MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Please feel free to read, share your thoughts, your stories and connect with others!
Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Tue Aug 28, 2018 5:46 pm

Hello everyone. I’ve visited this forum many times for information and inspiration. Today I received disturbing news after an MRI and visit with oncology. So, I’m finally reaching out for your support.

On January 24, 2018 I was diagnosed with Stage IV colon cancer. Liver had quite a few mets as well. Since then, I’ve had a partial colectomy right after diagnosis in January. FOLFOX+AVASTING followed for three months. Then on July 2nd, I had my first of what was supposed to be two liver rejections. My entire right lobe was removed plus 10% of my left.

About 2.5 weeks ago I had a CT scan. Surgeon and oncology where going to discuss whether to continue with chemo or get the second liver resection over with—if my body was up for it.

Well, today I had a scheduled MRI. My oncologist identified about 6 new spots. Yet, the CT scan from a couple of weeks ago didn’t show anything new. How can this be? New liver mets (about 1cmm for the biggest one) in just 2 weeks? Could the CT scans have missed this all along? I’ve never had an MRI before today. My CEA number is within normal range at 2.9 (down from 60 back in January).

I’m slightly deflated seeing as every other indicator suggested I was on my way to a very positive prognosis and possibly NED after resection and final 6 rounds of chemo.

Thanks for reading. Your support is incredibly appreciated.

Camilo
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7

martd
Posts: 54
Joined: Tue Nov 21, 2017 3:48 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby martd » Tue Aug 28, 2018 8:35 pm

Have you talked with the liver surgeon? Was your surgery open or laparascopic? If it was open the surgeon would have had a good look at the liver. There's always a possibility it's scar tissue from tumors killed by chemo. An MRI is more detailed than CT scan. I had a similar surgery. The second surgery was in July.

Dan
49 y/o male dx 11/2017 crc
Stage 4 with 17 liver Mets, cea 490
RAS, BRAF WT
12 rounds folfox , avastin / oxi
5/18 cea 2.8 liver resection and pve
7/18 part 2 liver resection, remove right side of liver
Surgical site mrsa infection, wound vac
8/18 cea .9 cCR, rectal tumor is gone
Rectal surgery postponed, watch and wait
10/18 clear scan CEA .7

Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Wed Aug 29, 2018 8:05 am

Hi Dan. Haven’t spoken to surgeon. Although the oncology team had their board meeting last night. They were going to discuss my case. My surgeon would have been part of that conversation.

My surgery was open, btw. And what’s puzzling my oncologist is that all my other markers are normal.
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7

boxhill
Posts: 122
Joined: Fri Apr 06, 2018 11:40 am

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby boxhill » Wed Aug 29, 2018 9:56 am

A liver MRI shows a lot more than a CAT scan. It's kind of the gold standard of liver scanning. I had a very small sub-capsular liver met that my surgeon found and removed that did not shoe up on my initial CAT scan. I've seen the scan, and my liver looks completely clear. My new scan, 3 months into FOLFOX, is still clear, but I would feel more certain about it with a liver MRI. Justifying it to insurance is the issue.

So unless you had a prior liver MRI there is no reason to assume that these spots are new. There is also no reason to assume that all of them are cancer. Lots of liver nodes aren't.

My big question if I were you would be whether you could switch to the HAI pump.
F, 64 at DX CRC Stage IV (or "3 1/2" per Dana Farber consult, LOL)
3/17/18 blockage, emergency surgery, r hemicolectomy
11 of 25 nodes
5 of 5 mesentery nodes, matted
0.5 cm sub-capsular liver met removed
pT3 pN2b pM1
Neg CEA, neg BRAF, KRAS G12D, germline mut ATM
dMMR, MSI-H, Neg for Lynch
5/4/18 FOLFOX started
Added Neulasta 6/28/18
7/9/18 CT scans show no masses or enlarged nodes, 2mm indeterminate lung nodule

stu
Posts: 876
Joined: Sat Aug 17, 2013 5:46 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby stu » Wed Aug 29, 2018 11:52 am

Hi . This is exactly what happened to my mum . Immediate recurrence . What a disappointment it was . However we decided it was probably part of the original spread just showing it’s face . Given she was chemo responsive we took that as a good sign and had probably been holding it at bay . A second lot of chemo it disappeared again and a second liver resection occurred. Her liver has been clear for seven years .
There was more than one step to Ned for her but she has had big long periods treatment free and good living going on .
It’s a big bump in the road but you will find a plan through this .
Someone mentioned dr K for a consultation. Worth looking into your options .
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

mpbser
Posts: 478
Joined: Wed Apr 19, 2017 11:52 am

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby mpbser » Wed Aug 29, 2018 4:29 pm

