T1 rectal cancer and LVI

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luvisme77
Posts: 2
Joined: Wed Nov 08, 2017 10:43 am

T1 rectal cancer and LVI

Postby luvisme77 » Wed Nov 08, 2017 1:07 pm

Hello,

My husband had a hemorrhoid removed via local excision (LE) three weeks ago. We were surprised to find out that there was a tumor along side the hemorrhoid. The tumor was T1, CT and MRI indicate no evidence of cancer anywhere in the body, low-grade, well-differentiated to moderately differentiated, the tumor was 3.3cm, CEA 1.4, and presence of lvi (small vessel lymph-vascular invasion). Our treatment options were 1) observe 2) chemo/radiation or 3) radical resection. We do not want to do option 3 (concerned about long-term morbidity/quality of life) so option 2 is what we primarily discussed with the doctors. They did not provide any information about observation. It seems their main concern is LVI, but I am wondering if LVI is a sufficient stand alone in advocating chemotherapy/radiation, if other factors are good? It seems that the doctors ignored everything else in the pathology report and focused on LVI; but in doing further research on LVI, there isn't much information about LVI, T1 rectal cancer and (LE). There are studies that indicate LVI is an independent predictor for Stage II and Stage III, but we are wondering if this is the case for stage 1. We are concerned about long-term radiation effects and also concerned about the possibility of recurrence with active observation. The doctor says there is a 30% change it has spread to lymph nodes, but I keep wondering about the 70% chance it's not there. Does anyone have any additional information about LVI and the role it should play in treatment options? Or are there any studies that talk about active surveillance considering the specifics of my husband's pathology report? What about CEA? Is this a useful indicator of whether or not cancer is in the bloodstream? Is the doctor's treatment plan normal for this stage? Finally, are there less invasive ways to determine lymph node involvement besides radical resection? Has anyone had stage 1 and opted for active observation? I apologize for asking so many questions and we know there are risks with whatever option we decided, but we just want to be able to make an informed decision. We will seek a second opinion, but I thought I'd post here to see if anyone had any additional insights. Thank you for taking time to read this and offer advice.

NHMike
Posts: 553
Joined: Fri Jul 21, 2017 3:43 am

Re: T1 rectal cancer and LVI

Postby NHMike » Wed Nov 08, 2017 4:59 pm

I've never heard of small-vessel lymph-vascular invasion before so I looked for a few papers and found only one that explained it and also explained the underreporting problem because pathologists apparently aren't always that good at recognizing it. So I'm curious to follow your thread to find out which course of treatment makes sense here.

The only thing that I could add as a suggestion would be to get a genomic analysis of the tumor as it might have treatment implications.
06/23/17: ER rectal bleeding; Colonoscopy+Biopsy
07/13/17: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm.
Xeloda 3,400 mg/day + radiation 07/31 - 09/08.
CEA 2.7; halfway through treatment: 1.9; after treatment: 1.8.
MSS, KRAS G12D
10/06/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV.
Surgery: 10/30/17 LAR, Temp Ileostomy

mozart13
Posts: 98
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: T1 rectal cancer and LVI

Postby mozart13 » Wed Nov 08, 2017 11:12 pm

Hi luvisme,
I went to few places, got few opinions, picked up chemo/rad, and hoped for complete clinical reaponse CCR, and it happened. 2,3 weeks after chemo/rad I went for scope, surgeon had hard time finding the spot, good thing the ink mark was there, not a trace of tumor.

Initial plan was chemo/rad, operation than 12 rounds of folfox.
When I told my oncologist about W&W approach, and its risky, the answer was “every thing is risky”, so at that point I started my folfox, 10 rounds, chemo during radiation was considered as 2 rounds.

One radiology resident told me that in 30% to 50% of CCR patients that went for operation cancer cells were found. So risk is high, another reason why I went for chemo after.
Will have biopsies at the begining of next year as part of observation.

As per some studies rectal cancer patients with lower CEA have good chance of being cured.
People that smoke, its normal to have CEA up to 5, so your husband CEA is really low.

There is tread with more info on this subject:
viewtopic.php?t=53498
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Chemo/rad finished end of January 2017, focus was on lymph nodes
Tumor erased, CCR, negative mri, ct, scope, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

SweetC80
Posts: 62
Joined: Fri Sep 01, 2017 1:28 pm

Re: T1 rectal cancer and LVI

Postby SweetC80 » Thu Nov 09, 2017 9:01 am

I'm really really happy to hear this was found during another routine procedure so it was caught. I am not familiar with LVI, so I have no advice in that area. Especially when dealing with cancer it is always good to get second opinions, so even if you and your husband are confident in any diagnosis and plans made based on that it's a good idea to get a second set of eyes.

