Is it possible for a Stage IV to have no met in LN at all?

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lovelife789
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Joined: Thu Aug 24, 2017 5:28 am

Is it possible for a Stage IV to have no met in LN at all?

Postby lovelife789 » Sun Sep 24, 2017 4:06 am

This is a question I have been having for a while. I had my liver and colon resection back in the Summer and to my surprise, in the pathology report there's actually no metastatic carcinoma found in any of my LN.

The tumor in my colon is in T3 or T2? (tumor has just spread to the submucosa or muscularis propria). So now without LN involvement it should be N0 but the cancer has spread to my liver so M1. This puzzles me, so how did the cancer spread to my liver? Just blood supply? So cancer is in my blood and does that mean it's harder to control? I know it probably doesn't change anything by looking back, but I still don't understand this. I have researched and found one medical journal that talks about Stage IV patients with no LN involvement, but it didn't say whether it is definitely a bad or good thing....

Anybody who is Stage IV but N0? Appreciate any advice or thoughts! :oops:
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

cbsmith
Posts: 87
Joined: Sat Nov 28, 2015 11:45 am
Location: New Brunswick, Canada

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby cbsmith » Sun Sep 24, 2017 6:21 am

For cancer to spread from one organ to another it has to travel through the blood. That does not mean you have a type of blood cancer, just cancer cells floating in your blood.

Colon cancer usually metastasizes to the liver first and rectal cancer to the lungs first.
06/14-DX with FAP as 36yo Male
07/14-total colectomy, rectum removal, permanent ileostomy
08/14-DX Stage IIIC, KRAS mutant, MSS
09/14-04/15 - 12 rounds of FOLFOX
07/15-CT showed para-aortic lymph node, onc thght inflammation
10/15-DX Stage IV, CT lymph node tripled in size, 1 small lung met
11/15-FOLFIRI + Avastin
06/16-lymph node is stable, now have a 2nd lung met
01/16-lymph node is stable, lung mets grown 2mm. Still on FOLFIRI + Avastin
11/17 - no chemo since. Lung growth minimal, lymph node is stable

lovelife789
Posts: 161
Joined: Thu Aug 24, 2017 5:28 am

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby lovelife789 » Sun Sep 24, 2017 10:18 am

Thanks cbSmith.

I think just the thought of having cancer cell all over in my blood was a bit terrifying. I have read some articles saying strong cardio exercise can help blood circulating faster and prevent those cancer cells from colonizing in distant organs.
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

Canada777
Posts: 62
Joined: Mon Mar 28, 2016 6:24 pm

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby Canada777 » Sun Sep 24, 2017 2:42 pm

Hi - my partner has stage IV. Mets to the peritoneum but no lymph nodes involved yet. I think they checked 20ish lymph nodes during his surgery and none were positive for cancer. I'm not sure if this is a good or a bad thing...but we choose to believe it's a good thing no lymph nodes are involved. One less area to worry about for the time being!
DH dx. Stage 4 Colon cancer with Peri mets Dec '15 @ age 29
12 Rounds FOLFOX & then successful HIPEC in 2016. Diagnosis changed to appendix cancer.
Recurrence to pelvis 9 months later.
Years of chemo.
At rest. Sept 2021.

stu
Posts: 1613
Joined: Sat Aug 17, 2013 5:46 pm

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby stu » Sun Sep 24, 2017 2:56 pm

Hi ,
Interesting question . My mum had reactionary lymph nodes around the tumour on a ct scan . No pet scan was done before chemo so I can't say if they were cancer or irritated!! But after chemo no evidence of cancer was found in the removed lymph nodes . She had a lung met removed last year but eight years later the lymph have behaved themselves . I often wonder if it was a spread through her blood . Chemo has done a great job at knocking it down anyway .
take care,
stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

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Bev G
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Facebook Username: Bev Golde
Location: Quechee, VT

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby Bev G » Sun Sep 24, 2017 5:02 pm

cbsmith wrote:For cancer to spread from one organ to another it has to travel through the blood. That does not mean you have a type of blood cancer, just cancer cells floating in your blood.

No, that's not true. Cancer can spread through blood, lymphatics or surface to suface.
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now

lovelife789
Posts: 161
Joined: Thu Aug 24, 2017 5:28 am

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby lovelife789 » Sun Sep 24, 2017 6:57 pm

She had a lung met removed last year but eight years later the lymph have behaved themselves . I often wonder if it was a spread through her blood .


