Results are confusing . . . First, CEA remains less than 1 (Dx was 10), CA 19-9 is 8 (Dx 36) and CA 125 is 10 (Dx was 99, then elevated to 180). Lungs, liver, spine/pelvic bones, spleen, right ovary all clear. No suspicious nodes. However, there's allegedly a 9 cm (!) complex mass in the upper right pelvis adjacent to the ureter. The radiologist has recorded it as nonspecific. There are no other suspect lesions, and her right kidney is not hydronephrotic. The location described to me is immediately behind the former stomal incision site. Primary was in the splenic flexure, so this can't be a locoregional recurrence. Tumor markers should be especially reliable for a retroperitoneal met, particularly one of this size. I haven't managed to speak to any consultants, and we haven't received any referral to medical oncology (the information was relayed to me on Friday evening after I said enough is enough with the lack of communication and insisted that someone relay information to us). Something is clearly amiss . . . A 9 cm mass should be palpable in that location (since my wife doesn't have a cecum/ileum anymore), and should be symptomatic. This is the first scan my wife has had since HIPEC in December, so maybe this is a radiologist's random incidentaloma. I have a pretty extensive dataset (every month) of LDH and CRP, so I'm ordering those now. This doesn't sound like a recurrence of colon cancer to me—I can't find a single comparable case (I have university access to a vast number of medical databases). Without having visualized the scans, I suspect (in order of likelihood) a retroperitoneal hematoma (quite likely because of her persistent thrombocytopenia at the time of her CRS/HIPEC and then over a month of prophylactic heparin and enoxaparin; she also had 2 units of blood and 1 litre of albumin transfused in theatre and then the same a few days later in ICU), retroperitoneal fibrosis (also entirely conceivable), or some other primary cancer (some kind of sarcoma?). I exclude both ureteral involvement (since her kidney isn't hydronephrotic) and right ovary involvement (since it was clearly visualized and her menstrual cycle has been occurring like clockwork every 27 days). Obviously, this revelation (from some random intern) has caused my wife unimaginable pain and anguish in the last several days, but I cannot for the life of me justify how this could possibly be metastatic colon cancer.
I dropped by medical oncology today, and they have received no referral (so the colorectal team lied to us) and no information. Fortunately, they were incensed at how we've been treated and have promised that my wife's former oncologist will call us tomorrow.
Wife Age 33
02/17 dx Ovarian mass, ascites, pleural effusions
03/17 Resection of 16 x 20 cm ovarian mass; CEA = 10, CA125 = 180, CA19-9 = 36
04/17 Emergency surgery, diastatic perforation, purulent peritonitis, extended right hemicolectomy, well-differentiated adenocarcinoma in splenic flexure, 1/16 lymph
11/17 CT = NED, CEA < 1
12/17 CRS (peritoneal nodules of foreign body giant cell reaction, no evidence of malignancy; liver resection—1 cm FBGCR and .5 cm focal nodular hyperplasia), HIPEC