Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

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Whatley
Posts: 1
Joined: Sun Jul 07, 2019 5:49 pm

Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby Whatley » Mon Jul 08, 2019 5:05 am

https://imgur.com/a/75cWJLV
https://imgur.com/a/RQ15Afc

Hi, found this site yesterday and the wealth of information here so far has been amazing, I feel like I understand everything much better now so thank you so much.

Dad got hospitalised with a bowel obstruction two weeks ago. Unfortunately he was working abroad at the time in Dubai, hence I can't really talk to the doctors or know anything other than what he passes on as 2nd hand info. He did send me this pathology report that I'm trying to make sense of though. They did a colonoscopy and confirmed it, but decided against neoadjuvant chemo in favour of just getting the mass out ASAP. Not sure if that's good or not but based on what they're saying they think they got all of it out and he's recovered from surgery super quickly and is feeling great. They haven't given a stage or anything though.

As far as the pathology report goes, the tumour looks like it was a big one and maybe went all the way to the abdominal wall, making it a T4b? From what I've read that's usually a pretty poor sign so that's worrying. On the other hand, it only being in 1/11 lymph nodes should be pretty positive right? I'm really not sure what to think in his case. I'm mostly worried about this whole business with it reaching his abdominal wall and penetrating the peritoneal layer...seems like that can lead to a rough prognosis. Overall looking at a stage IIIC from what I can tell?

Other than that he's 65 but in amazing shape, no other health issues, very good heart, goes to the gym regularly. The docs want to start him on 6 months chemo (Think it's FOLFOX), and radiation after that. I'm just trying to find out if this whole situation is positive or not...some of the stuff I've read about IIIC and T4b tumours seems extremely scary in terms of prognosis.

Thanks so much for this community being here, it's already been such a massive help.

boxhill
Posts: 355
Joined: Fri Apr 06, 2018 11:40 am

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby boxhill » Mon Jul 08, 2019 1:05 pm

Since your dad's tumor was causing an obstruction and was resectable, the hemicolectomy was a good thing to do. It is good that he only had one positive node, and no apparent metastases.

I am not a doctor, obviously, and I can't tell you what to think about the abdominal wall connection stuff. If you do some googling, you can find out about more it. One thing I urge you to do is keep you rational mind in gear while doing so, and don't get overwhelmed by stuff you read about survival statistics and what not that are very likely out of date. Don't forget that treatments now in regular use didn't exist 10 years ago, or even 5!

Now, the information that your and your dad REALLY need at this point is his tumor genetics, because that will affect his ongoing treatment significantly. At the minimum, his tumor should be tested by pathology to determine if it is MSS or MSI, and whether is has certain genetic mutations, the most basic probably being KRAS and BRAF. Google those terms to see what they mean. There are several different chemo possibilities, and which ones are selected depend on these genes, amongst other factors. He needs to mmake sure that this is being done right away.

It sounds like they plan to do what is known as adjuvant chemo when he heals from the surgery. That's a pretty standard course of treatment for Stage 3, and the idea is to try to mop up any stray cancer cells before they can cause trouble. I am figuring--and remember that I am NOT a doctor--that they might be talking about radiation because of the abdominal wall stuff.

Stay calm, educate yourself, and support your dad. Big hug to you!
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable

User avatar
Jacques
Posts: 520
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby Jacques » Mon Jul 08, 2019 1:27 pm

Whatley wrote:...
I'm just trying to find out if this whole situation is positive or not...some of the stuff I've read about IIIC and T4b tumours seems extremely scary in terms of prognosis.

I had a rectal T4b tumor seven years ago and have now been in remission for over 6 years.

You should try to obtain information from patients who had a T4b tumor involving the cecum, and who had a right hemicolectomy. For example:

http://coloncancersupport.colonclub.com/viewtopic.php?t=51454#p399364

Cecum tumors are different from rectal tumors

You should also ask about the data items that are still missing, for example: Pre-surgery level of CEA tumor marker; MSI (microsatellite instability) status, perineural invasion (PNI) status, and the results of all scans of the liver and lungs.

The overall outcome will depend on the efficacy of the chosen treatment regimen (surgery+chemo+radiation) and the skill of the doctors in managing the treatment. Normally, for this kind of diagnosis the treatment phases will take up most of the first year, then after all treatments are finished there is a five-year period of followup.

boxhill
Posts: 355
Joined: Fri Apr 06, 2018 11:40 am

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby boxhill » Mon Jul 08, 2019 7:04 pm

I had a right-sided tumor at the hepatic flexure, resulting, like your dad, in a right hemicolectomy, in which they removed the appendix, cecum, and everything else up to some point in the transverse colon: about 30% of the colon overall. (This is standard, and has to do with the configuration of the blood supply.) Although in my signature it says it was pT3, in fact there was a difference of opinion: the local pathologist said pT4, the Dana Farber review said pT3. I decided to go with the latter because it made me feel better. :) In any case, I was diagnosed stage 4, with a LOT more lymph node involvement than your dad. and a liver met. Today I have only one tiny 5mm liver thing, which may or may not be a met, and if I had believed what I first read on wikipedia about my likely survival I would be either dead or dying at this very moment. My prognosis is actually pretty good, especially if I can get back on Keytruda.

