Right Side vs Left Side

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Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Right Side vs Left Side

Postby Beckster » Fri Jun 22, 2018 7:56 am

I have been reading many articles that address right vs left side colon cancer. Apparently, it is becoming a topic for discussion in the medical field. Biologically, the tumors are different, but many are saying that right sided carries a worse prognosis. Research that I read is all over the page. Some say that Stage I and II have a more favorable prognosis that LS, while others are saying that stage does not matter and 3 year DFS is lower in right sided. I am trying to decipher the information, but it is all over the board.

Even though some of us are node negative, we still have a risk for recurrence. Has anyone had this discussion with your oncologist? Any info would be great.

Beckster
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

emkaye
Posts: 37
Joined: Tue May 22, 2018 1:37 am

Re: Right Side vs Left Side

Postby emkaye » Fri Jun 22, 2018 11:08 am

Bumping this up. I've seen the same research and yes it's all over the board.
I see you opted for chemotherapy at IIA. My mom has the exact same diagnosis. Adecarcinoma of cecum, staged at IIA (T3N0M0).
She just had a right helicolectomy about a week ago and we will f/u with the oncologist in a few weeks to determine if chemo is needed. Of course I don't want her to go through chemo but if it improves her prognosis then I think she should try it.
I also want to push the oncologist for ONCOTYPE testing which can determine her chances for recurrence.
It's important to have hope here and I think you've done all you can opting for chemo at IIA.
A lot of these studies are biased towards Stage III folks so that kind of muddies the results for Stage II folks.
I wish we could fast forward but we can't control everything. I'm sure in another 10 years we will have a clearer picture of:
a) does chemo reduce chances of recurrence in Stage II
b) what is the progrnosis for right sided vs. left sided tumors

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Right Side vs Left Side

Postby Beckster » Fri Jun 22, 2018 11:23 am

emkaye wrote:Bumping this up. I've seen the same research and yes it's all over the board.
I see you opted for chemotherapy at IIA. My mom has the exact same diagnosis. Adecarcinoma of cecum, staged at IIA (T3N0M0).
She just had a right helicolectomy about a week ago and we will f/u with the oncologist in a few weeks to determine if chemo is needed. Of course I don't want her to go through chemo but if it improves her prognosis then I think she should try it.
I also want to push the oncologist for ONCOTYPE testing which can determine her chances for recurrence.
It's important to have hope here and I think you've done all you can opting for chemo at IIA.
A lot of these studies are biased towards Stage III folks so that kind of muddies the results for Stage II folks.
I wish we could fast forward but we can't control everything. I'm sure in another 10 years we will have a clearer picture of:
a) does chemo reduce chances of recurrence in Stage II
b) what is the progrnosis for right sided vs. left sided tumors


When you see and ask the oncologist, let us know....Thanks! I am planning on asking when I see the oncologist in September. So far I am NED 1 year 7 months...so far, so good.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Right Side vs Left Side

Postby boxhill » Fri Jun 22, 2018 5:37 pm

My understanding was that right-side tumors were more likely to produce symptoms later, and thus more likely to be diagnosed at a later stage, and that they are also more likely to be associated with Lynch Syndrome. Both of those things would contribute to a lower survival rate.

I hadn't read anything that indicated that, everything else being equal, right side tumors had a poorer prognosis. I guess I haven't been looking in the right places. Actually, I tend to avoid the kind of articles, often out of date, that state that Stage 4 can't be cured, and stuff like that. For obvious reasons. I want to live.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

emkaye
Posts: 37
Joined: Tue May 22, 2018 1:37 am

Re: Right Side vs Left Side

Postby emkaye » Fri Jun 22, 2018 8:01 pm

Beckster wrote:When you see and ask the oncologist, let us know....Thanks! I am planning on asking when I see the oncologist in September. So far I am NED 1 year 7 months...so far, so good.


Awesome for your NEDness!
I'll let you know what the oncologist says.

emkaye
Posts: 37
Joined: Tue May 22, 2018 1:37 am

Re: Right Side vs Left Side

Postby emkaye » Sat Jun 23, 2018 9:11 am

boxhill wrote:My understanding was that right-side tumors were more likely to produce symptoms later, and thus more likely to be diagnosed at a later stage, and that they are also more likely to be associated with Lynch Syndrome. Both of those things would contribute to a lower survival rate.

