newly diagnosed newbie

Please feel free to read, share your thoughts, your stories and connect with others!
User avatar
LPL
Posts: 412
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: newly diagnosed newbie

Postby LPL » Tue Apr 25, 2017 2:47 pm

mpbser,
Regarding CA19-9.
Hubby and I live in Europe, France, and here they test both CEA and CA19-9. As you can see in my Signature his CEA has not reacted much (yet) but CA19-9, that was high from start, has gone down after surgeries and after chemo.
rp1954 mentioned the tests CRP & LDH to be added and we monetor those for hubby too. Need to ask about a new vitamin D check up or send one off ourself, at diagnose it was lowish (not terrible but a lot lower then he has had before the diagnose).

Best of Luck with your surgery!
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: newly diagnosed newbie

Postby mpbser » Tue Apr 25, 2017 5:26 pm

Great questions, JJH. I see my surgeon’s nurse tomorrow and I will ask her!
Thanks for the answer to my question, Beckster. This learning curve is steep.
Thanks, rp1954. Very informative, very helpful.
LPL, I was wondering if CA19-9 was standard procedure in Europe. You answered my question before I had to ask. Cheers!

So, this morning, I faxed in a bunch of questions I gathered from this discussion in this thread to my cardiologist and surgeon. I haven't heard back from the cardiologist, but I do see him next week. I got a wonderful phone message from my surgeon inviting me to discuss the questions that related to him. I see his nurse tomorrow so I will follow up then. He also said that I should have been offered a pre-surgery consultation with the oncologist and said that to have one "would be prudent." I called the oncologist's office to ask why such a consultation was not offered and said that I had a number of questions that were time sensitive and required action before surgery. The nurse I spoke with was very defensive about scheduling just the post-operative appointment, saying that the oncologists "normally don't get involved until after surgery." She asked me to fax in the questions I had and said she would get back to me. I faxed them in and then I was busy for the rest of the day and missed her two phone calls. She didn't leave any voice messages. Such defensive and evasive behavior doesn't exactly instill confidence.

My wife and I are going in separate cars to the surgery nurse appointment tomorrow. If I don't have time to stop in the Cancer Center I will have her stop in. Hopefully she will get some answers.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

Soccermom2boys
Posts: 196
Joined: Tue Nov 10, 2015 10:29 pm

Re: newly diagnosed newbie

Postby Soccermom2boys » Tue Apr 25, 2017 8:25 pm

mpbser wrote:I have noticed that some of you have received FOLFOX and others Xeloda. It would be great to know what made FOLFOX the cehmo of choice for those who use that and likewise for Xeloda.


From my time on this board, this is what I have learned in general regarding FOLFOX vs Xelox:

Generally FOLFOX is the standard, at least to start with, depending on your body's and/or tumor's unique reaction to the chemo. Both of the treatments use Oxaliplatin which is the OX in each term. FOLFOX is the IV infusion vs Xelox being the pill version. With FOLFOX your treatments are every two weeks and with Xelox I believe it is two weeks of pills and one week off. You also should be able to do Xelox without needing a port, but with FOLFOX it is highly recommended. I personally don't swallow large pills well and the Xeloda 500mg pills were challenging for me during my chemo radiation so no way could I have gone the Xelox route. I have found it interesting, and definitely disheartening, to hear that it seems some oncology offices fight you regarding taking Xelox over FOLFOX because of the money earned by having you at their infusion center vs going to a pharmacy to pick up your Xeloda pills. I only know of that based on what I have read here, but I could see where that could be the case in this day and age unfortunately.

Good luck with your appointment tomorrow and I hope you are able to get your questions answered--for the surgery you are undergoing it seems criminal that they wouldn't take the time to go over all of your questions and concerns. If only some of these people were in our shoes (not that I am in any way wishing any of this on anyone!) would they understand how scary it is and how life-altering it can be.