So find out about his tumor genetics, and take heart. It's good that you are here.

I would also suggest that you--and your dad--check out the private Facebook group Colontown.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable

Dionca
Posts: 38
Joined: Sat Dec 02, 2017 2:04 am

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby Dionca » Mon Jul 08, 2019 7:15 pm

I had a similar diagnosis, with cancer of the cecum, involving the valve. My pathology report showed an inflammatory reaction on the serosal surface raising the possibiity of a peritoneal breach. However as there were no tumour cells found at the surface, they staged it at T3 (if it had breached the serosa it would be a T4a but would not affect staging). I had 2/12 positive nodes as well as perineural and lymphovascular invasion (which your father doesn't appear to have).

My diagnosis was T3 N1b MX which is Stage 3B. I thought your father could possibly be a 3B (T4a) but you say 3C (T4b) but I don't want to give you any wrong information. If you go to this site, it shows staging in detail, along with good diagrams.
https://www.cancer.gov/types/colorectal ... atment-pdq

The 6 months of FOLFOX is standard, but I don't know why your father will be having radiation. I know its often used for rectal cancer, before surgery, but haven't heard of it for cecal cancer before.

You might want to get your father to send you a copy of his blood count, which is usually taken before chemo, so you can keep an eye on what is going on (and if he wants to share)

It has to be difficult for both of you, being in different countries (or will he be home for treatment?), but it sounds as everything is going according to plan and I hope your father does well with the chemo.
May 2015 right hemi CC cecum
removed terminal ileum, illeocecal valve, appendix, cecum, ascending colon, omentum
stage 3b T3 N1b MX 2/27 nodes (isolated tumour cells in 1 add'l node)
moderately differentiated
PNI - positive
LVI - positive
Folfox 12 sessions (without oxi for 11 & 12)
Neulasta with 3-12 due to low WBC count
CEA at diagnosis 8.6
CEA after surgery 1.2
CEA during chemo 4.6 / 3.3 / 2.3
CEA after chemo 1.5 / 1.2 / 1.2 /1.2 /1.2 / 1.4 / 1.1 / 1.2 / 1.9 / 1.3 / 1.6 /1.4 /1.5
neuropathy

dauofcamom
Posts: 34
Joined: Sun Apr 22, 2018 7:11 pm

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby dauofcamom » Mon Jul 08, 2019 7:45 pm

I am very sorry for what you are going through. It is a shock to get the diagnosis but you are doing well by gathering all the info you can.

My mom was diagnosed stage 3C with a mass in her cecum which grew to her abdominal wall in March last year. Chemo failed in the first round as she was not able to metabolize the drugs and it put her in the hospital for 15 days. So she could do nothing but hope the cancer wouldnt return. It did return five months later though. Fortunately for my mom she was MSI-High and a candidate for immunotherapy. She went on Keytruda in October and had a complete response to the immunotherapy. The returning two tumors were eradicated and she has no evidence of disease and she’s fortunate enough to have no side effects from the Keytruda. She is feeling better than she’s ever felt.

It would be very important for your Dad to have his tumor genetically tested, as someone has already mentioned, in case chemo is ineffective.

I wish you and your Dad strength as you go through this journey. This is a good place to be for support.
Long Distance Caregiver to 75 year old Mom
3/2018 - colonoscopy, DX malignant cecum mass
4/2018 - right hemi
Stage IIIC - T4bN1aM0
MSI High
5/2018 - Xelox Regime
10/2018 - peri Mets discovered
10/2018 - Start Keytruda every 3 weeks
12/2018 - scan all clear

NHMike
Posts: 2269
Joined: Fri Jul 21, 2017 3:43 am

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby NHMike » Wed Jul 10, 2019 8:05 am

Neoadjuvant Chemo and Radiation are usually for Rectal Cancer. With Colon Cancer, they can just remove it and then decide on Adjuvant Chemo. IIIC is scary but a lot of people survive. The Genomic Tumor testing mentioned above is not always covered by insurance and it's not available everywhere as most hospitals don't have the equipment or staff to do it. If you want to have it done, you'd have to check with the hospital where the tumor was removed and see whether or not they will do it. If they don't do it onsite, then it would have to be sent to a lab or hospital which offers the service. This is assuming that they kept the tumor specimen. The hospitals that I've used keep the specimen around for some period of time. My hospital sent it out to another hospital to have it done three months after the biopsy.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

boxhill
Posts: 355
Joined: Fri Apr 06, 2018 11:40 am

Re: Scared Son, dad maybe has IIIC? Can anyone help me understand this pathology?

Postby boxhill » Thu Jul 11, 2019 12:23 pm

Regional pathology labs ought to be able to do the basics: dMMR/MSS/MSI, BRAF, KRAS and I think it is standard for it to be done for everyone these days. I got the results of mine with the original pathology report when I was still in the hospital. Sending the tumor out for full genomic testing is indeed another matter.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable


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