My husband was diagnosed with Stage 3C rectosigmoid cancer in November of 2018. His tumor was 10.7cm x 10.2cm in greatest dimension. He had a low anterior resection and a loop ileostomy. The day after Christmas, he began chemotherapy(Folfox) and he finished his 12th and final round today. Yay! He will have his scan done in about 2 weeks and then we meet with the oncologist again on the 19th to discuss the results. His oncologist said that he feels optimistic that his scan will be clean. I think this is due to the fact that the surgeon had clean margins after surgery and my husband had a CT scan done in March because he was admitted to the hospital in March for a blood clot and according to the CT scan things looked clean. This is great news if our oncologist is correct, but we are still worried, even if it is a clean scan.
I wrote about the fact that he had distant lymph nodes that were hypermetabolic at diagnosis in an earlier post. I have some more information and would like to see if anyone can offer further advice or information. On our first visit to the oncologist prior to surgery, he mentioned that my husband had lymph nodes showing up on both his CT scan and his PET scan that were distant and if they were found to be cancerous, then he would be at Stage 4. We then proceeded with the surgery and the surgeon checked a total of 59 lymph nodes. Of those, 2 were positive. When we asked if he had been able to take out the distant lymph nodes to have them tested, he said no. He said they were too far out of reach and that because he had tested so many(local) and only two were positive, that statistically, the distant nodes were also probably negative. Therefore, the pathologist staged his cancer at T4bN1b and the M was listed on the report as "PM" which is "not applicable/cannot be determined from submitted specimen". When we spoke to the oncologist about the surgeon's reasoning on the distant lymph nodes he wasn't convinced and was still concerned that they could be cancerous. He did explain that sometimes with PET and CT scans there are false positives due to inflammation and that these lymph nodes could be inflamed due to the tumor itself. He told us that a clean scan with lymph nodes having shrunk could still mean they were cancerous and it's hard to know what to wish for.
I am curious if the distant nodes would be affected by his tumor in their location. As of right now, we are waiting for the scan. He is going to do a PET scan so that we can compare the 2 scans(before and after surgery and chemo). If the nodes show up on the scan, then he said we'll either try to biopsy or see if the surgeon can take them out laprascopically. If they don't show up, it's good, but it still may be that they were cancerous and that they have shrunk in size due to chemo. I really wish we could just get a biopsy. We just want to know for sure if we still need to be concerned about the lymph nodes. Here is what the pathology report from the PET-CT said:
"There are numerous presacral and inferior mesenteric artery chain lymph nodes which are hypermetabolic. A 2.2 x 1.4cm presacral node has SUV max 4.8. Small perirectal nodes are noted as well as a few hypermetabolic lower retroperitoneal lymph nodes along the left side of the distal aorta and left common iliac artery."
Does anyone know if it is likely these could just be inflamed lymph nodes? Do sigmoid colon tumors feed into those lymph nodes and if so would it make more sense that they were cancerous or just inflamed? Has anyone else had these lymph nodes identified as cancerous? I realize most out there are patients and caretakers and not medical professionals, but I thought I'd ask in case anyone had a similar experience or has medical knowledge. Thanks so much!