Focal Thickening of the Sigmoid Colon

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JustJen
Posts: 7
Joined: Mon Jan 22, 2018 2:24 am
Facebook Username: JenWEsq

Focal Thickening of the Sigmoid Colon

Postby JustJen » Mon Jan 22, 2018 2:46 am

I’m new here, and I am looking for some help understanding a recent MRI. After surgery for a rectocle, I had a follow-up MRI Defecography to see if the surgery resolved some or most of my issues with defecation (physically I could tell it had not). The MRI revealed a number of changes from the prior MRI just 11 months before. Most notably, the radiologist newly noted “Focal thickening of the sigmoid colon.” Per Dr. Google, that is frequently caused by cancer. Has anyone had experience with this finding? I don’t have a colonoscopy until February 8th, and this MRI was in December (for a variety of reasons, it has taken a long time to get the colonscopy scheduled). Any insights would be helpful.

Here is my 12/2017 MRI Summary:
IMPRESSION:
1. Focal thickening of the sigmoid colon may be related to prior surgery with colocolic anastomosis. If there is no surgical history, consider short-term interval follow-up or further evaluation with colonoscopy. (I have no related surgical history)
2. Interval curvilinear material in rectovaginal space consistent with post-surgical changes.
3. Moderate cystocele.
4. Mild vaginal prolapse.
5. Normal levator hiatus and normally positioned anorectal junction at rest with severe widening of the levator hiatus and severe descent of the anorectal junction during defecation/maximal strain.
6. Large peritoneocele containing redundant sigmoid colon.
7. Moderate rectocele
8. Full thickness intraanal intussusception of the anterior and lateral walls of the rectum.
9. Normal resting anorectal/levator-anus angle that demonstrates expected widening with defecation and expected narrowing with Kegel.

Subset of detailed findings:
Anatomic Evaluation: Status post hysterectomy. There is a 3.7 cm left adnexal cyst. Per ACR white paper guidelines, no follow-up is needed for a cyst of this size in a premenopausal patient.. The levator ani muscles are symmetric. Sigmoid colon is
redundant with a focal area of thickening in the upper part of the sigmoid colon (series 3, image 6). New curvilinear hypointensity in the rectovaginal compartment likely sequela of prior surgery.

1/2017 MRI Summary
IMPRESSION:
1. Status post hysterectomy.
2. Featureless visualized large bowel possibly related to chronic use of laxatives.
3. Grade 1 cystocele with excessive urethral hypermobility.
4. Grade 1 vaginal prolapse
5. Normal levator hiatus and low lying anorectal junction at rest with grade 2 widening of the levator hiatus and grade 2 descent of the anorectal junction during defecation/maximal strain.
6. Large enterocele.
7. Moderate rectocele.
8. No rectal intussusception.
9. Normal resting anorectal/levator-anus angle that demonstrates excessive widening with defecation and expected narrowing with Kegel.

Thanks in advance for your help!
Married 18 years
Mother to 2 boys
Awaiting diagnostic colonoscopy
Family Hx of digestive diseases. Mother died at 63 of cancer of unknown origin
No genetic testing performed

Lee
Posts: 5534
Joined: Sun Apr 16, 2006 4:09 pm

Re: Focal Thickening of the Sigmoid Colon

Postby Lee » Mon Jan 22, 2018 4:27 pm

JustJen wrote: . . . I don’t have a colonoscopy until February 8th, and this MRI was in December (for a variety of reasons, it has taken a long time to get the colonscopy scheduled). Any insights would be helpful.
Thanks in advance for your help!


I don't have any real info to offer, butt glad you are getting scoped. Colon cancer tends to be slow growing, so between December and February, "IF" it cancer, there will not be much change. It took 3 months for me just to see the GI doc the first time.

Hope by bumping this thread back up to the top, someone can give you more info.

How old are you? Does colon cancer run in your family? Ever been scoped in the past?

Good luck,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

JustJen
Posts: 7
Joined: Mon Jan 22, 2018 2:24 am
Facebook Username: JenWEsq

Re: Focal Thickening of the Sigmoid Colon

Postby JustJen » Mon Jan 22, 2018 4:52 pm

Lee wrote:
How old are you? Does colon cancer run in your family? Ever been scoped in the past?

Good luck,

Lee


Thanks Lee!

