Spread into Peritoneal

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nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Spread into Peritoneal

Postby nzjez » Sun Sep 01, 2019 11:43 pm

Hi Colon Club members
Just had an unpleasant phone call from the hospital - they have found peritoneal disease near where my original colon cancer tumor was.
I now have to wait for hospital board, and surgeon to get back to me about options and prognosis.
Can anyone else with experience or knowledge tell me what to expect? Is there any hope for me at all?
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

Rock_Robster
Posts: 375
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Spread into Peritoneal

Postby Rock_Robster » Mon Sep 02, 2019 1:09 am

Hi nzjez,

Sorry to hear your news mate.

I’m not an expert on peritoneal disease, but I understand if the spread is confined and can be removed through cyto-reductive surgery (CRS), then curative intent can still be on the table. Many times this is combined with intra-abdominal chemotherapy (HIPEC) to improve outcomes, though I think the evidence for this is less clear.

Main thing will be to get your surgeon’s views on surgical options, and go from there. It’s pretty specialised surgery to so depending on where you are, it might be worth travelling for a second opinion.

Other than that, of course we’re all here with you in the meantime.

Best of luck.
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Mon Sep 02, 2019 1:21 am

Hi Rob
Thanks for taking the time to reply.
I like the sound of curative intent.
I was just so deflated after the Dr's brief phone call, I felt like I had lost then and there. My world just came crashing down after such a big battle, and what felt like a short time recovering.
But I will now hold on to this chance in the meantime.
Cheers,
Jeremy
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

Rock_Robster
Posts: 375
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Spread into Peritoneal

Postby Rock_Robster » Mon Sep 02, 2019 1:30 am

nzjez wrote:Hi Rob
Thanks for taking the time to reply.
I like the sound of curative intent.
I was just so deflated after the Dr's brief phone call, I felt like I had lost then and there. My world just came crashing down after such a big battle, and what felt like a short time recovering.
But I will now hold on to this chance in the meantime.
Cheers,
Jeremy

No worries at all - hope the next conversation brings better news. Whatever it is, just know that there are options, and lots of folk here deal with this (which is why I’ll now shut up and let more experienced people chime in!). As my surgeon says, you don’t have to win every battle, you just need to win more than you lose.
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

bitchslapped
Posts: 1524
Joined: Tue Sep 09, 2014 3:23 pm
Location: PNW/USA

Re: Spread into Peritoneal

Postby bitchslapped » Sat Sep 14, 2019 2:50 pm

Sometimes hope is all we have Jeremy. Hope changes throughout the cancer journey, sometimes if it's just for a better tomorrow.
You are young, so the challenges may be greater in that the cancer can seem more aggressive, but there is always hope. For colon cancer patients, spread to the peritoneal cavity can be more challenging than appendix cancer spread to the peritoneal w/the exception being high grade appendiceal cancer.
I believe the difference for those colon cancer patients undergoing CRS/HIPEC is adjuvant chemotherapy is recommended where not necessarily for low-grade appendiceal cancer.
Lymph node involvement will also be a complicating factor.

Colorectal peritoneal metastases: Optimal management review, July 2019:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658395/


The role of HIPEC in relation to the PRODIGE 7 trial in this review:


The lack of consensus about the role of HIPEC may be due to several reasons: The marked heterogeneity of protocols, drugs, carrier solutions and methods of HIPEC administration (open, semi-open, closed techniques) and the discrepancy concerning patient eligibility and lack of randomized trials in the era of modern chemotherapy and targeted therapy.

The preliminary results of the PRODIGE 7 trial[76], presented at the American Society of Clinical Oncology (ASCO) meeting in 2018, questioned the widespread conviction of the beneficial effects of HIPEC. After complete cytoreduction of M1c CRC, 265 patients were randomized to standard treatment plus HIPEC with oxaliplatin or standard treatment alone. No significant difference in overall survival was found, with a median of 41.7 months in the HIPEC arm vs 41.2 mo in the non-HIPEC arm [Hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.73-1.37] and no significant difference in relapse-free survival (13.1 vs 11.1 mo, HR = 0.90, 95%CI: 0.69-1.90). However, a trend toward better disease-free survival was found on the Kaplan-Meier curves for the first 18 months after surgery, and a subgroup analysis for patients with a PCI between 11 and 15 showed significantly better overall and recurrence-free survival for the HIPEC group.

Regarding morbidity, the study reported a higher late, grade 3-5 morbidity (up to 60 d after surgery) in the HIPEC arm (24.1% vs 13.6%, P = 0.03). The unexpected results have encouraged the scientific community to continue searching for the role of HIPEC in PM, as its advantageous effects have been extensively reported in the biomedical literature for CRC and recently proven for other origins[77]. To our knowledge, high quality and complete cytoreduction has been confirmed once again as a pivotal pillar of treatment for peritoneal dissemination of CRC. Efforts are now focused on electing patients who would benefit the most from HIPEC because this trial remarks high PCI as an already known impaired factor.

