jp81 wrote:...with recurrence in a single 16x14mm para-aortic node (FDG update: SUV max 13)
At that SUV, you really, really, really want to get CA19-9, LDH added to the CEA, once or twice before the operation and then 5-7 days after.
To be more clear about potentially changing / interfering marker conditions, hsCRP, ESR, HgbA1C should be added to normal CMP, CBC with dif etc.
I would ask the doctor once. If dr's not agreeable with alacrity, we pick up the phone and order them ourselves. You can too.
While talking to doctors, I was hoping they will unanimously agree on Para Aortic Lymph Node Dissection (PALND), but got two opinions instead
Unanimous ?!? Ha, that's a good one. We interviewed around, got many different opinions in 2011, and got more background info.
Only an outstanding surgeon doing the operation really counts.
1. Surgical Resection with Chemo/Radiotherapy
We chose surgery with immunochemo - daily oral chemo + cimetidine, later with celebrex plus potent levels anticancer supplements.
What RT target, source machine and field is a big question. We steered a wide circle around the eager RT docs, others said too big or possibly too big and serious side effects. (IRL, the PALN cluster turned out to be way too big)
2. FOLFIRI with Avastin (older doctor; experienced but might lean towards conventional choices?)
That's basically all he has to offer per NCCN and ASCO. Probably might as well be a gas station attendant. Experience and fundamentals seem to show cyclic heavy chemo are a fundamentally limited approach for uneradicated distant LN...
Brearmstrong wrote:I have 2-3 para aortic lymph nodes that lit up on PET (12 uptake) and my CEA rose from 3.6 to 8.1 in just 30 days after ending Folfox.
My wife's CEA would jump ~5 units in less than 14 days, every time a small LN (say 2-6mm) blew up to a big one, say 20-23 mm, just by 1/4 reduction of her minimum daily chemo dose.
....I am doing 6 months of folfori w/ avastin. IF the nodes don't grow or IF the cancer doesn't spread, my surgeon said he can remove them. I think he's worried about agressive spread so really wants me to stay on folfori for 6 months- I'd like to have them taken out NOW but understand the risk. He said need to be off avastin 6 weeks and chemo 3 weeks which seems reasonable....
Actually if you were to replace the Avastin with IV vitamin C, high dose vitamin D3 and vitamin K2, and then perhaps replace the irinotecan with celebrex and/or cimetidine until close to surgery, I'd vote for sooner than later too. Some PALN are hard to kill, surgical removal is the sure answer.
The problem with standard treatment is that they are simply not aiming at stopping the metastases' spread via milder continuous
treatments like immunochemo (e.g. ADAPT plus immune building supplements and mild adjuncts). The sooner you can cut the little grenades out, the better - after a year, "ours" were starting to break out through the LN wall, that's bad, very bad. You need enough (immuno)chemo to stop the microclusters' spread and transition, and to preferably stop any micromet LNs' blowup from 2-4 mm to ca 20mm.
Btw, "no" really means you need to keep shopping and talk to better prepared or better suited surgeons if you can't turn them around on the PALNs. Also practice can make you a better presenter.