I hadn't read anything that indicated that, everything else being equal, right side tumors had a poorer prognosis. I guess I haven't been looking in the right places. Actually, I tend to avoid the kind of articles, often out of date, that state that Stage 4 can't be cured, and stuff like that. For obvious reasons. I want to live.


So how do they test for Lynch Syndrome? Is that standard or something that you must request separately?

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Right Side vs Left Side

Postby mpbser » Sun Jun 24, 2018 6:18 am

Depends on the cancer center you go to and your individual oncologist. My husband's local oncologist at our small cancer center only tested his tumor specimen for KRAS and did no testing for any inherited mutations, if I recall correctly. Then we went to Boston for second opinions at Mass General and Dana Farber. Dana Farber did genetic testing on the tumor as well as had my husband have blood tests for every known and suspected genetic disorders that are associated with gastrointestinal cancers.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Right Side vs Left Side

Postby boxhill » Sun Jun 24, 2018 6:53 am

The testing done for my initial pathology report tested the tumor for proteins of the four MMR genes commonly related to Lynch. This appeared to be their standard practice: I don't think anyone ordered it. It may be that they do it on right-sided tumors in particular. I didn't think to ask about it. They also tested for BRAF and CEA. Having detected a malfunction of MLH1, the report recommended further testing to identify Lynch status.

The oncology practice has genetic counselling, which recommended further genetic testing of the tumor and of my blood, to determine whether this was a sporadic mutation in this tumor, or a germline mutation (ie, Lynch). The blood test is what determines whether it is germline of sporadic. Luckily, mine is sporadic. (Unfortunately, they found a different germline mutation, ATM, which is associated with a higher risk of breast and prostate cancer, amongst other things, but that's another story.)

I found some articles that talked about the right vs left mystery. It seems that right-sided tumors are for various reasons less likely to respond to EFGR pathway treatment. (On a personal level, I take comfort in the fact that my micro satellite instability and level of mutations is extremely high, so I am more likely to have a good response to Keytruda, should we get to that point.)
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

Ron50
Posts: 699
Joined: Fri Feb 10, 2006 7:04 pm

Re: Right Side vs Left Side

Postby Ron50 » Mon Jun 25, 2018 1:08 am

The results of my first scan stated that I had a right side hemicolectomy. I pointed it out to my surgeon and he nearly wet himself. It appears that the technician was looking at the scans and decided if the missing portion of colon was on his right hand it must be a right hemi. I assume my surgeon set him straight , but it did give us a good laugh. Ron.
dx 1/98
st 3 c 6 nodes
48 sessions 5Fu/levamisole
no recurrence cea <.5
numerous l/t side effects of chemo

emkaye
Posts: 37
Joined: Tue May 22, 2018 1:37 am

Re: Right Side vs Left Side

Postby emkaye » Tue Jun 26, 2018 8:50 am

There seems like so many things to test for. I am looking into the ONCOTYPE testing. I would assume that this would include these genetic mutations such as KRAS or Lynch. So confusing. I'm getting a list together for the oncology visit. I've already talked to the surgeon at her last visit and he says that I need to ask the Oncologist for the testing.
A lot of good information here though. Things to think about.

DarknessEmbraced
Posts: 3816
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Right Side vs Left Side

Postby DarknessEmbraced » Tue Jun 26, 2018 10:09 am

My tumor was tested for Lynch Syndrome and MAP. Both tests were negative. No more testing was done. They wouldn't do oncotype because they said it's only for breast cancer and I couldn't convince them otherwise.
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Right Side vs Left Side

Postby Beckster » Tue Jun 26, 2018 10:54 am

emkaye wrote:There seems like so many things to test for. I am looking into the ONCOTYPE testing. I would assume that this would include these genetic mutations such as KRAS or Lynch. So confusing. I'm getting a list together for the oncology visit. I've already talked to the surgeon at her last visit and he says that I need to ask the Oncologist for the testing.
A lot of good information here though. Things to think about.


For Stage II and III, MD Anderson automatically tests for MSI before starting any type of chemo. I tested positive for all parts of the MSI testing, which means I do not have Lynch. Pathology came back that it is more likely sporadic colon cancer. I asked about the OncotypeDX and my oncologist felt that it is great for breast cancer, but not accurate enough for colon cancer. He said that he would do it if I requested. I had already started chemo, so I declined.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D


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