Scanxiety - Good thoughts Please

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LPL
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Location: Europe

Re: Scanxiety - Good thoughts Please

Postby LPL » Sun Jan 13, 2019 3:36 pm

Dear O Stoma Mia,

I have been reading about ’possible biopsi and ablation/surgery’.
Suddenly I remembered the feeling that I wished I had known about Cimetidine when DH had his surgeries (did not know/understand until after DH’s surgeries in 2016).

From http://coloncancersupport.colonclub.com ... ry#p447809
Maia: ”Those going for surgery (or even for biopsies) might benefit, if your doctors do not object, by taking cimetidine some days (or a week) before and after surgery (specially before). There are several articles, over the years, that state that cimetidine may help to prevent seeding and, therefore, recurrence.
Cimetidine is Tagamet, the anti-acid, over-the-counter. It is a histamine H₂ receptor antagonist that inhibits stomach acid production but happens to have this effect also.”
(She has references to studies)
—-
In that same thread you OSM post about interactions...
http://coloncancersupport.colonclub.com ... 81#p384289

I used your link posted there now and checked DH’s prescribed meds.

Metformine BGR 850mg
”cimetidine will increase the level or effect of metformin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.”

Urorec 8mg
(Silodosin)
”cimetidine will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.”

Coveram 10mg
(Perindopril arginine/Amlodipine)
Sadly I can not find info about perindopril)
”cimetidine will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.”

So... thinking out loud.. should I order Cimetidine? and try to contact/ask our Onc before the appointment? (worried she will say no). If the PET is not good I presume the biopsi/ablation will take place soon after our appointment with the Onc so I guess then it will be too late to start Cimetidine :-(

If you O Stoma Mia or anyone else would like to comment on this - I will be very grateful.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb lung met

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O Stoma Mia
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Re: Cimetidine / Tagamet

Postby O Stoma Mia » Mon Jan 14, 2019 4:19 am

LPL wrote:Dear O Stoma Mia, ...
So... thinking out loud.. should I order Cimetidine? and try to contact/ask our Onc before the appointment? (worried she will say no). If the PET is not good I presume the biopsi/ablation will take place soon after our appointment with the Onc so I guess then it will be too late to start Cimetidine :-(

If you O Stoma Mia or anyone else would like to comment on this - I will be very grateful.

I have read your post above andI bookmarked it. Unfortunately, I have not done any literature-review updates on Cimetidine since 2015, and I myself have never used it in this context.

I think it would be better if you looked for feedback from members who have actually used it in the peri-operative context and who may have more recent information than I currently have.

There is one member here with "Ongoing - Tagamet" in their Signature who logged in here less than a month ago, so I know that there are some experienced Cimetidine / Tagamet users still around and monitoring this forum.

On a different but related issue, if the PET scan turns out to be bad, my own first reaction would not be to prepare for an ablation but would be to first look for a second PET-scan opinion -- in other words, an additional radiology reading of the same PET-scan CD-rom, but by a different radiologist from a different radiology center. In addition, I would look for an additional oncology opinion, -- i.e., a second oncology opinion, but from a specialist in lung oncology (i.e., a pulmonary diseases expert). This is what I did when I had a surprise lung nodule appear on my scan a few years ago.

Ablations (RFAs) are not the only way of getting rid of suspicious lung nodules. There are several other ways to be considered and to be evaluated at the same time. It is not at all clear to me that ablation would be the best type of procedure to use. I would want to have more information given to me about all of the possible procedures to use, and the risks and benefits of each.

hopeful1
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Joined: Wed Jan 21, 2015 5:39 am

Re: Scanxiety - Good thoughts Please

Postby hopeful1 » Mon Jan 14, 2019 6:31 am

Praying for good results for you.
Husband diagnosed with stage III a 2013.
Bowel resection and Folfox 2013/14. CEA less than 3.
Rev ileostomy 2014.
6 monthly CT's NED 3 monthly CEA's slow increase to 5's.
PET scan NED for bowel cancer. Early stage thyroid cancer.
Thyroidectomy 2015. CEA's still in 5's. NED on CT.
2017 small liver mass. CEA 35.Liver res'n + Folfox CEA less than 3.
November 2018 CEA 18. PET scan: +ve lymph node near liver. Node resection
2019 Jan CEA 9 PET NAD, April CEA 15 - PET NAD, July CEA 21 awaiting PET

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LPL
Posts: 650
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Scanxiety - Good thoughts Please

Postby LPL » Mon Jan 14, 2019 10:36 am

O Stoma Mia wrote:
On a different but related issue, if the PET scan turns out to be bad, my own first reaction would not be to prepare for an ablation but would be to first look for a second PET-scan opinion -- in other words, an additional radiology reading of the same PET-scan CD-rom, but by a different radiologist from a different radiology center. In addition, I would look for an additional oncology opinion, -- i.e., a second oncology opinion, but from a specialist in lung oncology (i.e., a pulmonary diseases expert). This is what I did when I had a surprise lung nodule appear on my scan a few years ago.

