Just Diagnosed. 19-24 lymphs. Need advice

[Achilles Torn]

Hi Everyone,
I am a newbie to this having just been diagnosed after pathology with T3N2M0. So IIIC but with 19 of 24 Lymph Nodes Positive. Had sigmoid resection 2 weeks ago and have not had a meeting with an oncologist yet. Had a CT just before surgery that showed no mets (but not super confident in just a CT). From my own looking around 19 of 24 is the highest lymph involvement I have seen which isn't bolstering me much. My question is: with such a high ratio of positive nodes is it an option to have further surgery to remove more nodes ? I'm worried that with about 80% of nodes positive there might be some left that should be surgically removed.

I'm 40 year old male.


Thoughts ?

[Pat]

I had 25 of 30 nodes positive for cancer. So far I am NED and hope to stay that way.

[Green Tea]

Was your resection a Left Hemicolectomy?

I think it would help if you could create a signature block here to give people the basic information on your situation.
A link to the signature creation page is here

http://coloncancersupport.colonclub.com/ucp.php?i=ucp_profile&mode=signature

The kinds of things that you might want to put in your signature are listed in this post:

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=52681&p=421597#p421597


Once you create your signature you should update it each time you have additional, relevant information to add.

[Alessandria]

It might be a good idea to get a PET scan- I had more distant lymph nodes affected and they were only picked up on PET.

[Achilles Torn]

My colectomy as about 9inches of sigmoid colon so that would be the left side I believe.

Sorry I'm a little low on details. I just want to be prepared to be my own best advocate.

Anyone have thoughts on asking for additional surgery to remove more lymph nodes ?

[plastikos]

I think the best option now would be to start chemotherapy. Unless it's standard procedure where you had it done, request to have your tumor tested for KRAS, MSI status. A PET this early post-op would have areas of inflammation lighting up all over and would not be accurate. Maybe sometime during chemotherapy would be more appropriate.

[stu]

Hi,
Just to add another angle . My mum was stage 4 at the point of detection . A significant spread was already in her liver , the largest being the size of a small orange. The lymph nodes around her bowel tumour were enlarged and reactive. She went straight to chemo , which worked well on these fast growing tumours. Surgery was then possible... no cancer cells were detected after surgery in her lymph nodes. Maybe chemo did a great job . Who knows but getting a baseline pet scan if possible could be a clever plan and a reassuring one. Funny enough a pet has only ever confirmed what the ct was showing for my mum but everyone is different and it's good to get a baseline assessment .
I wish you the best,
Stu

[teri3]

I'm in agreement with Plasitkos. I'm betting your oncologist wants you to start Folfox chemo. that should help mop up any residule cancer cells. Also like Plastikos said demand testing for MSI and Kras, these are very important on how they treat your cancer. Good luck!!
Hugs,
Teri

[Alessandria]

Correct me if I'm wrong, but kras, braf testing doesn't make any difference to adjuvant chemo, you just get folxfox/capox. Which is why it's important for any metastatic disease to be picked up, and then other treatments like avastin, cetuximab can be added, depending on the kras, braf testing. Again, correct me if I'm wrong.

[fumaros]

You should probably wait for the result of a PET Scan before requesting further surgery. When the surgeon cuts out the cancer tumor, they take all the lymph nodes attached to it. So he can't randomly take out more lymph nodes without some prior awareness of where the tumors are. Besides, if you undergo surgery right now, you will push back when you can start chemo as your body will need to heal sufficiently before chemo can begin.

I know you are anxious, but an oncologist at MSKCC told me that sigmoid colon cancers tend to be less aggressive. The chemo will take care of the any tumors and metastasis that the surgeon and CT and PET scan can't see.

Patience is a big part of the approach to cancer.

All the best on this journey, try not to give in to worry, and focus on healing and getting ready for what''s next.

[DarknessEmbraced]

I can't answer your question regarding lymph nodes but just wanted to welcome you.*hugs* I'm sorry for your diagnosis.*hugs* I had half of my sigmoid and half of my rectum removed. Stage 2a, T3N0M0, no chemo, have been NED since surgery. Lymph vascular invasion undetermined. I hope that your chemo goes well.*hugs*

[jdepp]

I was diagnosed with 19 infected lymph nodes, too. Maybe we can start a club?

My advice is to let the chemo do its work. A lot of treatments are in development now and might well mature by the time you need them.

[Achilles Torn]

Thanks so much for all the responses. I apologize for being so clueless but there is so much to digest. I probably should just be waiting to speak with an Onc. but can't seem to drive the questions out of my mind. I will definitely be seeking full chemo. My pathology report has a lot of scary comments in it (even beyond the 19 positive Lymph Nodes) so I am sure I won't be turned down

With this pathology I am worried about Lymph nodes having already spread (not to mention having one swell up behind my knee about 4 nights after surgery and then go away which I put down to a response to the removal of the others)

Does anyone know how much time after surgery you would need to have the PET scan be effective. I am only 12 Days out now so I am guessing more like a month (around the time Chemo should start from my understanding)

Thanks so much

AT

[rp1954]

I agree with plastikos to begin testing asap. Getting and using molecular information is a key to survival in advanced CRC.

A lot of patients dx'd stage IIIc are either already metastatic or will be, tissue KRAS and serum CA19-9 are big clues. Stage IV's initially (mis)diagnosed as IIIc are not that uncommon either, changed with more information later. The high lymph node count is certainly a risk factor. Also high lymph node activity tends to be associated with some CA19-9 elevation (above 22). In any case, we got the CA19-9, ESR, CRP, and LDH (a really cheap biomarker that can be added to the standard monitoring package) done sooner than "standard" and profited from the extra information. I don't even trifle with oncologists that can't get this much done. The more data you can compare from before chemo, the more effective your treatment choices are likely to be.

Also we have seen benefit from permanent, daily 5FU combination treatments on lymph nodes asap until they could be cut out, or suppressed by the combination of chemo, targeting and immunotherapies. Some ADAPT (xeloda+celebrex) patients with active lymph nodes may have seen a long term benefit, too. You might review the CT archives here on ADAPT. There are several inexpensive adjuncts that help prevent or suppress metastasis even before stage IV.

[Wonderfullymade]

I had a lot of nodes too after each of my surgeries ( just didn't bother to put it in my sig) and am still fighting them, in my case the suggested course of treatment is chemo/immunotherapy, not surgery.
I wish you all the best and will keep you in my prayers! Try to stay positive there really are a lot of new treatments out there and new ones in the works!
Wonderfullymade