Another goal is to ascertain the real morbidity (as most of the publications only report the 30-day morbidity-mortality and have widely been compared, similar to other major abdominal surgeries[78]) and reduce the side-effects of HIPEC[79]. This may be achieved by either minimizing drug doses (which has been one critic of the PRODIGE 7, considering previous experimental studies)[80], establishing the benefits of hyperthermia alone and combined with the chemotherapy agents, or trying different drugs or delivery systems. Additionally, the final results are published; to date, only one multicenter randomized trial studying the effects of HIPEC vs standard treatment for patients with established PM of CRC origin (NCT02179489). Therefore, the search is ongoing, and further trials are needed to determine what HIPEC can offer.




Bottom line you would need laparoscopic surgery to determine PCI (peritoneal cancer index). Of course less is best so PCI of <10 = highest rate of 5-year survival rates.
My best friend had discomfort similar to what you describe in a previous post...in the vicinity of her right ribcage. Several doctors & several months later her persistence paid off. It was discovered through laparoscopic surgery that her appendix was cancerous (rare) & removed. She had mucinous spread to her perotineal w/PCI index of 10. If you go ahead w/any procedures have them check that appendix too. She was able to travel to find a highly regarded, high volume CRS/HIPEC cancer center. I highly recommend you do the same if @ all possible.

Do check back in with what you have learned from your doctors.

Best Wishes
BS
DSS,35YO,unresect mCRC DX 7/'14,lvr,LN,peri,rib
FOLFOX+Avstn 4 Rnds d/c 10/'14
Stent 9/'14
FOLFIRI+Avstn 10/'14
Gone From My Sight 2/20/15
Me:garden variety polyps + precancerous polyp, diverticulitis
Carergver x2 DH,DM dbl occupancy,'03-'10
DH dx 47YO mCRC,'04-'07 fried x HAI
DM dx CC 85YO,CC,CHF,stroke,dementia,aphasia

tcross
Posts: 3
Joined: Mon Mar 26, 2018 6:42 pm
Facebook Username: Tadd L Crosslin

Re: Spread into Peritoneal

Postby tcross » Sun Sep 15, 2019 7:17 am

I’m in the same boat as you currently. Found out in August I have spread in the periometuem. I’m currently three rounds into FOLFOXFIRI and had a diagnostic laparoscopy conducted two weeks ago and given a PCI of 6. The plan is to perform 6-9 chemo sessions prior to CRS/HIPEC and then another 3-6 after and then take it from there.
Most insurance companies will fight paying for the HIPEC portion but CRS is typically covered. You can seek out information at insurancewarrior.com for how to appeal. The author appealed her HIPEC 14 years ago and won. She had appendixeal cancer but there are several with colon cancer that are survivors as well.
Find an NCI-designated hospital and they will have a surgeon that specializes in the procedure. https://www.cancer.gov/research/nci-rol ... nters/find

boxhill
Posts: 386
Joined: Fri Apr 06, 2018 11:40 am

Re: Spread into Peritoneal

Postby boxhill » Mon Sep 16, 2019 11:23 am

nzjez, what is your MSS/MSI, KRAS, BRAF, etc status?
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

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Fri Sep 20, 2019 8:48 pm

boxhill wrote:nzjez, what is your MSS/MSI, KRAS, BRAF, etc status?

Hi Box hill
My details i know of are:
pMMr
LSI+
TD+
CEA non-secretor
Not KRAS
BRAF was not done
And have been told as if yesterday that the PET/CT found cancer in one area peritoneal in my Low Anterior.
This was found 3 weeks ago. Nothing has yet happened as far as treatment, and discussion from my surgeon started during my meeting yesterday. Now inquiring with specialists and looking into either CRS/HIPEC, or Pelvic Exenteration.
I'm surprised I'm in such limbo, should I be on some chemo to help slow things down in the mean time? Or will it effect the possible surgery?
Curious on any thoughts or advice.
Cheers,
Jeremy
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Fri Sep 20, 2019 9:02 pm

bitchslapped wrote:Sometimes hope is all we have Jeremy. Hope changes throughout the cancer journey, sometimes if it's just for a better tomorrow.
You are young, so the challenges may be greater in that the cancer can seem more aggressive, but there is always hope. For colon cancer patients, spread to the peritoneal cavity can be more challenging than appendix cancer spread to the peritoneal w/the exception being high grade appendiceal cancer.
I believe the difference for those colon cancer patients undergoing CRS/HIPEC is adjuvant chemotherapy is recommended where not necessarily for low-grade appendiceal cancer.
Lymph node involvement will also be a complicating factor.