Ablations (RFAs) are not the only way of getting rid of suspicious lung nodules. There are several other ways to be considered and to be evaluated at the same time. It is not at all clear to me that ablation would be the best type of procedure to use. I would want to have more information given to me about all of the possible procedures to use, and the risks and benefits of each.

That sounds as a good plan! Thank you O stoma Mia.

hopeful1 - Thank you for prayers.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb lung met

DarknessEmbraced
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Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Scanxiety - Good thoughts Please

Postby DarknessEmbraced » Sun Jan 20, 2019 11:18 am

I hope he gets good scans! :D
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

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O Stoma Mia
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Re: Scanxiety - Good thoughts Please

Postby O Stoma Mia » Sun Jan 20, 2019 12:31 pm

Best wishes for a good meeting with the doctor on Monday! :)

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LPL
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Re: Scanxiety - Good thoughts Please

Postby LPL » Sun Jan 20, 2019 1:11 pm

DE Thank you !

OSM, It feels so good to get well wishes from people who understand.. and wow! remembering to post when I need it the most <3
I will get back and report what we will find out.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb lung met

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LPL
Posts: 650
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Scanxiety - Good thoughts Please

Postby LPL » Mon Jan 21, 2019 3:23 pm

So.. I have not translated the PET result yet but I think our Dr appointment went well. We did not get any definitives, she is going to consult (more) with expert (professor) colleges. She does not believe the lung nodule(s) are malignant. Says: probably inflammation.. we will check again in 3(?) month.
However, there were high SUV in DH’s colon, different places. I see that the report are mentioning (due to) Metformin?? (We followed the preparations and DH took his metformin the morning before the PET).
Our Onc now talked about Metformin also. And I have seen research (see below). She now want hubby to have a new colonoscopy.
That is where we are now.
It could have been worse...

From (2010) https://www.ajronline.org/doi/10.2214/AJR.10.4663
”..,Metformin is a well-established first-line antihyperglycemic drug used in the treatment of patients with type 2 diabetes mellitus (DM) [6–8]. Recently, emerging evidence that metformin influences FDG uptake in the intestine has been reported [9, 10]. Gontier et al. [9] reported that the intestinal FDG uptake induced by metformin is typically intense and diffuse, so it can mask an actual malignant lesion and can lead to false-negative results. For reducing this unwanted intestinal FDG uptake, Ozulker et al. [11] investigated the effect of stopping medication. The increased FDG uptake in the intestines during metformin treatment was significantly decreased after stopping medication for 3 days. Considering the relatively short plasma half-life of metformin after oral administration (range, 4.0–8.7 hours) [12], we investigated the feasibility of medication discontinuation for 2 days on reducing the increased intestinal FDG uptake induced by metformin. In addition, we also investigated changes in blood glucose level after the discontinuation of medication for 2 days with intrasubject (study 1) and intersubject (study 2) analysis.”
”CONCLUSION. The discontinuation of metformin for 2 days is feasible for reducing the high intestinal FDG uptake induced by metformin.”
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb lung met

Punky44
Posts: 360
Joined: Mon Oct 01, 2018 4:29 pm

Re: Scanxiety - Good thoughts Please

Postby Punky44 » Mon Jan 21, 2019 3:49 pm

Glad your appt went well!
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17 at diagnosis
MRI/CT/PET puts staging at T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
CEA 4/23: 2.1; 7/24: 1.9
6/28/19 Reversal and port out

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Educator
Posts: 39
Joined: Mon Apr 09, 2018 3:38 pm
Facebook Username: Ebru köse

Re: Scanxiety - Good thoughts Please

Postby Educator » Mon Jan 21, 2019 4:03 pm

LPL wrote:So.. I have not translated the PET result yet but I think our Dr appointment went well. We did not get any definitives, she is going to consult (more) with expert (professor) colleges. She does not believe the lung nodule(s) are malignant. Says: probably inflammation.. we will check again in 3(?) month.
However, there were high SUV in DH’s colon, different places. I see that the report are mentioning (due to) Metformin?? (We followed the preparations and DH took his metformin the morning before the PET).
Our Onc now talked about Metformin also. And I have seen research (see below). She now want hubby to have a new colonoscopy.
That is where we are now.
It could have been worse...