Ditto what boxhill said. This is one of my biggest pet peeves with CT scans for surveillance of mets to the liver. I honestly don't understand why CTs are done at all for Stage IV CC. I had to advocate for my husband to get an order for a MRI (it's late November) after he had a clean CT this spring. His CTs and PETs never picked up his two liver spots (one a tumor, the other a benign cyst), so it made absolutely no sense to monitor with CT. Luckily, the oncologist didn't object but I'm fairly sure he will have to argue with the insurance company's subcontractor (for radiology orders) when the prior authorization finally gets around to being processed. I spoke about my dismay -- what sense does it make not to make sure that you catch any recurrence as early as possible??? -- with a customer service representative at Blue Cross Blue Shield. She seemed very understanding, but she's not the policy maker.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Sat Sep 01, 2018 7:21 am

Thanks, all, for your feedback. It’s encouraging to read your thoughts and recommendations given your experiences.

My medical team at Duke met on Tuesday including my oncologist and surgeon. Sadly, the concensus is that the new liver Mets are new. At least in terms of this being the first time they are seeing them. What’s incredibly frustrating is that my insurance company denied an MRI in June. It would have provided a baseline for comparison. So, docs can’t say for sure if it’s really new mets, scar tissue, or just part of the original bunch of spots that CT didn’t/couldn’t pick up.

It’s worth noting that according to my oncologist, these “new” spots are on my “left over” liver. Nothing new shows up on the regenerated side. I am now scheduled for a PET scan and a new CT scan on Tuesday. I suppose this will provide more clues.

In the meantime, my oncologist has hinted that there is a new study I might be interested in participating in. It’s a clinical trial going into phase 2 from AbbVie (ABT-165). But frankly, I don’t want to jump the gun.
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7

stu
Posts: 876
Joined: Sat Aug 17, 2013 5:46 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby stu » Mon Sep 03, 2018 12:30 pm

My mum’s mets were in new locations too but I think the microdisease was already there . No evidence for that though .
Great the regenerated liver is clear . That’s positive .
You respond well and there is no reason to think you won’t again .
I know nothing of the clinical trials but I can understand your dilemma.
Wishing you every success .
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Thu Sep 06, 2018 12:12 pm

Thanks, Stu.

Tuesday, I had a PET scan and a chest CT. Chest is clear. Very happy about that. But, now PET shows lit up spots—even in new regenarated liver. This makes no sense to me since MRI did not show growth on new liver just a week ago. Hoping this just false-positives on the imaging side.

Not only that, but CEA back down a tad from 2.9 to 2.7. Negligible, I know. But still. Markers once again normal. So now, onc is ordering a biopsy on 9/17.

What a rollercoaster.
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7

rp1954
Posts: 1382
Joined: Mon Jun 13, 2011 1:13 am

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby rp1954 » Thu Sep 06, 2018 2:23 pm

Two other common cancer markers, AFP ("for liver cancer") and CA199 ("for pancreatic cancer"), have been elevated, or a rising series of values, for a large percentage of advanced CRC patients, as published in other countries; CA125 is not common. We have had these markers' series of measurements stay low, rise and fall separately to varied degree with CEA, which to me suggests changing biology, and treatment effects, are at work while on immunochemo. Also LDH has been useful as a rough indicator of cancer favorable conditions or metabolism, when increasing above 180 (!), for those with previous CRC diagnoses, that we thump on with chemo and IV vitamin C.

Whatever my wife's liver objects were (no biopsy), they shrank on a daily diet of oral 5FU, celecoxib and/or cimetidine, massive vitamin D3, K2, Q10, astralagus, various high strength flavonoids, beta glucans and supplements. Also after some years, an AFP trend increased 40x, then was stopped and reduced 4 fold with (re)increased IV vitamin C, D3 and K2, along with chemo and goodies. Potentially something for in between other treatments.
watchful, active caregiver for stage IVb CC since early 2010. immuno"Chemo forever," for mCRC

Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Mon Sep 10, 2018 4:39 pm

rp1954 wrote:Two other common cancer markers, AFP ("for liver cancer") and CA199 ("for pancreatic cancer"), have been elevated, or a rising series of values, for a large percentage of advanced CRC patients, as published in other countries; CA125 is not common. We have had these markers' series of measurements stay low, rise and fall separately to varied degree with CEA, which to me suggests changing biology, and treatment effects, are at work while on immunochemo. Also LDH has been useful as a rough indicator of cancer favorable conditions or metabolism, when increasing above 180 (!), for those with previous CRC diagnoses, that we thump on with chemo and IV vitamin C.