Let us know how the meeting goes and how you choose to proceed--good luck! I am by no means an expert, just trying to help you out with some of the basics as you are trying to figure all of this out.
8/3/15 Went in with a hemorrhoid, came out with a tumor
8/12/15 Biopsy from colonoscopy confirms RC (45 yrs old--zero family history!)
9/21 - 10/29/15 chemorad 28 tx (with Xeloda)
12/17/15 APR with perm colostomy
Pathology report stages me as IIIA (T2N1M0)--1/15 LN detects cancer
2/3/16 chemo port inserted
2/8-6/2/16 8 rounds of Folfox

JJH
Posts: 167
Joined: Mon Apr 24, 2017 7:26 am
Location: Europe

Re: newly diagnosed newbie

Postby JJH » Tue Apr 25, 2017 11:46 pm

mpbser wrote:I have noticed that some of you have received FOLFOX and others Xeloda. It would be great to know what made FOLFOX the cehmo of choice for those who use that and likewise for Xeloda....

If you opt for Xelox (Capox), then you will have to decide on how you want the oxaliplatin infusion to be done. Mine was done with peripheral IV to the wrist. This can be very tough on the veins,where they shrink or recede over time to the point where, after a number of cycles of oxaliplatin it is almost impossible for the nurse to find a vein large enough to set up the IV -- at least that was my experience. If I had to do it over again, I would choose a different mode of infusion.
Last edited by JJH on Thu Apr 27, 2017 2:28 am, edited 1 time in total.

JJH
Posts: 167
Joined: Mon Apr 24, 2017 7:26 am
Location: Europe

Re: newly diagnosed newbie

Postby JJH » Wed Apr 26, 2017 2:54 am

mpbser wrote:... This learning curve is steep...

Yes, it's true -- there's a lot to assimilate in the first few weeks. However, many on this forum have been through the same situation, and the archives here show answers to some of the same questions and concerns that you now have. You just have to find them in the archive. Here are a few examples:

http://coloncancersupport.colonclub.com/viewtopic.php?t=42706&p=300903#p300903
.
http://coloncancersupport.colonclub.com/viewtopic.php?t=50520&p=388015#p388015
.
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=50471&p=387437#p387437
.
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=51436&p=399172#p399172
.
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=46204&p=337624#p337624
.
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44542&p=321388#p321388
Last edited by JJH on Fri Apr 28, 2017 8:57 am, edited 2 times in total.

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: newly diagnosed newbie

Postby mpbser » Wed Apr 26, 2017 6:51 am

"I have found it interesting, and definitely disheartening, to hear that it seems some oncology offices fight you regarding taking Xelox over FOLFOX because of the money earned by having you at their infusion center vs going to a pharmacy to pick up your Xeloda pills."

Not surprising and, actually, to be expected. Thanks for the heads up!

Thanks to everyone with the helpful input! I will be back later to update with today's news.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: newly diagnosed newbie

Postby mpbser » Wed Apr 26, 2017 7:41 am

BTW, these were the questions I faxed yesterday:

