Distant Lymph nodes

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Boys0406
Posts: 9
Joined: Mon May 13, 2019 8:56 pm
Facebook Username: dcrase

Distant Lymph nodes

Postby Boys0406 » Sun May 19, 2019 9:46 pm

Has anyone had distant lymph nodes show up on their CT and PET scans that were enlarged and then they turned out to just be inflammation from the tumor and negative for cancer? My DH had some distant nodes show up on his scans that they were unable to biopsy during surgery and now we are waiting to see if they’ll still show up after surgery and chemo. The scan is in a few weeks. If the lymph nodes shrunk, it could mean they were cancer and responded to chemo or they were not cancer and just inflamed. It seems odd that they’d just be inflamed if they were distant, since that means Stage IV. I just want them to biopsy no matter what, so we know for sure.

Anyone know if a lymph node that was no longer enlarged and was cancer prior to chemo would test positive in a biopsy if chemo had shrunk it ?
Wife of DH-46yrs old
DX’d-11/18 rectosigmoid colon cancer
T type-adenocarcinoma
Positive LN-2/59
CEA- 239.8
CDX-2 positive
dMMR-retained nuclear expression of all 4 mismatch repair proteins
T4bN1bM-pm(or listed as n/a, couldn’t biopsy possibly LN)
Stage3c (invaded bladder wall)
11/18-surgery, ileostomy, and removal of back of bladder
12/18-Folfox started (12 cycles)
2/19-CEA 1.1
3/19-blood clot,hospital 3 days
3/19- began Eliquis
5/31/19-Completed Folfox

rp1954
Posts: 1518
Joined: Mon Jun 13, 2011 1:13 am

Re: Distant Lymph nodes

Postby rp1954 » Fri May 24, 2019 4:46 pm

Boys0406 wrote:Has anyone had distant lymph nodes show up on their CT and PET scans that were enlarged and then they turned out to just be inflammation from the tumor and negative for cancer? My DH had some distant nodes show up on his scans that they were unable to biopsy during surgery and now we are waiting to see if they’ll still show up after surgery and chemo. The scan is in a few weeks. If the lymph nodes shrunk, it could mean they were cancer and responded to chemo or they were not cancer and just inflamed. It seems odd that they’d just be inflamed if they were distant, since that means Stage IV. I just want them to biopsy no matter what, so we know for sure.

If you're going to talk distant LN and screen most effectively, you need the radiologist's estimated size (mm), and location(s). Also we favored more information on bloodwork to hit back with, from markers to inflammation and liver panels, on daily immunochemo (regular chemo messes with more panels). Your husband's bloodwork right before surgery, after surgery and before chemo may have more useful data for your husband's metastatic situation, if they took enough data.

There have been some cases of presumed inflamed/infected LN that subsided. Not sure of the time intervals and percent. By and large, people don't go fishing in the LN. The only case I can think of here, had already rapidly snowballing problems that left everyone here traumatized. Perhaps a selective memory.
Anyone know if a lymph node that was no longer enlarged and was cancer prior to chemo would test positive in a biopsy if chemo had shrunk it ?

I don't have a direct answer. One problem that I will note that we had was a discrepancy between all the radiologists' estimate of number (either 1 or 2 LN mets) and size(s), and the actual conglomerated LN cluster. The actual cluster was larger than scanned and reported, filled with small LN mets like a little bag of BBs and smaller, and 3 large ones, 1.7 - 2.3 cm. The head surgeon appeared horrified, I got the impression they wouldn't have done the surgery if they had realized its true numerous, conglomerated LN nature.

If distant, LN are considered likely disseminated, although single LN sites are now more often considered resectable. A quarter of my wife's LN cluster contained mets from 1 mm micromet to a 23 mm met with extensions. Chemo had necrosed part of the LN cell loads, and apparently, certain cell types and not others.

We did keep more kinds of nicer chemistry targeted on my wife, sooner, longer, and more continuously than anyone else I've seen, to stop the metastatic LN spread, and kill post surgical residual cells that blossom at any opportunity, for some years until their exhaustion(?).
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

Nohogirl
Posts: 114
Joined: Sun Oct 14, 2018 12:15 am

Re: Distant Lymph nodes

Postby Nohogirl » Wed May 29, 2019 12:14 pm

Yes. My husband has similar situation. A distant lymph node (at the level of aortic bifurcation) enlargement was seen on his post surgery CT and MRI in October of 2018. Was discussed at the tumor board and everyone agreed it was inflammation from surgery. PET scan was done in February of this year and the report stated that no activity was shown and is likely granulation from surgery. We have another PET scan coming up in July to see if it has changed in size. the location of my husband's lymph node was too risky for biopsy or removal. If your husband's lymph node can be biopsied or removed and sent to pathology it would be the best definite way of determining if its malignant or not to put your mind at ease. Good luck
04/18 DH 49 Stage 2A T3N0M0 rectal cancer moderately differentiated.
05/18 chemorad. (Xeloda) 28 days
08/18 Surgery- 24 cm, including entire rectum out
Path -Stage II T2N0M0 moderate to poorly diff. adenocarcinoma
0 of 15 lymph nodes
No PNI
No LVI
Clear margins
10/18-02/19 8 cycles of Folfox
02/19 Normal Pet Scan

Boys0406
Posts: 9
Joined: Mon May 13, 2019 8:56 pm
Facebook Username: dcrase

Re: Distant Lymph nodes

Postby Boys0406 » Wed May 29, 2019 8:44 pm

Thanks for your reply. With my husband, his distant lymph nodes were inflamed and were hyper metabolic previous to him having the tumor removed and ileostomy etc... Therefore, his couldn’t be inflammation from surgery, but we were told it could be from the tumor just being there and causing inflamed lymph nodes.

Today was my husband’s last chemo and he will be unhooked for his pump Friday morning. So happy that he is through his 12 rounds of FolFox!

We discussed the lymph nodes with his oncologist today. At first he said that he expects a clean scan, but that could still mean that the lymph nodes were cancerous, just that they shrunk due to chemo. I know that would still be good news either way, but it wouldn’t let us know the definite stage. He said that if the lymph nodes still light up on the PET scan, then we’ll try to do a biopsy. He also mentioned that they are located in a difficult place to get to. I am not sure what to hope for. Obviously, we want it to be clear, but then we still may not know if his cancer was metastatic stage 4 or not. At least if his lymph nodes still show up on the PET scan, maybe we’ll get a definite answer from a biopsy, although we may not like what we find out. It would be really nice to know if they are not cancerous though!! This is very nerve wracking and I know the next few weeks will be filled with more anxiety as we wait for the scan and results.

We will do a PET scan in about 2 weeks or so and have an appointment to see the Oncologist to discuss results on the 19th of June.

Good luck to you and your husband Nohogirl!
Wife of DH-46yrs old
DX’d-11/18 rectosigmoid colon cancer
T type-adenocarcinoma
Positive LN-2/59
CEA- 239.8
CDX-2 positive
dMMR-retained nuclear expression of all 4 mismatch repair proteins
T4bN1bM-pm(or listed as n/a, couldn’t biopsy possibly LN)
Stage3c (invaded bladder wall)
11/18-surgery, ileostomy, and removal of back of bladder
12/18-Folfox started (12 cycles)
2/19-CEA 1.1
3/19-blood clot,hospital 3 days
3/19- began Eliquis
5/31/19-Completed Folfox


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