Colorectal peritoneal metastases: Optimal management review, July 2019:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658395/


The role of HIPEC in relation to the PRODIGE 7 trial in this review:


The lack of consensus about the role of HIPEC may be due to several reasons: The marked heterogeneity of protocols, drugs, carrier solutions and methods of HIPEC administration (open, semi-open, closed techniques) and the discrepancy concerning patient eligibility and lack of randomized trials in the era of modern chemotherapy and targeted therapy.

The preliminary results of the PRODIGE 7 trial[76], presented at the American Society of Clinical Oncology (ASCO) meeting in 2018, questioned the widespread conviction of the beneficial effects of HIPEC. After complete cytoreduction of M1c CRC, 265 patients were randomized to standard treatment plus HIPEC with oxaliplatin or standard treatment alone. No significant difference in overall survival was found, with a median of 41.7 months in the HIPEC arm vs 41.2 mo in the non-HIPEC arm [Hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.73-1.37] and no significant difference in relapse-free survival (13.1 vs 11.1 mo, HR = 0.90, 95%CI: 0.69-1.90). However, a trend toward better disease-free survival was found on the Kaplan-Meier curves for the first 18 months after surgery, and a subgroup analysis for patients with a PCI between 11 and 15 showed significantly better overall and recurrence-free survival for the HIPEC group.

Regarding morbidity, the study reported a higher late, grade 3-5 morbidity (up to 60 d after surgery) in the HIPEC arm (24.1% vs 13.6%, P = 0.03). The unexpected results have encouraged the scientific community to continue searching for the role of HIPEC in PM, as its advantageous effects have been extensively reported in the biomedical literature for CRC and recently proven for other origins[77]. To our knowledge, high quality and complete cytoreduction has been confirmed once again as a pivotal pillar of treatment for peritoneal dissemination of CRC. Efforts are now focused on electing patients who would benefit the most from HIPEC because this trial remarks high PCI as an already known impaired factor.

Another goal is to ascertain the real morbidity (as most of the publications only report the 30-day morbidity-mortality and have widely been compared, similar to other major abdominal surgeries[78]) and reduce the side-effects of HIPEC[79]. This may be achieved by either minimizing drug doses (which has been one critic of the PRODIGE 7, considering previous experimental studies)[80], establishing the benefits of hyperthermia alone and combined with the chemotherapy agents, or trying different drugs or delivery systems. Additionally, the final results are published; to date, only one multicenter randomized trial studying the effects of HIPEC vs standard treatment for patients with established PM of CRC origin (NCT02179489). Therefore, the search is ongoing, and further trials are needed to determine what HIPEC can offer.




Bottom line you would need laparoscopic surgery to determine PCI (peritoneal cancer index). Of course less is best so PCI of <10 = highest rate of 5-year survival rates.
My best friend had discomfort similar to what you describe in a previous post...in the vicinity of her right ribcage. Several doctors & several months later her persistence paid off. It was discovered through laparoscopic surgery that her appendix was cancerous (rare) & removed. She had mucinous spread to her perotineal w/PCI index of 10. If you go ahead w/any procedures have them check that appendix too. She was able to travel to find a highly regarded, high volume CRS/HIPEC cancer center. I highly recommend you do the same if @ all possible.

Do check back in with what you have learned from your doctors.

Best Wishes
BS

Thanks BS
That was really informative. I find it comforting to understand options and details.
Specialist has been contacted by both me privately (appt in 2 weeks), and publicly with no known details yet.
Also public surgeon has contacted a Pelvic Exenteration specialist surgeon, as this is suggested if know further spread from the suggested metastasis in the PET/CT.
Good to have options, would be great if things start moving along before my chances disappear.
Many thanks
Jeremy
Last edited by nzjez on Fri Sep 20, 2019 9:19 pm, edited 1 time in total.
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Fri Sep 20, 2019 9:16 pm

tcross wrote:I’m in the same boat as you currently. Found out in August I have spread in the periometuem. I’m currently three rounds into FOLFOXFIRI and had a diagnostic laparoscopy conducted two weeks ago and given a PCI of 6. The plan is to perform 6-9 chemo sessions prior to CRS/HIPEC and then another 3-6 after and then take it from there.
Most insurance companies will fight paying for the HIPEC portion but CRS is typically covered. You can seek out information at insurancewarrior.com for how to appeal. The author appealed her HIPEC 14 years ago and won. She had appendixeal cancer but there are several with colon cancer that are survivors as well.
Find an NCI-designated hospital and they will have a surgeon that specializes in the procedure. https://www.cancer.gov/research/nci-rol ... nters/find

