My husband was diagnosed with colon cancer in April 2017. He had a laparoscopic resection in May 2017 to remove a nearly completely obstructing tumor in the lower descending colon that had invaded into the surrounding tissue. 9 of the 52 lymph nodes taken were malignant. The surgeon noted a mass on his liver and wedged it for biopsy. Adenocarcinoma. He has no inherited mutations, normal immunochemistry, and low tumor mutational burden.
A follow-up PET scan showed another tumor at the transverse-ascending colon juncture, so he had a laparoscopic sub-total colectomy in August 2017. This tumor was considered a secondary primary but it had not invaded outside the colon, was T1. The surgeon took 44 lymph nodes and none were malignant. The surgeons had planned to do the liver at the same time as the colectomy. However, when they performed the intraoperative inspection, they saw that the mass was too close to his vasculature and larger than expected. It would have to be done at a later time in an open surgery. The liver surgeon also noted a number of tiny masses about 1 mm in size.
He did four rounds of chemo (XELOX) in fall 2017. The liver tumor shrank in half. In January 2018, a couple days before the liver surgery, he had a second spot (1.5 cm) that the MRI showed on segment 5 biopsied. It was a benign hamartoma. He then had his liver surgery, an open hepatectomy, on segment 4A at the bifurcation of a hepatic blood vessel. The surgeon achieved clear margins. He also ablated all the tiny masses that he saw. The operative notes state: [Dr. Qadan] noted there were six to eight 1-2 mm lesions on the liver surface likely consistent with biliary hamartomas but he burned them with the “Bovie” just in case these were metastases.
No mop-up chemo. He had a clear CT in May 2018, although CTs never picked up on his liver metastasis and is not a good tool for him due to his weight (except for Chest CTs). Therefore, NED. In August 2018, colonoscopy was clear. Still NED. In November 2018, he had another clear CT. However, in early December, a radiologist at Mass General Hospital reported a recurrence in his liver. We sought a second opinion at MSK. MSK's January 4th PET scan did not confirm any hot spots in the liver or anywhere else, only cysts/scarring/benign lesions when comparing to all his other scans. He had a MRI on Friday, January 11th at MSK with their machines, their contrast, their technicians. Now, waiting for those results which will put us at a crossroads. Hopefully still NED. Fingers crossed!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
5 x 4 x 1 cm
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, 2.9, 2.2
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows met
Resection & HAI Mar 7??