I’m 43. I have been scoped 6-7 times before due to blood in my stool. At one point I was diagnosed with Crohn’s Disease, and then it was backpeddled to IBD, ramped up to UC, and back down to IBS. Frankly, I just gave up worrying about it... Until now. My mom had Crohn’s and in 2015 died suddenly of small-cell carcinoma that had metastasized to the liver with no known origin. She went from belly ache to dead in 8 days. Before she passed she was unable to see an oncologist - thus there is no definitive diagnosis. The hospice nurse talked us out of an autopsy (BIG mistake). So, while the usual culprit for small-cell is lung cancer, her lungs were clear on x-ray. So... I don’t know. There are some colon cancers that are small cell... Both my maternal grandmother and her mother (great grandmother) had IC of some sort. My maternal grandfather and his father (my great grandfather) died of lung cancer.

I was just reviewing my Colonoscopies, and it appears in 4/2012 a hyperplastic polyp in the rectum was removed and in 12/2012, a sigmoid polyp was removed and “colonic mucosa with focal hyperplastic changes” in the sigmoid were noted. I had a colonoscopy in 2016, and no polyps were removed, biopsies were taken, but I don’t seem to have those biopsy results.

Today, I saw the Uro-Gynocologist, whose care I am currently under due to rectocele/enterocele/cystocele that was the focus of the MRI defecography and the procedure in which the focal thickening was visualized. Today, my doctor said that after he consulted with the radiologist, the sigmoid colon looks as if my colon was dissected and sewn back together, but I have never had bowel surgery. Because I have never had bowel surgery, the radiologist was quite insistent with my doctor that I get a colonoscopy. My doctor called the focal thickening a possible “lesion”. I flat out asked if it could be cancer, and he said, “well, that’s what they are concerned about, but I just don’t think that’s likely.” FWIW, my mother was told in the ER that if she had cancer “it was the most unusual presentation” that doctor have ever seen, and he did not believe she had cancer. So, I’m taking my Uro-gynecologist’s lack of concern with a grain of salt.

So, in short, it appears that I have some sort of “lesion” in my sigmoid based off the “focal thickening of the sigmoid colon” that looks like my bowel had been resectioned with a history of bloody stools, IBD symptoms, as well as hyperplastic rectal polyp, and a sigmoid polyp with colonic mucosa with focal hyperplastic changes. Recent routine blood tests were normal.

ANY insight would be appreciated. My colonoscopy is scheduled for 2/8 and that date can’t come fast enough! I was moderately obsessing before today’s appointment, and as someone posted on another post, I am severely afflicted with OGD (obsessive googling disorder). I figured the best place to get the best answers and support were from the experts - patients in the trenches that have a better handle on what it means to have colon cancer than the world’s best doctors.

Thanks in advance for your help.

Blessings,
Jen
Married 18 years
Mother to 2 boys
Awaiting diagnostic colonoscopy
Family Hx of digestive diseases. Mother died at 63 of cancer of unknown origin
No genetic testing performed

Caat55
Posts: 345
Joined: Sat Dec 23, 2017 6:01 pm

Re: Focal Thickening of the Sigmoid Colon

Postby Caat55 » Mon Jan 22, 2018 8:20 pm

Hi Jen
I had blood in stools in July. Cat scan showed thickening of wall and I was diagnosed with UC. I had made an appoint for a colonoscopy in April...earliest appointment available was 9/26. ER told me to call get scope moved up but there wasn't an earlier appointment. My scope was positive for a tumor.
Did they do any blood work?
It is scary but you can't change the appointment. Eat health, breath and don't think my experience or anyone else's will be yours.
S
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18

TXLiz
Posts: 249
Joined: Thu Sep 22, 2016 3:31 pm

Re: Focal Thickening of the Sigmoid Colon

Postby TXLiz » Mon Jan 22, 2018 9:56 pm

Just chiming in to say Dr.Google is a jerk.

February 8th will be here soon. I know it seems like forever. Doesn’t it seem that the medical system works so very very slow as we twist in the wind? I hope the best for you, and feel your pain.
Vomiting and blockage 9/19/16 46 y F
R hemi colectomy 9/20/16
Stage 3 B CRC, located in cecum
3 out of 16 lymph nodes positive
perineural invasion/lymphovascular invasion
infiltrating, mod differentiated adenocarcinoma with a mucinous component
separate tumor nodules present in pericolonic adipose tissue
MSI-high
Baseline PET scan clear 9/16 CEA 0.5
FOLFOX 10/16- 3/17
April 16th, CT scan clear. CEA 1.1
Lynch "inconclusive"
Colonoscopy 10/5/2017 clear

JustJen
Posts: 7
Joined: Mon Jan 22, 2018 2:24 am
Facebook Username: JenWEsq

Re: Focal Thickening of the Sigmoid Colon

Postby JustJen » Mon Jan 22, 2018 10:06 pm

Caat55 wrote:Did they do any blood work?