Whatever my wife's liver objects were (no biopsy), they shrank on a daily diet of oral 5FU, celecoxib and/or cimetidine, massive vitamin D3, K2, Q10, astralagus, various high strength flavonoids, beta glucans and supplements. Also after some years, an AFP trend increased 40x, then was stopped and reduced 4 fold with (re)increased IV vitamin C, D3 and K2, along with chemo and goodies. Potentially something for in between other treatments.


Thanks, rp1954.

I am meeting with a new oncologist next week at Duke Hospital. I have been registered for a Phase II trial of a new treatment from AbbVie (ABT-165). It's a blind study, so there's a chance I'll end up in the control group taking FOLFIRI + Avastin. Even so, I responded extremely well to FOLFOX + Avastin. Made liver resection possible. So, at worse, I won't have to deal with the side effects of Oxaliplatin. Not a horrible trade-off. Would rather deal with managing "the runs" as opposed to cold sensitivity and neuropathy.

That said, I will be pushing for an integrative treatment approach. Many friends want me to avoid chemo and go with natural treatments. That's just not something I'm willing to do. Too much at stake not to throw the kitchen sink at this.

I've already began implementing dietary changes to include cancer-fighting foods. I've started a consistent habit of drinking 40-60oz of green tea each day. Now, I'd like to speak with my oncologist about introducing supplements as additional adjunct therapy.

I noticed you didn't list Curcumin in your list. I've read quite a bit about it's cancer-fighting potential. Did your wife take it at some point?
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7

rp1954
Posts: 1382
Joined: Mon Jun 13, 2011 1:13 am

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby rp1954 » Mon Sep 10, 2018 11:34 pm

Curcumin is a flavonoid mixture, one of several that we use, like quercetin, silymarin and EGCG too. I'm very favorable to flavonoids and other supplements disrupting cancer pathways and re-sensitizing chemo, at least 5FU. There are probably two dozen commonly used flavonoid anti-cancer extracts, and many, many more available. Pick 5 - 10, carefully.... At one point, we were up to over 3 dozen components.

If you want to review integrative components, Life Extension has free articles on cancer and CRC specifically. There are The Moss Reports, $300-$400 integrative medicine guides for specific cancers, like CRC, updated every year or so. I've discussed some inexpensive options and tactics not covered there. I've mentioned Riordan Clinic's free conference calls (mostly vitamin C [for Kras/Braf mutants]; some on supplements, or paid phone consults like Lexington. Others have used Donnie Yance. I prefer to read ahead, start a review and plan some months before implementation.
watchful, active caregiver for stage IVb CC since early 2010. immuno"Chemo forever," for mCRC

Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Tue Sep 11, 2018 7:21 am

Thanks, for the great resources, RP. Greatly appreciate your continued and generous contributions to this community.

There is so much information out there. Truly overwhelming. I've been researching integrative oncologists in my area to help me navigate the non-conventional treatment approach.
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7

mpbser
Posts: 478
Joined: Wed Apr 19, 2017 11:52 am

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby mpbser » Tue Sep 11, 2018 10:51 am

Good luck on 9/17. Fingers crossed the PET was a false positive/alarm.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

Cmac1275
Posts: 36
Joined: Mon Aug 06, 2018 4:21 pm

Re: MRI shows 6 new liver Mets 2 weeks after clean CT scan? CEA normal.

Postby Cmac1275 » Tue Sep 11, 2018 12:17 pm

Thank you!
42 yr, male, husband and father of 3
01/24/2018 — Dx with Stage IV Colon Cancer and liver mets
01/26/2018 — Partial colectomy. Two thirds colon removed
02/21/2018 — CEA @ 60
03/21/2018 — Began 6 rounds of FOLFOX / Avastin
06/21/2018 — CEA @ 4.7
07/02/2018 — Right hepatic lobectomy
08/28/2018 — MRI shows new spots on remaining ("old") liver)
09/04/2018 — PET scan shows new spots on both lobes
09/05/2018 — CEA @ 2.7


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 55 guests