Lung met but no liver mets - is that possible?

[musicluvr]

turns out my initial 'spot' was viewed as an anonmoly on the initial CT scan. Docs said we would watch it. It wasn't until my 12 rounds of FOLFIRI ended, then the scan 6 months later that showed they had gone crazy. Multiple spots, both lungs. Apparently the chemo kept them 'at bay', but once the chemo ended, they grew like an S.O.B.

[KWT]

I don't agree that a pet is worthless for a module under 2cm mine lit up at 8mm. Also I don't think I'd wait till something was 2cm to deal with it. I went to stanford (pretty good place) and they plucked out my nodule via vats for biopsie. It's the only way to know for sure. Not to scare you but if you have rectal cancer and a spot in your lungs there's a pretty good chance it's not "nothing". I would have had that thing wedged out of there yesterday.

Well, you know what we went through Kenny. When we were deciding what to do back in December, I found a study of 700 patients that had small nodules with SUV ranging from 1 to 4 on PET/CT and subsequently had biopsies. The R-squared value of correlation was 0.17, which means, for that size tumor there is no relationship. In other words, the PET is a good as a coin flip. Above 2cm there is better reliability, but (if I recall correctly) Lydia is dealing with a 4mm nodule. I would not expect a radiologist to get near that with a needle, so VATs would be the only option. VATs is a major surgery... I would wait.

That's cool, I'm just saying I had nods that lit up and were taken out and were cancer. Coin flip Personally I would rather have a 1 cm wedged out than a two cm. I didn't see anything regarding a four mm. I would just want a single nodule out ASAP. in a rectal cancer case it is highly suspect maybe that's crazy. I'm well aware of what a vats procedure is like as I've had two.
I don't think folks with lung spots are usually quite as comfy with the the watch and wait as the oncs without.

[Lee]

Lydia,

I sure hope this is nothing, but I do understand your concern. My understanding rectal cancer generally will met to the lungs, while colon cancer tends to travel to the liver. But cancer does not follow rules.

I would avoid doing any type of needle biospy to confirm. If it is cancer, and when they removing the needle, some cancer cells have been known to spread.

Will be swing chicken for good news.

Lee

[Lydia666]

Lydia,

I sure hope this is nothing, but I do understand your concern. My understanding rectal cancer generally will met to the lungs, while colon cancer tends to travel to the liver. But cancer does not follow rules.

I would avoid doing any type of needle biospy to confirm. If it is cancer, and when they removing the needle, some cancer cells have been known to spread.

Will be swing chicken for good news.

Lee

Thank you, as always, Lee. I was not worried about it until they scheduled me for a scan (at my request). Now i am all worked up about it... Ugh!

[Lee]

Try not to get to far ahead of yourself. It could be a lot of things, cancer is just 1 possible reason.

Something that helped through scans. Prior to scans and blood work I would tell myself not to worry. No one out there had information on my condition, BUTT once I had the test, I would let myself stress big time till I got I got the results. Don't feel bad about bugging your Doc to get the results ASAP

Again, swing chicken for good news.

Lee

[Nik Colon]

I have 3, 3mm spots on lungs which I know as of first and last CT didn't change, hoping same next months CT. Hoping yours will be the same. Best wishes

[chrissyrice]

So where the heck do I fit into this scenario... not normal.

But, I already knew that definitely I am a rare person and I am always one of the outliers in medical matters.

one single lymph node in the left iliac artery after 5 years of clean scans.

no liver or lungs nodes

[lpas]

So where the heck do I fit into this scenario... not normal.

But, I already knew that definitely I am a rare person and I am always one of the outliers in medical matters.

one single lymph node in the left iliac artery after 5 years of clean scans.

no liver or lungs nodes

Chrissy,

Just FYI, I stumbled across some research the other day suggesting that people with extra-capsular invasion (ECI) are more prone to distant lymph node metastasis. The rationale was a little unclear to me as a layperson but I thought it was interesting. I think I remember you mentioning a while back that you had ECI, right? Am definitely planning to be on the lookout for this, since I have it too.