I just had my annual physical, and they did routine bloodwork, but nothing more beyond that. I asked my Uro-gynecologist for a CEA, but he didn’t think it was a very good diagnostic tool, so he didn’t order the test.

The good news for today was that the Colorectal Surgeon contacted me to schedule an appointment. Of course first available is Feb. 20th. But he is one of the best colorectal surgeons in N. Texas - so that’s good.

Thanks for responding. It is helpful. I have no one to talk to about all of this. Man, this period of uncertainty is so lonely. I don’t want to alarm people, and I don’t want to be placated.
Married 18 years
Mother to 2 boys
Awaiting diagnostic colonoscopy
Family Hx of digestive diseases. Mother died at 63 of cancer of unknown origin
No genetic testing performed

menreeq
Posts: 65
Joined: Fri Jun 30, 2017 10:26 am

Re: Focal Thickening of the Sigmoid Colon

Postby menreeq » Tue Jan 23, 2018 12:52 am

Focal thickening of the colon is not specific on MRI or CT and can be due to many causes, including inflammation (under which IBD, the umbrella term for Crohn's and UC, would fall into), diverticulitis, postsurgical scarring, infection, neoplasm (cancer), and many other things. The colonoscopy will be the only way to tell, based on how it looks on camera and on biopsy results (Pathology).

I think it is natural to be concerned, but February 8th is on its way!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17), 0.8 (2/28/18)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Xeloda monotherapy 8/13/17-1/22/18
PET/CT 3/21/18 NED

JustJen
Posts: 7
Joined: Mon Jan 22, 2018 2:24 am
Facebook Username: JenWEsq

Re: Focal Thickening of the Sigmoid Colon

Postby JustJen » Tue Jan 23, 2018 7:34 am

menreeq wrote:Focal thickening of the colon is not specific on MRI or CT and can be due to many causes, including inflammation (under which IBD, the umbrella term for Crohn's and UC, would fall into), diverticulitis, postsurgical scarring, infection, neoplasm (cancer), and many other things. The colonoscopy will be the only way to tell, based on how it looks on camera and on biopsy results (Pathology).

I think it is natural to be concerned, but February 8th is on its way!


Thanks for your feedback! I’m curious if your assessment changes with my doctors comments yesterday that the focal thickening is likely caused by some sort of lesion? I specifically asked about inflammatory conditions, and he said possibly, but that the appearance of “stitching” in that segment of my colon leans more towards a “lesion.” When I asked if it could be cancer, he said “that’s what they [the radiologists] are concerned about.”

I do need to stop obsessing, and just focus on today. Feb 8th, is just a few weeks away. But sometimes weeks feel like an eternity. :|
Married 18 years
Mother to 2 boys
Awaiting diagnostic colonoscopy
Family Hx of digestive diseases. Mother died at 63 of cancer of unknown origin
No genetic testing performed

Lee
Posts: 5534
Joined: Sun Apr 16, 2006 4:09 pm

Re: Focal Thickening of the Sigmoid Colon

Postby Lee » Wed Jan 24, 2018 2:23 pm

Good luck with your upcoming colonoscopy, it will be here before you know it. Between now and then avoid Dr. Google, you can diagnoses yourself with anything with Dr. Google 8)

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

menreeq
Posts: 65
Joined: Fri Jun 30, 2017 10:26 am

Re: Focal Thickening of the Sigmoid Colon

Postby menreeq » Thu Jan 25, 2018 2:48 am

Hi JustJen --

I think that the only thing I would take away from what your doctor said is that it needs further evaluation. The description about stitching is a bit unusual, but there's nothing specific about that description. A "lesion" is a generic term that means there's something there that looks different from the normal tissue around it. There are specific words that can be used to indicate something worrisome (like mass, tumor, etc.). For now, I think your doctors don't know either, so deciphering their words may not be helpful.

I wish you well in the next couple of weeks. May you have many good distractions!

And good luck!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17), 0.8 (2/28/18)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Xeloda monotherapy 8/13/17-1/22/18
PET/CT 3/21/18 NED

JustJen
Posts: 7
Joined: Mon Jan 22, 2018 2:24 am
Facebook Username: JenWEsq

Re: Focal Thickening of the Sigmoid Colon

Postby JustJen » Thu Jan 25, 2018 6:58 am

Thanks all! I will try to stay distracted. I hate the waiting game...
Married 18 years
Mother to 2 boys
Awaiting diagnostic colonoscopy
Family Hx of digestive diseases. Mother died at 63 of cancer of unknown origin
No genetic testing performed


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