1. Why won’t he be tested for CEA right away?
2. Will there be CBCs done routinely? Renal function tests? In Japan, it is standard to test renal function before doing chemo.
3. Tumor can be graded from biopsy at colonoscopy. What was it?
4. Why not tested for genetic mutations or other biological abnormalities that might influence treatment or staging? There is a range of new genetic tests that can be done to determine whether a patient will be a good candidate for this or that type of therapy. Some of these tests require tissue specimens captured in a certain way or preserved in a certain way. If these options are not discussed beforehand, then later on it may not be possible to get the desired test done because the opportunity to do so was missed.
5. Relative to #4, Oncotype DX test -- a genetic test that is mainly relevant for patients diagnosed as T3N0M0. The test is useful for determining whether such a patient would benefit from chemo or not. The test needs to be done before the decision is made about starting any first line chemo. This test has very specific specimen requirements. Will the surgery collect the specimen in a manner that will be appropriate for: http://colon-cancer.oncotypedx.com/en-U ... ingASample ?
6. Is there any anticipation of needing PET scanning?
7. Michael’s father died of pancreatic cancer in his early 60s. He was diagnosed with type 2 diabetes a few decades earlier. Michael was recently diagnosed with type 2 diabetes. Apparently, sudden diabetes is an early predictor of pancreatic cancer as it affects insulin production. While diet has also largely influenced the condition in Michael, he has dramatically changed his diet yet his blood glucose levels remain high. Shouldn’t he be tested for CA19-9?
8. The easiest CA19-9 information patients can get is the CA19-9 blood levels before and after treatments, especially surgery. Although other conditions can raise CA19-9, it is a targetable biomarker in CRC. Those advanced CRC patients who had the common CA19-9 biomarker in their tumor tissue had dramatic improvements in survival. According to another patient, after analyzing various literature, he decided he should buy cimetidine for post op use if peak (presurgical) blood CA19-9 was in the 20s (or higher). Cimetidine has been used with great successes in CRC perioperative use - before, during and after surgery to prevent further metastasis due to immune suppression. Interestingly, in the six to eight months leading up to Michael’s initial March 27th hospitalization, he stocked up on cimetidine for the “stomach” issues he was experiencing. Cimetidine could have a dramatic effect if taken before initial surgery, but is said to be not so useful if applied long after surgery has occurred. Shouldn’t Michael be a candidate for cimetidine?
9. CEA, CA19-9, lactate dehydrogenase (LD or LDH), 25 hydroxy vitamin D, ESR and hsCRP all before treatment or surgery (and 5-10 days after) are among the tests that are part of a standard of care for a patient with Michael’s profile.
10. Michael had/has severe anemia, HCM, and a host of issues comorbid with the cancer. Given this fact, combined with his need to have cardiologist clearance for the surgery May 5th, shouldn’t he have these tests done?
11. An LD/LDH blood test may be used: 1) As a general indicator of the existence and severity of acute or chronic tissue damage, 2) To detect and monitor progressive conditions such as anemia, and 3) To help stage, determine prognosis, and/or monitor treatment (i.e., chemotherapy) of cancers. Also, an LD/LDH test on pleural, peritoneal or pericardial fluid and help determine whether the accumulation of fluid is due to injury and inflammation (exudate) or due to an imbalance of pressure within blood vessels and the amount of protein in the blood (transudate). This information is helpful in guiding treatment.
12. The same in #10 applies to the other listed tests.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

JJH
Posts: 167
Joined: Mon Apr 24, 2017 7:26 am
Location: Europe

Re: newly diagnosed newbie

Postby JJH » Wed Apr 26, 2017 8:32 am

mpbser wrote:... I am still learning what MSI is, and how that might affect treatment. There is just so much new information and often its contradictory info....

Yes, it is a bit confusing and contradictory at times.

Here is an article that reviews various MSI findings as of 2014. There now seems to be a push towards requiring MSI testing of all colorectal cancer patients prior to deciding on first-line therapy. In the European Union, universal MSI testing is already approaching a standard, though in the US it seems to be optional right now, though highly recommended.

It should be noted that this article is about MSI in a non-metastatic context relevant for adjuvant-therapy decision making. It is not about MSI in the context of Stage IV metastatic cancer.

Prognostic and predictive significance of MSI in stages II/III colon cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051919/

I think you should request MSI testing for your tumor. The results might be useful for later discussions with your oncologist.

JJH
Posts: 167
Joined: Mon Apr 24, 2017 7:26 am
Location: Europe

Re: newly diagnosed newbie

Postby JJH » Wed Apr 26, 2017 8:42 am

One question you might ask the surgeon is how extensive the left hemi-colectomy surgery is expected to be, and how far down the lower cut will be.

This is important because if the lower cut is in the rectal area, then there may be some problems later on related to loss of function for bowel movements. You can ask how far from the anal verge the anastomosis junction is expected to be, and from this information you can deduce how much (if any) of the rectum will be removed.

Left hemicolectomy diagram

Laparoscopic left colectomy technique
http://emedicine.medscape.com/article/1965584-technique

User avatar
LPL
Posts: 412
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: newly diagnosed newbie

Postby LPL » Wed Apr 26, 2017 3:23 pm

mpbser,

To me your faxed questions looked good, I hope you will get replies. Please share.

Regarding renal function tests - it would surprise me if that is not a standard test in USA, at least that has been tested every time my hubby (in France) has had tests prescribed.

