Lung met but no liver mets - is that possible?

[Lydia666]

Getting close to my scan for a lung nodule. Are there people on here with lung mets but no liver mets? I was told tge first stop for cancer would be the liver and since that is clear, the lung nodule is unlikely met.

[midlifemom]

Lydia,
I can't speak from personal experience - I went the normal route, liver then lungs.
However, cancer has its own mind and seems to go where it wants. I'm pretty sure others will speak up. I'm sure others have gone straight to lungs, bypassing the liver. I think that is also a bit more common with rectal cancer than with colon.
There are also many on here with lung things that are NOT mets, so don't give up hope.

[radnyc]

I've read that metastasis to the lung is more common with rectal cancer, where as to the liver in colon cancer.

[JDinNC]

I have colon cancer with one lung met, no lymph nodes and no liver mets. My cancer traveled by way of blood.

[aja1121]

My husband has rectal cancer. He had a single met to the right lung, no liver involvement.

[DH2Sleen]

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.

[musicluvr]

I am proof that this happens. Awaiting first scan after 5 rounds containing Erbitux on Oct 13th. My thoughts are with you.

[Mastan]

Getting close to my scan for a lung nodule. Are there people on here with lung mets but no liver mets? I was told tge first stop for cancer would be the liver and since that is clear, the lung nodule is unlikely met.

My Onc told me that the first stop for mets from rectal cancer is in the lungs. It has to do with the blood flow path. It was certainly true for me.

[ams5796]

I have had rectal cancer with lung mets. No liver involvement.



Ann

[CRguy]

Also rectal / lung.... no liver.

[dianetavegia]

Lydia,
The 3mm nodule may have been there in your original scan. The Fleisher Society, who makes all these suggestions for radiologists, leave anything under 4mm to the discretion of the radiologist who reads the files.

So, a year ago my onc said 'and no change in the 2mm nodule' and I freaked. NEVER had a nodule been mentioned. I demanded a recheck in 3 months and then had my regular scans 3 months after that. On that one it mentioned 4 nodules and said 'no change in the nodules'....... so we both were confused. He offered to call head of radiology and have him look. That guy went back to the old CT scanner scans from Jan. 2009 and said they were all there and even pointed out that on one PET scan there was a note at the bottom saying none of the nodules lit up and there had been no change since the previous PET scan. My onc told me nodes don't sit, unchanged, for 6 years and the chief felt I had zero chance of any of these becoming cancerous.

Of course, that will be my first question with this scan but.......... Since the first mention and my scan 6 months ago, it had been over a year.

This is the 'standard' from that society. Oh and I also read that if it's the same group or same reader, after a certain number of 'no changes', they let them 'fall off the books' and don't mention them again unless they begin to grow.

[mariane]

Rectal cancer can unfortunately by-pass liver and get to the lungs. The rectum has three segments: an upper, a middle, and a lower. Distal rectal tumors may easily metastasize initially to the lungs because the inferior rectal vein drains into the inferior vena cava (systemic circulation), bypassing the portal (liver) venous system. Distant metastasis of cancer is presumed to occur via lymphatic or vascular drainage routes, and the liver is the destination of colon and upper-rectal cancers entering through the portal vein. Drainage of distal or mid-rectal cancer cells is via systemic circulation rather than drainage into the portal system (such as the colon and upper rectum ), the metastasis patterns might differ based on the location of the rectal cancer.

http://www.wjso.com/content/12/1/197


DH2Sleen is right. I think an oncologist would suggest watch and see approach.

[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.

[Lydia666]

I am holding on to two details- they said i have no vascular invasion and my tumour was 10cms from the anus, so in the upper rectum. Also Pet scan declared me clear but i realize it's too small maybe. By the time i ll have the scan, it will be about 3.5 months from the initial one- so we'll see what happened to it.

[DH2Sleen]

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.