Cancer Again: Not Colon?

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

Re: Cancer Again: Not Colon?

Postby mpbser » Mon Sep 24, 2018 1:12 pm

How the heck can it be determined if lung tumors are from the original colon adenocarcinoma or independent lung cancer? This mystifies me. My husband smokes cigars so who the heck knows if he wasn't going to get/got lung cancer anyway regardless of the colon->liver cancer he has/had? I wish I understood this devil that is cancer.
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

NHMike
Posts: 2555
Joined: Fri Jul 21, 2017 3:43 am

Re: Cancer Again: Not Colon?

Postby NHMike » Mon Sep 24, 2018 10:43 pm

I imagine that they could do genomic tumor testing to get the mutations and then compare them. It looks like MGH did the analysis on the CRC and that they'd do it for any other areas. There are probably some mutations that aren't seen in CRC too.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

User avatar
Atoq
Posts: 412
Joined: Wed Oct 25, 2017 9:31 am

Re: Cancer Again: Not Colon?

Postby Atoq » Tue Sep 25, 2018 12:02 am

They have a different histology. So when they do a biopsy, can recognize where the cells come from by looking at them with a microscope.

Claudia
1972, 2 kids
Dx rectal cancer 10.2017
T3N2aMX (met left lung 8 mm)
Lynch neg
CEA 1.8
Neoadjuvant chemoradio Xeloda + 25x2 Gy
05.12.17 laparotomic surg. for blockage, colostomy
25.01.18 laparotomic lar, hysterectomy, ileostomy
05.03.18 core needle lung biopsy
07.05.18 CAT scan, lung met 11 mm
04.06.18 ileo reversal
26.06.18 wedge VATS
24.08.18, 31.02.19 CAT scan
12.09.18, 06.02.19 scope, CEA 1.6
19.11.18 scope
20.08.19 CAT, eco
13.09.19 scope, CEA 1.2
18.03.20 CAT, eco, scope, NED
29.11.20 CAT, NED
2023 NED

AppleTree
Posts: 267
Joined: Fri Mar 18, 2016 8:16 am

Re: Cancer Again: Not Colon?

Postby AppleTree » Tue Sep 25, 2018 2:10 am

Sorry to hear your news. I would think the best method of attack is to wait until all the biopsies are confirmed, then you know what you are dealing with! I hope you are feeling better without the pressure of the brain tumors now.
Diag Feb 5, 2016 Age 45
3 cm tumor 5 cm from verge
Radiation + Xeloda pills - 3000mg 5x week
3/14 - 4/16 - 25 sessions
Shrank just over 50% L nodes 0/13
Remove rectum with temp Ileo 6/17
Reversal 7/20 due to infection
Acute hepatitis August. Chemo cancelled
June to September 2016 - 58 days in hospital

2017
6/16, MRI shadow in lung
Pet - 6.6mm Met in Upper R lobe
7/30 VAT surgery Mass General/Boston
8/24 port
8/30 - 4/28 Folfox. 12 rounds
2018
June CT shows new lung Mets.
July/Oct PETs...CLEAR!

lovelife789
Posts: 161
Joined: Thu Aug 24, 2017 5:28 am

Re: Cancer Again: Not Colon?

Postby lovelife789 » Tue Sep 25, 2018 8:48 am

mpbser wrote:How the heck can it be determined if lung tumors are from the original colon adenocarcinoma or independent lung cancer? This mystifies me. My husband smokes cigars so who the heck knows if he wasn't going to get/got lung cancer anyway regardless of the colon->liver cancer he has/had? I wish I understood this devil that is cancer.


This was a question I used to have too.

Not sure what is genomic tumor test, may be it is the same thing I had. What the lab did is first they use microscope to see if they present a certain visible traits, but some types of lung tumors look quite similar to colon mets, so if under the microscope is not determinable, they will place the removed tumor in specific chemical dye. If the specimen presents a certain color then it would mean it is one of the two types of tumors.

For my case, it already looked like colon met at point of removal, it was confirmed by the color showed after chemical dye. English is not my first language, I hope it's understandable. I can recap my own path report where it mentions the chemical dye part if anybody needs.

Best of luck to Cured
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

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

Re: Cancer Again: Not Colon?

Postby mpbser » Tue Sep 25, 2018 9:19 am

Super helpful comment, lovelife789. Thanks!!!
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

NHMike
Posts: 2555
Joined: Fri Jul 21, 2017 3:43 am

Re: Cancer Again: Not Colon?

Postby NHMike » Tue Sep 25, 2018 11:06 am

lovelife789 wrote:
mpbser wrote:How the heck can it be determined if lung tumors are from the original colon adenocarcinoma or independent lung cancer? This mystifies me. My husband smokes cigars so who the heck knows if he wasn't going to get/got lung cancer anyway regardless of the colon->liver cancer he has/had? I wish I understood this devil that is cancer.


