Biomarker Tests on Tumor Tissue - What should I request?

[chrissyrice]

I will be seeing my new oncologist at Emory University on Sept 30th for our first visit.

A lot has changed since 2010 and he is a top doc... but I don't want to assume what tests will be done on the tumor and iliac vein removed during surgery in August.

The path report stated:

Final Pathologic Diagnosis
A. "LEFT ILIAC LYMPH NODE," EXCISION:
· ADENOCARCINOMA, MORPHOLOGICALLY CONSISTENT WITH COLORECTAL PRIMARY, INVOLVING FIBROADIPOSE TISSUE.
· PERINEURAL INVASION IS PRESENT.
· SEE COMMENT.
B. LEFT ILIAC ARTERY, EXCISION:
· ADENOCARCINOMA, MORPHOLOGICALLY CONSISTENT WITH COLORECTAL PRIMARY.
· CARCINOMA IS PRESENT AT ADVENTITIA AND EXTERNAL CONNECTIVE TISSUE OF PROXIMAL MARGIN.
· DISTAL MARGIN IS NEGATIVE FOR CARCINOMA.
C. "AORTIC MARGIN," EXCISION:
· POSITIVE FOR CARCINOMA.
D. "RECTAL ARTERY TISSUE," EXCISION:
· FIBROADIPOSE AND NEUROVASCULAR TISSUE WITH SUTURE MATERIAL, NEGATIVE FOR CARCINOMA.

Comment
Part A: Microscopically there is a tumor nodule involving the fibroadipose tissue with no definitive evidence of lymph node involvement.
This tumor nodule may represent a metastatic nodule or a lymph node metastasis where the lymph node is entirely replaced by the carcinoma.
Parts A and B were reviewed and discussed at our GI Pathology Consensus Conference on 8/17/2015.

So what is the new standard for biomarker testing for targeted chemo?

Also not sure if I should even do chemo as it seems to be so non aggressive over the last 5 years?

I could just be monitored through PET/CT? CEA is not a marker for me... just constipation.

Just thinking...

[NateA]

Scroll down a ways to the thread talking about adding MSI and MSS to your biomarker list...it's the new deal with immunotherapy me thinks.

[Nik Colon]

I will be seeing my new oncologist at Emory University on Sept 30th for our first visit.

A lot has changed since 2010 and he is a top doc... but I don't want to assume what tests will be done on the tumor and iliac vein removed during surgery in August.

The path report stated:

Final Pathologic Diagnosis
A. "LEFT ILIAC LYMPH NODE," EXCISION:
· ADENOCARCINOMA, MORPHOLOGICALLY CONSISTENT WITH COLORECTAL PRIMARY, INVOLVING FIBROADIPOSE TISSUE.
· PERINEURAL INVASION IS PRESENT.
· SEE COMMENT.
B. LEFT ILIAC ARTERY, EXCISION:
· ADENOCARCINOMA, MORPHOLOGICALLY CONSISTENT WITH COLORECTAL PRIMARY.
· CARCINOMA IS PRESENT AT ADVENTITIA AND EXTERNAL CONNECTIVE TISSUE OF PROXIMAL MARGIN.
· DISTAL MARGIN IS NEGATIVE FOR CARCINOMA.
C. "AORTIC MARGIN," EXCISION:
· POSITIVE FOR CARCINOMA.
D. "RECTAL ARTERY TISSUE," EXCISION:
· FIBROADIPOSE AND NEUROVASCULAR TISSUE WITH SUTURE MATERIAL, NEGATIVE FOR CARCINOMA.

Comment
Part A: Microscopically there is a tumor nodule involving the fibroadipose tissue with no definitive evidence of lymph node involvement.
This tumor nodule may represent a metastatic nodule or a lymph node metastasis where the lymph node is entirely replaced by the carcinoma.
Parts A and B were reviewed and discussed at our GI Pathology Consensus Conference on 8/17/2015.

So what is the new standard for biomarker testing for targeted chemo?

Also not sure if I should even do chemo as it seems to be so non aggressive over the last 5 years?

I could just be monitored through PET/CT? CEA is not a marker for me... just constipation.

Just thinking...

Sending PM

[lpas]

CEA isn't a good indicator for me either. I had my tumor tissue stained for CA19-9 and it came back positive. Now I always have CA19-9 drawn along with CEA because I know it should be a good marker for me, even if CEA isn't.

There's also a another tissue stain that should help to determine whether or not long-term cimetidine is effective. I believe it's E-selectin (taken together with the CA19-9 result). rp1954 is the resident expert on this--hopefully he'll chime in.

I assume you're also having the standard tests run for mutations (KRAS, BRAF, etc.)?

[rp1954]

My personal view of lymph node control and tumor cell residues is continuous chemistry, whatever mild chemo and of label immune modulation it takes to suppress active/elevated biomarkers. At different times CEA, CA19-9 or even another, like AFP, may be the most elevated cancer marker, backed up by less specific responses in LDH, GGT, d-dimer.

Getting very many extra tissue markers done may be a little bit of a chicken and egg situation. The best way to start is with blood markers before and after surgery. This rapidly "scans" for candidates, now and later. The most numerically common markers after CEA are probably CA72-4 and CA19-9, then perhaps AFP and CA125. AFP can reflect a slow mover.

Right now there are two add-on targeted treatment possibilities: tissue stains with CA19-9 and E-selectin for cimetdine (not yet recognized as a "standard" even though it appears to be more definitive to me) to control mets if + +; and extended Kras for Erbitux. SInce cimetidine seems to work on many Kras mutants (which codons/exons?), it is unclear to what degree cimetidine and eribtux might overlap, if any. They might be exclusive and complementary, that a tumor could be susceptible to one but not the other.

Even starting late, I'd run the extra blood markers and panels to create a benchmark, to find anomalies either now, or later.
I would hold any oncologists and pathologists to a more aggressive survey than just "standard" biomarkers. We only live once. We've only been able to succeed on nodes because we exceed "standard", both surveillence on blood work and continuous tx.

[DK37]

Seconding Nate's comment, for sure find out your MSI status if not already known. The key to strategizing immunotherapy possibilities. If you are MSI-high, you have a decent shot of responding to PD-(L)1 inhibitors already in trials/approved.

-DK

[chrissyrice]

Thank you all... MSS high or low... have to be tested.

I will google it

Chrissy

[DK37]

Thank you all... MSS high or low... have to be tested.

I will google it

Chrissy

Here's a recent pretty detailed thread here on it Chrissy!

viewtopic.php?f=1&t=52480

Take care,
DK

[mariane]

I think you should discuss with your oncologist the positive aortal margin. I would send tumor tissue to foundation one or car is to check it for mutations. Do you know your kras, nras, braf status?