Wow eight years! I'd take it! Many new drugs can be available in 8 years! :D

I was invited to participate in a study at a major hospital on whether "circulating tumour cells" play a significant role in causing cancer and if so, how to prevent it/ slow it down. I have read some articles that say cancer spreads via blood supply, LN or organ to organ. In my case, if LN is negative (they checked a few during surgery and also none found in my PET scan) and colon wall is a-okay, cancer in my body would have to travel via blood supply....at least by elimination...
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

lovelife789
Posts: 161
Joined: Thu Aug 24, 2017 5:28 am

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby lovelife789 » Sun Sep 24, 2017 7:00 pm

but we choose to believe it's a good thing no lymph nodes are involved. One less area to worry about for the time being!


That's the direction I'm heading! I always think lymph node is a strong indicator of severity of cancer. Now looking at my T2N0M1a (but with 6 liver mets)... I changed my mind a bit!
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

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CRguy
Posts: 10473
Joined: Sun Feb 10, 2008 6:00 pm

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby CRguy » Sun Sep 24, 2017 7:05 pm

Hey lovelife789,
please read Bev G's reply : she is correct about "spread"

CTC's are a developing technology and
cancer in my body would have to travel via blood supply....at least by elimination...

is not the whole story :shock: .... sorry

just because rogue cells do NOT set up housekeeping in any particular lymph node,
does NOT mean that they won't travel further and colonize elsewhere....VIA LYMPHATICS = MY STORY !!!!! :twisted: :twisted: :twisted:
I had NO positive local nodes... BUTT had a lung met anyway ... go figure :evil:

Yeah I know .. seems that is not playing by the rules :
cancer never plays by the rules ! :twisted:

Keep the docs and Oncs LOOKING at all available results : imaging, blood tests and scans.

JMO
BTDT

Harmony my friend
CRguy on the Journey
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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rwightman
Posts: 211
Joined: Sat Jan 17, 2015 6:50 pm
Location: Southwest

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby rwightman » Mon Sep 25, 2017 12:03 am

I have aways wondered the same thing. Mine has spread from colon to liver to peritoneal to lung. Never any lymph node involvement. Always one met to each place, though peritineal had two. My doctors says this is rare and don't say it is better or worse. They always say it s 50/50 it could come back. I am an avid exerciser so not sure if it helped or not. Would love to know more.
10/9/14 DX Age 50 - MSS
10/23/14 - Colon Resection - Stage II - 0/15 lympth nodes
12/30/14 - Stage IV - 1 liver met 2cc - Liver Resection - No lymph nodes and margins clear
3/10/15 - peri mets
3/15 - Folfox with Avastin - 7 tx
7/15 - HIPEC - 2 peri mets
10/14 - resection of abdominal met
11/12 - 5FU

lovelife789
Posts: 161
Joined: Thu Aug 24, 2017 5:28 am

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby lovelife789 » Mon Sep 25, 2017 5:31 am

just because rogue cells do NOT set up housekeeping in any particular lymph node,
does NOT mean that they won't travel further and colonize elsewhere....VIA LYMPHATICS = MY STORY !!!!! :twisted: :twisted: :twisted:
I had NO positive local nodes... BUTT had a lung met anyway ... go figure :evil:


Oh i get it now, so sometimes those cancer cells pass through blood supply AND/OR lymph nodes but they don't stay LN or set up a "camp" to distribute more bad cells... so scans wouldn't reveal a nodule or anything but they pass through LN....
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

hany
Posts: 15
Joined: Wed Aug 23, 2017 10:39 am

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby hany » Mon Sep 25, 2017 7:55 am

CRguy is right! Cancer never plays by the rules. My mom is also T2N0M0 when she was diagnosed with rectal cancer. But on her CT scan last August, the radiologist saw a 4 upper lung nodules. and her CEA is still in normal values. Though these nodules are still undetermined, there’s a possibility that these are mets and i realized that your history when you diagnosed does not really have a huge impact on what will happen to the patient in the future. You’re history could not even be the basis of the current test result because anythin can happen and it seems that cancer can go anywhere regardless of its stage on the initial diagnosis.
Now, all we can do is wait and pray that these nodules are not metastases. :(
My mom
dx 8/2016 ultra low rectal cancer
Stage 1 T2N0M0
perm colostomy
no chemo/rad
2/2017 CEA 0.97
clear abdomen ct and chest xray
8/2017 CEA 1.15
clear abdomen ct
4 lung nodules 7mm biggest

prayer can move mountains

lovelife789
Posts: 161
Joined: Thu Aug 24, 2017 5:28 am

Re: Is it possible for a Stage IV to have no met in LN at all?

Postby lovelife789 » Wed Sep 27, 2017 5:17 am

Hany,

Yeah I am slowly getting it now.
Cancer doesn't play by the rules darn it...but according to the latest study, I have a 60% chance of facing a recurrence and I'm aiming for the minority of that study, which is the 40% of no recurrence!!! :twisted: :twisted: :twisted: 8)
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot


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