CEA is a good indicator for some and not for others. It's hard to tell after just one, but the fact that your husband's is low is really good. My mother's was low and stayed under 5 until it spread then it really jumped. At this point it seems to be a good indicator for her, but since there are minor normal fluctuations up and down unless there is a big jump or dip her Onco doesn't change his plans for scans or treatment. He uses it as a guide not a diagnostic tool.

Best of luck to you and your husband.
My Mom's history
68 years old at diagnoses
12/16 Stage IIIb Rectal Cancer CEA 1.2
1/17-2/17 Chemoradiation CEA 4.4
5/17 Entire Colon (9 non resectable pre cancerous polyps), Rectum and Anus removal Perm Ileostomy Bag
7/17 Starts FOLFOX
9/17 Stage IV 9cm Liver Met plus abdominal Lymph Nods and suspicious Lung Nodule CEA 197
9/17 Starts Irincotecan CEA 160
10/17 Confirmed KRAS Positive CEA 210
11/17 CEA 425 waiting on scan

Beckster
Posts: 181
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: T1 rectal cancer and LVI

Postby Beckster » Thu Nov 09, 2017 11:11 am

luvisme77 wrote:Hello,

My husband had a hemorrhoid removed via local excision (LE) three weeks ago. We were surprised to find out that there was a tumor along side the hemorrhoid. The tumor was T1, CT and MRI indicate no evidence of cancer anywhere in the body, low-grade, well-differentiated to moderately differentiated, the tumor was 3.3cm, CEA 1.4, and presence of lvi (small vessel lymph-vascular invasion). Our treatment options were 1) observe 2) chemo/radiation or 3) radical resection. We do not want to do option 3 (concerned about long-term morbidity/quality of life) so option 2 is what we primarily discussed with the doctors. They did not provide any information about observation. It seems their main concern is LVI, but I am wondering if LVI is a sufficient stand alone in advocating chemotherapy/radiation, if other factors are good? It seems that the doctors ignored everything else in the pathology report and focused on LVI; but in doing further research on LVI, there isn't much information about LVI, T1 rectal cancer and (LE). There are studies that indicate LVI is an independent predictor for Stage II and Stage III, but we are wondering if this is the case for stage 1. We are concerned about long-term radiation effects and also concerned about the possibility of recurrence with active observation. The doctor says there is a 30% change it has spread to lymph nodes, but I keep wondering about the 70% chance it's not there. Does anyone have any additional information about LVI and the role it should play in treatment options? Or are there any studies that talk about active surveillance considering the specifics of my husband's pathology report? What about CEA? Is this a useful indicator of whether or not cancer is in the bloodstream? Is the doctor's treatment plan normal for this stage? Finally, are there less invasive ways to determine lymph node involvement besides radical resection? Has anyone had stage 1 and opted for active observation? I apologize for asking so many questions and we know there are risks with whatever option we decided, but we just want to be able to make an informed decision. We will seek a second opinion, but I thought I'd post here to see if anyone had any additional insights. Thank you for taking time to read this and offer advice.


I have been researching articles on colon cancer and LVI because I had LVI listed in my pathology. Hopefully, you might find so info to answer your questions. Here are some articles...

http://www.sciencedirect.com/science/ar ... 6X12000710
https://wjso.biomedcentral.com/articles ... 016-0826-4
http://ar.iiarjournals.org/content/34/6/3147.full.pdf
https://www.ahcmedia.com/articles/11932 ... -carcinoma
http://ascopubs.org/doi/full/10.1200/jco.2006.06.2968
57/Female
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Tumor type: Adenocarcinoma
Tumor size: 3.5 cm x 2.5 x 0.7 cm
Tumor grade: G3 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
Positive lymph nodes: 0/24
Lymphovascular invasion
Surgical margins: clear
Lynch- Negative
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/26/17- CT scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8
Clear Colonoscopy 10/17 :D

Deb m
Posts: 354
Joined: Tue Jan 14, 2014 10:08 am

Re: T1 rectal cancer and LVI

Postby Deb m » Thu Nov 09, 2017 11:59 am

My husband was a stage ll with positive LVI in the small blood vessel. Our oncologist considered this to be a high risk feature and 6 months of folfox was advised. He was also a t4, but even if he wasn't a t4, they would of advised chemo because of him being positive for LVI. He told us that LVI is just one step away from having lymph node involvement.