About CA19-9 - for some reason, before today, I had not thought about searching for studies/info if people with diabetes tested at a CRC diagnos migh have higher value just because of having diabetes? My hubby was diagnosed diabetes type 2 two-three years ago. I found these studies below, maybe good to know.
(2014) https://www.ncbi.nlm.nih.gov/pubmed/24114405
"Our results indicate not only that CA 19-9 is influenced by glycemic control state but also can be elevated irrespective of any malignancy in diabetes. Therefore, CA 19-9 should be interpreted carefully in diabetic patients when CA 19-9 is used as the tool for malignancy screening"
(2016) https://www.ncbi.nlm.nih.gov/pubmed/28133696
"Serum levels of CA19-9, CEA, CA72-4, and NSE were elevated in type 2 diabetes; however, only CA19-9, CEA, and CA72-4 levels were associated with hyperglycemia."

As I have read/interpreted your posts, you are interested in CAM. You also have said: "Right now, my problem is being able to research enough in time to make the big decisions that I need to make. ".
This might be very wrong of me to suggest but as I understand it there are naturopaths who have a special interest/education in oncology. Maybe you can find one in your area on this list http://www.fabno.org/membership.html and maybe you can hear what they think, 'get a 2nd opinion', about your ideas, for example the graviola powder (I agree with other members here, your link did not show a good study for helpful in CRC.)
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: newly diagnosed newbie

Postby mpbser » Wed Apr 26, 2017 5:42 pm

Thanks for all the helpful comments today. What a wealth of information among you! I'm very glad to have found this forum because I simply don't have the time to wade through the internet in search of info. It's been a whirlwind today between the visit with the surgeon's nurse, phone tag with the oncologist's nurse, and finally touching base with the surgeon.

Surgeon assures me that he won't be touching any part of my rectum. My renal function blood tests were all within normal range.

He also (quite proactively which I greatly admire) had ordered a CEA test on me when I was in the ER getting blood transfusions the day of my colonoscopy (4/12/17). He must have ordered that immediately when he learned from the gastroenterologist that I had this tumor and would need the colon resection. (That just seems something that an oncologist would be on top of and I am sure that her office got a call at the same time surgeon did....) My CEA was 1.4 which I think isn't "too bad." I am just very glad to have a baseline at least.

For some reason he didn't mention anything regarding my questions about specimen collection. He sounded like he was in a great hurry, so I let him off the hook with that.

He also said that it looks like I was added to tomorrow's "Cancer Talk" a weekly event that happens every Thursday at noon. I wonder if I would have been added to the discussion had I not called the oncology department yesterday with my concerns about not having a pre-surgery consultation. Anyway, I am glad that all the doctors involved in cancer cases get invited to this meeting and my surgeon said he is going to try his best to make it. Right now, it feels like he is my strongest ally in this fight.

There are many other things to discuss but I have to go for now.

Thank you all for your support!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

User avatar
LeonW
Posts: 348
Joined: Sun May 03, 2015 4:59 pm
Location: Amsterdam, Netherlands

Re: newly diagnosed newbie

Postby LeonW » Thu Apr 27, 2017 5:19 am

Hi again, mpbser,

Good to see you're in good hands, they seem to be following the protocols.

Two comments:
CEA of 1.4 is a perfect score - you must be a non-smoker.
This may either mean that your cancer is hardly active (yet?), or that CEA is not a good marker for you.

The 'cancer talk' that you're mention, is standard protocol. You may want to find out who all are involved. They meet to agree a best course of action. My team had all local (=local hospital) doctors on board, plus the liver experts from the university hospital as liver was involved, via video link. They kept monitoring my case throughout treatment.

