, so I should see another doctor to treat that. Five months later both were confirmed to be bone mets, along with 4 in my spine. Do not assume anything when it comes to cancer - or you may regret it. No way will I assume that I won't get brain mets because I had colon cancer and not rectal. No way will I assume I will never have organ involvement just because I haven't yet. Any new problem is suspect for cancer growth/spread.

[livingbyfaith]

You know as spouses and caregivers, the stress can be overwhelming which is not helpful to fight the beast. My husband is on a chemo break however they said this will be the rest of his life, battling cancer off and on. We went to Florida for a trip, the best thing we ever did to get away from the situation for a while. I suggest short frequent breaks whether movies, a driving trip just to see scenery, anything to get away from constant stress. I told the assistant doctor they were being negative, that God was in control and he laughed and said that was true but they all speak to patients from a medical standpoint. I've loved this site since the beginning, gives me strength seeing others survive the battle. All we really need is timeto wait for new things that are coming up all the time. God bless.

[Laurettas]

Just a quick update on Jake. Went to the experts this week and all they could offer was a 1-2 month extension on Jake's life with aggressive treatment, so he has opted to forego any more treatment. They give him 1-2 months without treatment.

I agree livingbyfaith, it is good to get away. Even the travel to and from the doctors, a five hour drive, Jake found relaxing. We are taking off tomorrow for a couple of days to attend a cousin's 60th birthday party. It's an 11 hour drive so lots of time to smell the roses on the way--although we will be driving mostly in the desert, so it will be more like smelling the sagebrush!

Again, thanks everyone for the input. It was all very helpful.