mike1965
Posts: 114
Joined: Mon Jan 25, 2016 11:07 pm

Re: T1 rectal cancer and LVI

Postby mike1965 » Thu Nov 09, 2017 4:25 pm

I would get a second opinion. I did wait and see for 6 months because I listened to the doctor who found my polyp. I was T1 and he felt he cut it all out. I went to for 2nd opinion and they said I needed surgery. I did get the surgery and it saved my life. The cancer had moved and it was heading toward the lymph nodes but ended up in the fat cells near my lymph nodes. I went from Stage 1 to Stage 3A. I did 6 months of chemo. My scans have been clear for 18 months. Question every thing the doctors tell you and get many opinions. It is your life and you have to make decisions that you are comfortable with. There are risks with all the options. I hope all goes well for you.
Colonoscopy 09/06/15 Doctor removed polyp
DX - Rectal cancer 09/10/2015 T1M0N0
Surgeon recommended wait and see approach 09/2015
Tumor board recommended LARs Surgery 10/2015
Oncologist and PCP recommended LARs Surgery 11/2015
Seeking 2nd opinion from another Surgeon 01/2016
Having Sigmoidscopy on 02/01/16.
Figured out treatment 02/2016
LARS Surgery 03/2016
Stage 3A T1 N1C M0
Chemo Folfox to begin 04/18/16

Hey Daddy
Posts: 28
Joined: Wed Nov 30, 2016 8:42 am

Re: T1 rectal cancer and LVI

Postby Hey Daddy » Sun Nov 12, 2017 7:15 pm

My son was also lvi so I, too, tried to learn what I could about its significance in affecting outcomes. I came across a prediction tool on the Sloan Kettering website that had lvi as one of its inputs to determine probability of recurrence in 5 years. For my son's circumstances, his chances of having a recurrence went from 23 percent to 33 percent when I isolated the lvi keeping all other factors the same. Of course it is only a simplistic tool and his circumstances were significantly different (colon cancer, stage 2...), but this does give you some quantitative idea, at least, of the significance that one reputable source places on this factor. Interestingly enough, the prediction tool for overall survival did not even use lvi as an input.
DS dx CC Stage IIB (T4N0M0) 3Aug16, 21 yr old
poorly differentiated, lymphovascular and perineural invasion
CEA 29
Colon resection 4Aug16
CEA 2.5
Genetics testing negative
6 mo FOLFOX Sep16 - Mar17
CT Scan Mar17 clear
Colonoscopy Apr17 clear
CEA 1.8
NED

del
Posts: 47
Joined: Thu Mar 03, 2016 11:21 pm
Location: Sydney, Australia

Re: T1 rectal cancer and LVI

Postby del » Tue Nov 14, 2017 7:36 am

I'd definitely recommend getting as many second opinions as you can. I also had LVI listed on my pathology report. I spoke to two colorectal surgeons and a medical oncologist, who all told me that LVI is not so important for stage 1.
Male, 33 @ dx, stage 1 RC (T1N0M0 0/29 LNs)
2016-02 - Cancerous polyp removed during colonscopy, 0.5 mm margin
2016-03 - ULAR & TME surgery, temp ileostomy
2016-04 - DVT, pulmonary embolism
2016-08 - Clean CT
2016-11 - Ileostomy reversal
2017-03 - Clean CT & colonoscopy
2017-09 - Clean CT

luvisme77
Posts: 2
Joined: Wed Nov 08, 2017 10:43 am

Re: T1 rectal cancer and LVI

Postby luvisme77 » Wed Nov 15, 2017 10:45 am

Hello Everyone,

I want to thank you all for taking time to reply to my post. I really appreciate it! Also, thank you for your kind words, links to articles and for sharing your experience. My husband and I sought a second opinion and they too recommend surgery and chemotherapy/radiation.

The studies were helpful and similar to some of the things that I found during my research. One of the issues seem to be that they lump both venous and lymphatic invasion together into LVI and some studies indicate that venous, is a better predictor of potential lymph involvement. There are few studies that even address stage 1.

Overall, these are not easy decisions to make, as I am sure you all are aware, but I think he maybe leaning toward being actively observed every 3 to 6 months. We have one more appointment next week, with the surgeon.

Again, I just wanted to thank you all for taking time to address my concerns.

Best wishes!

mozart13
Posts: 98
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: T1 rectal cancer and LVI

Postby mozart13 » Wed Nov 15, 2017 3:31 pm

luvisme77 wrote:Overall, these are not easy decisions to make, as I am sure you all are aware, but I think he maybe leaning toward being actively observed every 3 to 6 months. We have one more appointment next week, with the surgeon.

Again, I just wanted to thank you all for taking time to address my concerns.

Best wishes!

Ain’t easy dessicion at all.
If he decides to go for observation, make sure he gets chemo after chemo/rad.
Chemo after is capable of killing small micro cells if any left, those cells are not detecteable by any current technology available.
This kind of approach is curentlly on trial, not much of info out there, some studies on 3 rounds of folfox after chemo/rad, CCR and PCR went up significantly, but those were very small studies.

Good luck your to husband, which ever way he decides to go !
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Chemo/rad finished end of January 2017, focus was on lymph nodes
Tumor erased, CCR, negative mri, ct, scope, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative


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