From (2010) https://www.ajronline.org/doi/10.2214/AJR.10.4663
”..,Metformin is a well-established first-line antihyperglycemic drug used in the treatment of patients with type 2 diabetes mellitus (DM) [6–8]. Recently, emerging evidence that metformin influences FDG uptake in the intestine has been reported [9, 10]. Gontier et al. [9] reported that the intestinal FDG uptake induced by metformin is typically intense and diffuse, so it can mask an actual malignant lesion and can lead to false-negative results. For reducing this unwanted intestinal FDG uptake, Ozulker et al. [11] investigated the effect of stopping medication. The increased FDG uptake in the intestines during metformin treatment was significantly decreased after stopping medication for 3 days. Considering the relatively short plasma half-life of metformin after oral administration (range, 4.0–8.7 hours) [12], we investigated the feasibility of medication discontinuation for 2 days on reducing the increased intestinal FDG uptake induced by metformin. In addition, we also investigated changes in blood glucose level after the discontinuation of medication for 2 days with intrasubject (study 1) and intersubject (study 2) analysis.”
”CONCLUSION. The discontinuation of metformin for 2 days is feasible for reducing the high intestinal FDG uptake induced by metformin.”



Hi
I understood that nodules wasnt seen. That is great and others were could be ımflamation. Dont be stress. I think pet result is not bad. But every little think is important so they will observe. But i think chemos side effect . Good luck. My husband MR will be given tomorrow. Nervous too. But we try to live with this.


Ebru
Caregiver of husband
Stage 4 rectum ca 14 dec 2017
Chemo 3 rounds vectibix
Pet ;10 mm met in liver
MRI; 1-4 mets in liver
Chemo 3 rounds
Pet ;NED
MRI ;1-5 mets in liver
6 rounds chemo
Pet;Ned
MRI; shows Unoperable liver mets ( 10-15)
6 rounds chemo ( pills changed)
Pet shows 1,4 cm and 1,7 cm mets in liver
MRI shows 5 mets
Planned chemo
Wellcome 2019

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LPL
Posts: 650
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Scanxiety - Good thoughts Please

Postby LPL » Mon Jan 21, 2019 5:25 pm

Educator, thank you for your comment.
I have also been thinking maybe these nodels due to chemo? Who knows.. Good luck with your MRI tomorrow!
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb lung met

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O Stoma Mia
Posts: 1600
Joined: Sat Jun 22, 2013 6:29 am

Re: Scanxiety - Good thoughts Please

Postby O Stoma Mia » Tue Jan 22, 2019 1:48 am

LPL-
Thank you for providing the update on PET scan results. It's reassuring to see that they didn't find any obvious metastatic nodules. Now they will do a new colonoscopy and a followup scan, but this is probably just standard procedure to double-check that everything is OK.

You have been doing quite a lot of research on this lately. I hope your DH appreciates all of the hard work that you have been doing.

Educator
Posts: 39
Joined: Mon Apr 09, 2018 3:38 pm
Facebook Username: Ebru köse

Re: Scanxiety - Good thoughts Please

Postby Educator » Tue Jan 22, 2019 6:12 am

LPL wrote:Educator, thank you for your comment.
I have also been thinking maybe these nodels due to chemo? Who knows.. Good luck with your MRI tomorrow!



Thanks :o Im waiting
Caregiver of husband
Stage 4 rectum ca 14 dec 2017
Chemo 3 rounds vectibix
Pet ;10 mm met in liver
MRI; 1-4 mets in liver
Chemo 3 rounds
Pet ;NED
MRI ;1-5 mets in liver
6 rounds chemo
Pet;Ned
MRI; shows Unoperable liver mets ( 10-15)
6 rounds chemo ( pills changed)
Pet shows 1,4 cm and 1,7 cm mets in liver
MRI shows 5 mets
Planned chemo
Wellcome 2019

mpbser
Posts: 928
Joined: Wed Apr 19, 2017 11:52 am

Re: Scanxiety - Good thoughts Please

Postby mpbser » Tue Jan 22, 2019 10:14 am

Just checking in to see how it's going. The waiting sucks, doesn't it!?!?
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

Educator
Posts: 39
Joined: Mon Apr 09, 2018 3:38 pm
Facebook Username: Ebru köse

Re: Scanxiety - Good thoughts Please

Postby Educator » Tue Jan 22, 2019 4:21 pm

mpbser wrote:Just checking in to see how it's going. The waiting sucks, doesn't it!?!?



Yes, and today doctor said pet and mr results good . Chemo achieved. And I am relax now to another scan. Lots of mets gone . But go on chemo . This is little boring . But he is smiling this enough for me
Caregiver of husband
Stage 4 rectum ca 14 dec 2017
Chemo 3 rounds vectibix
Pet ;10 mm met in liver
MRI; 1-4 mets in liver
Chemo 3 rounds
Pet ;NED
MRI ;1-5 mets in liver
6 rounds chemo
Pet;Ned
MRI; shows Unoperable liver mets ( 10-15)
6 rounds chemo ( pills changed)
Pet shows 1,4 cm and 1,7 cm mets in liver
MRI shows 5 mets
Planned chemo
Wellcome 2019


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