LymphoVascular Invasion in Rectal Cancer

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Sammy2067
Posts: 13
Joined: Wed Jul 18, 2018 9:38 pm
Facebook Username: Laban Sam DeFriese

LymphoVascular Invasion in Rectal Cancer

Postby Sammy2067 » Wed Jul 18, 2018 9:55 pm

Surgery for Rectal Cancer in May 2018. LAR with TME. Did short course RT for 5 days before the surgery. Pathology came back T3(c) N0 Mo. Same as the CS and Same as the MRI showed before surgery.

Pathology report stated:

Lymphovascular Invasion: "Present"
Perinureal Invasion: "Identified"
Nodes: 0/21
Margins: All Margins Negative
Tumor Grade: Well Differentiated Tumor

Great report regarding Nodes and Margins but have a few "high risk" issues regarding LVI and PNI although not as concerning as Nodes or Margins!

Question: What does "Present" mean for LVI? Seems very VAGUE! Has it invaded all over the Mesorectal Fat and in multiple Vascular Vessels both small and Large? OR are a few tumor cells near the tumor site found but limited to that small area?

At Stage 2a Node Negative, Chemotherapy is undecided as helpful or not regarding DSR and OS? Im basing my decision to do Chemo on a "high risk Factor" LVI that only states the word, "Present". Seems very limited in scope and its meaning. My Oncologist didnt really have any answers. He states stage 2a is to unknown and controversial on whether Chemo will be over treatment or help. "Mop up" chemo seems like a weak reason when disease cant be shown and studies don't really support it.

Any thoughts on this matter is appreciated!
Last edited by Sammy2067 on Sun Jul 22, 2018 6:55 pm, edited 1 time in total.
51
1-15-16 to 3-22-18: On and off Rectal Bleeding
3-22-18: CSoscopy Rectal Can
4-8-18: MRI: T3(c) N0 M0
5-4-18 Short Course RT 5 days
5-13-18: Robot Lap LAR TME
5-20-18: Nodes: 0/21 LVI: present, Perinerral Invasion: Present, All Margins: Negative
5-21-18 Stage 2a
5-25-18: Oncol discuss if Chemo needed for Stage 2a. 3 months Capox
7-01-18 Oxy cause vomiting/Nasea.
7-06-18: Oncolt discontinued Oxy
7-23-18: Xeloda Monotherapy
7-23-18: CEA post surg .5, CA19-9 2.9

Deb m
Posts: 558
Joined: Tue Jan 14, 2014 10:08 am

Re: LymphoVascular Invasion in Rectal Cancer

Postby Deb m » Thu Jul 19, 2018 8:54 am

My husband was a stage II as well with positive LVI. We did 12 rounds of folfox which was highly recommended by our oncologist at MDA cancer center in Houston Texas. He told us that it is a "High risk" feature. Have you thought of getting a second opinion from a major cancer center. It might be very beneficial and give you piece of mind.

It's a hard decision to make. You don't want to put your body thru all that if it's not needed, but you don't want to have any regrets down the road either. If you cancer returns, it's always much, much harder to take care of.

You didn't say what your cea level's were or the T rating of your tumor. My husband has been NED for almost 8 years now and if we had to do it all over again, we would do the same treatments.

I wish you peace in your decision making.

deb m

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

Re: LymphoVascular Invasion in Rectal Cancer

Postby Beckster » Thu Jul 19, 2018 10:02 am

Sammy2067 wrote:I had rectal Cancer with a Well Differentiated tumor 8 cm from anal Verge. Did LAR with TME with Robotic Laproscopic Surgery on 5-13-18. Very successful. Pathology showed 0/21 Nodes all negative. All Margins were negative. The only concern was LymphoVascular Invasion was listed as: "Present" Perenurail Invasion listed as: "Present"

No other explanation of what "Present" meant. Was it a little bit? Was it a lot? My understanding is its a precursor to Lymph Node Metastasis, but I was lucky enough to have 21 nodes taken and all were Negative.

Is LVI still a problem or concern considering the Lymph Nodes themselves were in fact Negative? ITs possible that other Lymph Nodes had Metastasis but with a sample size of 21, everything I have read says that is more than adequate sample and very strong prognosticator for a good result.

Trying to decide on Chemo, I thought it might be better to try it if I could handle it as a "clean up" scenario even though the studies don't back up the need for adjuvant therapy in Stage 2a patients. But LVI is a high risk factor but seems to be mitigated by the fact that all lymph nodes sampled were negative.

Should I be doing the Adjuvant therapy with stage 2a and only LVI as a risk factor?

Positive risk Factors: Well Differentiated tumor, 0/21 Lymph nodes negative, above 5 cm from the anal verge, all Margins were negative
Negative risk factors: LVI

Thank you in advance for your thoughts or opinions



Stage IIA here...had LVI and did chemo. However you also stated the PNI was present...PNI is another risk factor.
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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