This was a question I used to have too.

Not sure what is genomic tumor test, may be it is the same thing I had. What the lab did is first they use microscope to see if they present a certain visible traits, but some types of lung tumors look quite similar to colon mets, so if under the microscope is not determinable, they will place the removed tumor in specific chemical dye. If the specimen presents a certain color then it would mean it is one of the two types of tumors.

For my case, it already looked like colon met at point of removal, it was confirmed by the color showed after chemical dye. English is not my first language, I hope it's understandable. I can recap my own path report where it mentions the chemical dye part if anybody needs.

Best of luck to Cured


A genomic tumor test is where they do a sequencing and then check it for known gene variants for cancer.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

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

Re: Cancer Again: Not Colon?

Postby mpbser » Tue Sep 25, 2018 12:40 pm

Ok, so if I understand this correctly -- the same mutations that are found in the colon specimen would appear in the lung specimen if it's a colon met, but would not (i.e. would be different mutation) if it was a separate lung cancer?
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

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Cancer Again: Not Colon?

Postby MissMolly » Tue Sep 25, 2018 8:44 pm

mpbser:
Pathohistology of a tissue sample examines the microscopic structure of the cells and the process of identifying the type of cancer and primary origin. A lung cell is different in the structure of its appearance than that of a colon cell when viewed under a microscope or electron microscope. Just as a skeletal muscle cell is structurally unique/different than a lung cell.

Laboratory analysis, as pointed out by another poster, uses dyes and stains to enhance the visibility of intra-cellular structures.

The pathohistology of a biopsy tissue sample will be able to identify the primordial/original cell origin by looking at the microscopic features unique to cell types. A metastatic lesion of lung origin looks structurally different at a microscopic level than a metastatic lesion of colon origin, based on the cell type of origin (primordial lung cell or primordial colon cell).

A mutation suggests alteration in a cells’ DNA, a “mistake” in one or more chromosomes during cellular division.

Ex. My own father had a stage 2 colon cancer and had surgery with no chemotherapy. Three years later, a spiral CT scan of the chest showed “shattered glass” appearance lung lesions. Microscopic biopsy (histology) identified a new primary lung cancer. The lesions were not of colon origin. Sadly, my father passed away 3 months later of complications from lung cancer (primary lung cell origin). I miss my father everyday.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

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

Re: Cancer Again: Not Colon?

Postby mpbser » Wed Sep 26, 2018 6:17 am

Thanks for the reply, missmolly. So sorry to hear about your dad.

I think I understand this now. There are these two ways of investigating the lung nodules for whether they are mets from the colon cancer or are new primary lung tumors. You describe them very well. My husband's colon tumors (assuming both did but I can recall receiving only the path report from his first colectomy) had tumor DNA variants: MTOR, APC, TP53. If and when these nodules get biopsied and a pathology done, they will also have MTOR, APC, TP53 mutations. A lab analyst can also look at the cell with the dyes/stains as lovelife789 describes.

Do both usually get done? I would think both should be done on a sample for the most definitive possible diagnosis.
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

Cured
Posts: 581
Joined: Thu Nov 27, 2008 10:53 pm
Location: MO

Re: Cancer Again: Not Colon?

Postby Cured » Wed Sep 26, 2018 10:50 am

Guys, thanks for the insights. I am overdue in posting.

Yesterday I began Folfiri. My Onc swears it is a metastasis of the Rectal cancer, so finally we begin the treatment as if that is so. But the day before we got a report from a CT scan, and again a radiologist says it could be lung primary. I hate to treat this as Rectal for months only to discover the tumor happily growing due to being a lung. I hat for the diagnosis to be dead wrong.....

While I was not posting, I went to Sloan Kettering, consulted with specialist & had their lab analyze the slides. They concur it is Rectal.

So on with the journey! The heck of it is, I don’t feel anything - except occasional cough, which at times is bloody.
7-18 Stg 4
5-08:Stg 3 Rectal: 6/14 Nodes
Ace Surgn Remvd 90%Rectm,lots of Colon-Full Incision
Ileo Rev'd 6 Mos.
Radian+5fu Pre-Surg
FOLFOX 8 Cyc,1-09
Clear Scope 8-17; CEA 2-18
Glory to God! Healed by prayers of many: for 10 yrs
7-18: tumor pressing brain Remove
Met to lung. CEA 6.9
Folfiri
CEA 4.5 after 1 chemo
8rds CEA 3 1.8, 2.3,1.7 then up:32
12rd Folfiri
Avastin ev 2 wks
Seizure Anti-seiz meds work-no driving for 6m
4-20PET: Lng spots=Chemo
2-21 tumr gth =Folfiri
Radiation 7-22

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dianetavegia
Posts: 2731
Joined: Sat May 16, 2009 8:47 pm
Facebook Username: Diane Weldy Tavegia
Location: Villa Rica, Georgia

Re: Cancer Again: Not Colon?