[justin case]

Our onc said that the lower the primary is in the colon/rectum, the more pathways for lung things. Of course, cancer doesn't follow rules, but it certainly was confirmed multiple times for Sleen that she has colon cancer mets to her lungs and nothing anywhere else. But we spent almost four months confirming that they were not something else... they can be other things that are not cancer. And, if they are small, imaging (CT or PET) can be inconclusive. Even her first needle biopsy was inconclusive and we now think we shouldn't have done it.

Here is what I think (not that it is of any value): if they are below 2cm on CT, just keep an eye on them and wait and watch (PET scan is total worthless for this size and they can't be reliably biopsied by needle). If they grow at an exponential rate, then they are likely mets and action needs to be taken.

I hope this helps and doesn't cause more stress.

I 100% agree with this. I had a 8mm nodule in the lungs, probably due to a life of smoking. It never showed up on PET scans. Living in large cities can also give you nodules, associated with normal intake of emissions generated by cars, factories etc. Keep an eye on it, but even size is not conclusive with a CT. Serious growth is an indication of problems.
Michael

[mariane]

Interesting from Dr Kemeny article about biology of the tumor:

http://www.healio.com/hematology-oncolo ... tal-cancer

"Kemeny and colleagues evaluated genomic data on RAS and PIK3CA mutations from 918 patients with metastatic colorectal cancer.

Overall, 477 patients had wild-type RAS and 441 had RAS mutations. RAS mutations included those at KRAS exon 2 (n=394), at KRAS exon 3 or 4 (n=29), and in NRAS (n=18). Researchers also identified PIK3CA-activating mutations in 76 (9.7%) of 786 eligible patients.

Patients who had wild-type RAS demonstrated significantly longer median OS following diagnosis of metastatic disease than those who had RAS mutations (81 months vs. 47 months; P˂.001). Results of a multivariate analysis indicated RAS mutations were significantly associated with shorter OS (HR=1.6; 95% CI, 1.29-1.9).

Among patients who did not have metastases in these sites at the time of the diagnosis of metastatic disease, those who harbored RAS mutations demonstrated significantly higher incidence of metastases in the lung (32.5% vs. 19%; P=.001), bone (8.8% vs. 4.4%; P=.024) and brain (1.4% vs. 0.2%; P˂.01) at 2 years. The incidence of liver metastases was comparable between patients with and without RAS mutations (12% vs. 14.3%; P=.78).

Multivariate analyses indicated RAS mutations were significantly associated with the risk for brain metastases (HR=3.7; 95% CI, 1.7-8.1), bone metastases (HR=1.62; 95% CI, 1.1-2.3) and lung metastases (HR=1.52; 95% CI, 1.21-1.92).

PIK3CA mutations were not associated with OS, nor were they associated with liver, lung or bone metastases. However, PIK3CA mutations were associated with an increased occurrence of brain metastasis (1.4% vs. 0.8%; P=.001).

“Our findings have implications for understanding the biologic effects of RAS activation in metastatic colorectal cancer and suggest RAS mutations not only affect initiation of disease but also progression,” Kemeny and colleagues wrote. “An understanding of this pattern of spread may help inform physicians’ assessment of symptoms in patients with metastatic colorectal cancer and alert physicians to have a lower threshold to evaluate neurologic or bony-related symptoms in patients with RAS-mutant metastatic colorectal cancer.”

[Lee]

Bumping this back to the top. I don't always check in everyday. Lydia, did you get your scan done yet? If yes, what did it say? Did I miss something? Hoping and praying for good news!!!

Thinking of you,

Lee

[Lydia666]

Bumping this back to the top. I don't always check in everyday. Lydia, did you get your scan done yet? If yes, what did it say? Did I miss something? Hoping and praying for good news!!!

Thinking of you,

Lee

Thanks Lee. My scan is not until the 20th. I will certainly post an update.