Right now, it feels like [my surgeon} is my strongest ally in this fight


Congrats :D.
Having an expert who you trust helps tremendously in escaping anxiety. Much better than any amount of time spent with Dr. Google.
Best wishes, as always.
L
Dec 2012 CC (7 cm mass), 2 unresect liver mets, CEA 41.8 (MM @65yrs)
Jan 2013 colectomy @ spleen, 2/26 nodes IVa T3N1bM1a MSI-low
Feb-Aug - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Sept - 2x failed PV embolization
Oct 2013 - R liver resect 28 hosp days (delirium, liver failure, emboli, encephalopathy) pCR - no cancer cells
2014/15 - recovery; scopy finds polyp
2016 - new town, new life
June 2018 - 5 yr mark, 2 polyps
clean CTs and (1.3-1.4) CEAs: 4x2014, 6x2015-17, 1x2018; next June 2019

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: newly diagnosed newbie

Postby mpbser » Thu Apr 27, 2017 11:27 am

Quick update. I got a call from the oncologist's nurse who went over my questions with the oncologist. She said that most of my questions would be handled after surgery, but that didn't make much sense to me. She also said that their center does not test CA19-9 and that any of the other tests, if at all necessary, don't need to be done pre-surgery. She offered to facilitate a second opinion at Dana Farber or Dartmouth Hitchcock but neither of those are in our insurance network. I think, however, that she may be able to make the case for having to go out of network so we could get prior authorization (possibly). Thing is, there is just one week before surgery and my schedule is totally packed between now and then. It seems like any second opinions will only be available until post-surgery. I'm totally overwhelmed about what to do at this point. I can't even think straight about this as there has been too much information at an extremely stressful time.

Any thoughts?
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

User avatar
LPL
Posts: 412
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: newly diagnosed newbie

Postby LPL » Thu Apr 27, 2017 11:59 am

I agree with Leon,
The feeling like you are in good hands with your Surgeon is great :) That is how hubby & I felt with his. His Surgeon was/is an expert in CRC liver mets and that was important for us. Hubby's Surgeon replied to all questions we had before & after surgery.
Best Whishes from me also. /LPL
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: newly diagnosed newbie

Postby mpbser » Thu Apr 27, 2017 2:25 pm

I was finally able to get online to see my medical records and I haven't really been given a full picture. This is disheartening:

CT FINDINGS:
Lung bases: Clear. There is note of a small amount of pericardial fluid.
Free air: None.
Free fluid: Small amount of free fluid seen in the cul-de-sac.
Liver: Evaluation partly limited by relatively early phase of contrast enhancement. No focal mass seen.
Gallbladder: Normal.
Spleen: Spleen appears normal. There is a small accessory spleen.
Pancreas: Normal.
Adrenal Glands: Normal.
Right Kidney: There are 2 small hypodense lesions seen within the RIGHT renal parenchyma. One is in the upper pole and another in the mid RIGHT kidney. These are most likely cysts but too small to accurately characterize. There is a punctate nonobstructing stone in the lower pole.
Left Kidney: Normal.
Pelvic organs: The urinary bladder, seminal vesicles and prostate are normal.
Stomach: Relatively collapsed. No gross abnormality.
Small bowel: Normal caliber. No obstruction.

Colon: There are a few areas of globular high density within the descending and sigmoid colon likely representing undigested pills. There is a masslike area of wall thickening in the lower descending colon producing an apple core lesion. This has some irregular protrusions posterior medially which is concerning for tumor invasion into the pericolonic fat. There is a crossed cluster of prominent lymph nodes adjacent to the colonic abnormality with the largest measuring approximately 1.3 cm in diameter. These are suspicious for regional nodal metastasis. There is mild stranding in the pericolonic fat in this region. There are no additional colonic mass is seen. Evaluation is limited by lack of oral contrast.
Appendix: The appendix is visualized and appears normal.
Aorta and IVC: Normal
Bones: No significant abnormality.
Lymph nodes: Pericolonic adenopathy adjacent to the lower descending colon mass. No additional adenopathy seen.
Hernia: None

IMPRESSION:
1. There is an apple core mass seen in the lower descending colon in the LEFT lower quadrant likely representing primary colonic neoplasm. This measures approximately 4 cm in length and there are features suggesting tumor extension into the pericolonic fat.
2. Prominent lymph nodes seen adjacent to the LEFT colon mass likely representing regional nodal metastasis.
3. No evidence of distant metastatic disease however evaluation of the liver is limited because of contrast phase.
4. Incidental punctate nonobstructing stone in the RIGHT kidney.
5. Incidental small pericardial effusion.
6. Minimal free fluid in the cul-de-sac
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: LeonW and 48 guests