Postby dianetavegia » Sat Sep 29, 2018 10:09 am

Bill, when did they stop your scans? I read a paper that said rectal tends to recur later than colon so doctors should scan for 7 to 10 years to be proactive. I was colon, so I didn't save the link.

So sorry to hear about this mess and pray they can get those lungs healed up for you! It's super rare to have a brain met. 1% if I remember correctly.

Diane
Stage III cc surgery 1/7/09. 12 tx FOLFOX
Stage IV PET = 1.5cm liver met. HR 4/11/12

14 years since dx and 11 years post liver resection.
Pronounced CURED and discharged by onc

“O Lord my God, I cried out to You, And You healed me.” Psalms 30:2

Cured
Posts: 581
Joined: Thu Nov 27, 2008 10:53 pm
Location: MO

Re: Cancer Again: Not Colon?

Postby Cured » Sun Sep 30, 2018 6:15 pm

Diane, My Onc never wanted to scan after year 1. I had many colonoscopies & all were clear.
I hate hearing I am Stage IV/ metastatic; but we have to deal white what we have. Thank God for the strength he has given me to endure,and for all the prayers and support I am receiving.

I’m not worried about the brain - I will believe that it is fixed for good (which is possible). But I will have an MRI of it at 90 days past the radiation treatment, to be sure.

At the end of the first week of chemo, I feel good. Now just have to tolerate months more of the Folfiri treatments.

Thanks for the support.
7-18 Stg 4
5-08:Stg 3 Rectal: 6/14 Nodes
Ace Surgn Remvd 90%Rectm,lots of Colon-Full Incision
Ileo Rev'd 6 Mos.
Radian+5fu Pre-Surg
FOLFOX 8 Cyc,1-09
Clear Scope 8-17; CEA 2-18
Glory to God! Healed by prayers of many: for 10 yrs
7-18: tumor pressing brain Remove
Met to lung. CEA 6.9
Folfiri
CEA 4.5 after 1 chemo
8rds CEA 3 1.8, 2.3,1.7 then up:32
12rd Folfiri
Avastin ev 2 wks
Seizure Anti-seiz meds work-no driving for 6m
4-20PET: Lng spots=Chemo
2-21 tumr gth =Folfiri
Radiation 7-22

User avatar
dianetavegia
Posts: 2731
Joined: Sat May 16, 2009 8:47 pm
Facebook Username: Diane Weldy Tavegia
Location: Villa Rica, Georgia

Re: Cancer Again: Not Colon?

Postby dianetavegia » Mon Oct 01, 2018 11:06 am

Was it Brown Bagger or Traveler whose onc didn't scan and when he went in at 5 years mentioned a cough after his bike rides and they found it was in his lungs.

Wish your onc had scanned you regularly and this could have been found very early in the game. I agree with you about the brain. It's funny how those seem to be easily dealt with.

Best of luck, Bill! Hope the chemo helps clear up your lungs very quickly. You and I are close in age. I'm turning 68 the end of December. I try to tell myself not to worry because I'm not going to live to 110, but it's hard when you mentally feel 30 something!

I'd like to keep you in prayer, if that's okay.

Diane
Stage III cc surgery 1/7/09. 12 tx FOLFOX
Stage IV PET = 1.5cm liver met. HR 4/11/12

14 years since dx and 11 years post liver resection.
Pronounced CURED and discharged by onc

“O Lord my God, I cried out to You, And You healed me.” Psalms 30:2

Cured
Posts: 581
Joined: Thu Nov 27, 2008 10:53 pm
Location: MO

Re: Cancer Again: Not Colon?

Postby Cured » Tue Oct 02, 2018 4:55 pm

Diane, prayers are always appropriate.
I would not be here today without everybodys’ Prayers. None of us knows the days we have (although I believe I have a decent number of years left), but as Christ tells us to life each day as it were our last.

I should be finishing chemo in time to head to Georgia for the Super Bowl, as long as our Chiefs keep winning. :D
7-18 Stg 4
5-08:Stg 3 Rectal: 6/14 Nodes
Ace Surgn Remvd 90%Rectm,lots of Colon-Full Incision
Ileo Rev'd 6 Mos.
Radian+5fu Pre-Surg
FOLFOX 8 Cyc,1-09
Clear Scope 8-17; CEA 2-18
Glory to God! Healed by prayers of many: for 10 yrs
7-18: tumor pressing brain Remove
Met to lung. CEA 6.9
Folfiri
CEA 4.5 after 1 chemo
8rds CEA 3 1.8, 2.3,1.7 then up:32
12rd Folfiri
Avastin ev 2 wks
Seizure Anti-seiz meds work-no driving for 6m
4-20PET: Lng spots=Chemo
2-21 tumr gth =Folfiri
Radiation 7-22


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