Extramural vascular invasion - significance for stage IV

[risto]

I understand that EMVI has a worse prognosis, and that it has clinical significance for how stage II or III is treated, but I have not found in the literature any reference to the prognostic significance for a patient who is already stage IV. Does anyone know or can point me in the right direction? Thanks in advance.

[Achilles Torn]

I don't think it has been studied much in stage IV as it doesn't impact treatment. From my reading it seems once cancer is stage 4 it has shown its ability to spread mets and the local pathology becomes less important. Some poor prognostic factors such as more aggressive cancer like grade 3 at stage 3 may actually respond better to chemo as a stage 4 and for met shrinkage etc.

Genetic testing is probably more important at stage 4 for BRAF, KRAS, NRAS etc. To determine treatment options.

Cheers
AT

[Beckster]

I have also been research this...and think the reason why there is not much information on EMVI is because it is significant for recurrence in stage II and III. In fact I can find little information on LVI as well. Most of the info I found on EMVI dealt with colorectal cancer. Did you find this also?

[LPL]

Aschilles Torn wrote:
I don't think it has been studied much in stage IV as it doesn't impact treatment. From my reading it seems once cancer is stage 4 it has shown its ability to spread mets and the local pathology becomes less important. Some poor prognostic factors such as more aggressive cancer like grade 3 at stage 3 may actually respond better to chemo as a stage 4 and for met shrinkage etc.

Genetic testing is probably more important at stage 4 for BRAF, KRAS, NRAS etc. To determine treatment options.

To me it looked like a good thing when hubby's colon surgery pathology report came back saying grade 1 (the biopsi had said grade 3) but when I asked the onc Dr she said "when stage 4 this doesn't matter". CT showed his resectable liver mets did not shrink much after 4 chemo but after surgery the pathology report of the mets said 'major response', as I understand it that means 1% to 49% residual cancer cells - so even if the mets hardly shrank in size it sounded to me like the chemo had effected the cancer cells.
I hope I understand this correct?

[risto]

Thanks to your replies! From what I gather based on what the doctors have said, due to the EMVI they recommend radiation to prevent local recurrence. It has something to do with increasing the likelihood of clear margin post surgery. Just because the fear is over liver recurrence, it doesn't mean that local recurrence is not a concern. It is just as likely if not more likely and in the long run just as bad. I just have not been able to find much data on it in the scientific literature.