Hi Tcross
Sorry to hear you've also found this :(
I'm really impressed your team has moved along with treatment so fast - I'm 3 weeks in and nothing has happened. First investigatory calls made yesterday during our follow up appt.
Don't know if I should be on Chemo now? Maybe CRS/HIPEC or Pelvic Exenteration ops if possible. I mention about laparoscopic surgery to find extent of spread- and he said not necessary as PET tells them all they need. Weird as I keep reading about the PCI scoring system for CRS feasibility?!
My surgeon is very well respected, but in my region they are extremely under resourced and worry this fact might effect my outcomes due to time delays.
What were your timeframes after discovery of peri meds? It sounds like things moved fast.
All the best with your treatment!
Cheers
Jeremy
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

Rock_Robster
Posts: 375
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Spread into Peritoneal

Postby Rock_Robster » Fri Sep 20, 2019 9:25 pm

nzjez wrote:
tcross wrote:I’m in the same boat as you currently. Found out in August I have spread in the periometuem. I’m currently three rounds into FOLFOXFIRI and had a diagnostic laparoscopy conducted two weeks ago and given a PCI of 6. The plan is to perform 6-9 chemo sessions prior to CRS/HIPEC and then another 3-6 after and then take it from there.
Most insurance companies will fight paying for the HIPEC portion but CRS is typically covered. You can seek out information at insurancewarrior.com for how to appeal. The author appealed her HIPEC 14 years ago and won. She had appendixeal cancer but there are several with colon cancer that are survivors as well.
Find an NCI-designated hospital and they will have a surgeon that specializes in the procedure. https://www.cancer.gov/research/nci-rol ... nters/find

Hi Tcross
Sorry to hear you've also found this :(
I'm really impressed your team has moved along with treatment so fast - I'm 3 weeks in and nothing has happened. First investigatory calls made yesterday during our follow up appt.
Don't know if I should be on Chemo now? Maybe CRS/HIPEC or Pelvic Exenteration ops if possible. I mention about laparoscopic surgery to find extent of spread- and he said not necessary as PET tells them all they need. Weird as I keep reading about the PCI scoring system for CRS feasibility?!
My surgeon is very well respected, but in my region they are extremely under resourced and worry this fact might effect my outcomes due to time delays.
What were your timeframes after discovery of peri meds? It sounds like things moved fast.
All the best with your treatment!
Cheers
Jeremy

Hi Jeremy, thanks for the update - this is all helpful.

The surgeries you’re discussing are no small thing, so it makes sense to take the time to get the right procedure, with the right surgeon in the right hospital. A couple of weeks are not going to make a major difference to your outcome, but getting these things right could.

That said, time is never on our side - and unfortunately no-one else will likely push as hard as we can. For this, you need to stay on them - it’s easy to lose a couple of weeks with every step, and you don’t want this delay to build up. Keep the pressure on and try for quick turnarounds on appointments etc.

Like you I thought exploratory lapro was fairly standard prior to CRS, however perhaps he is confident enough based on the PET and will make the final call during the surgery. If so and it saves you a procedure and delay, then great.

In terms of neoadjuvant chemo, I’d seek the advice of a medical oncologist with experience in peri mets. Typically with metastatic disease they like to achieve some degree of ‘systemic control’ prior to surgery, however I don’t know how applicable this is to peri mets given the area is famously not well vascularised and traditional chemo is of limited effectiveness anyway.

I note you mention BRAF testing wasn’t done - whilst it’s not highly likely I would also be asking to rule this out as it would change your treatment regime.

Hope this is of some help; feel free to come back on any specifics.

Cheers
Rob
Last edited by Rock_Robster on Fri Sep 20, 2019 9:54 pm, edited 1 time in total.
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Rock_Robster
Posts: 375
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Spread into Peritoneal

Postby Rock_Robster » Fri Sep 20, 2019 9:28 pm

One other comment on the PRODIGE 7 trial results - this trial used oxaliplatin as the HIPEC drug. I’ve seen inconsistent results between this and mitomycin-C (MMC), some research suggests Oxaliplatin has the edge, but some more recent studies indicate significantly better results from MMC. Might also be a topic for discussion with whomever is planning the surgery.

Cheers
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

DarknessEmbraced
Posts: 3357
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Spread into Peritoneal

Postby DarknessEmbraced » Sat Sep 21, 2019 7:37 am

I'm sorry it wasn't better news and that you're dealing with this!*hugs*
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

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Sat Sep 21, 2019 8:14 pm

DarknessEmbraced wrote:I'm sorry it wasn't better news and that you're dealing with this!*hugs*

Thanks DE :)
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Sat Sep 21, 2019 8:21 pm

Rock_Robster wrote:One other comment on the PRODIGE 7 trial results - this trial used oxaliplatin as the HIPEC drug. I’ve seen inconsistent results between this and mitomycin-C (MMC), some research suggests Oxaliplatin has the edge, but some more recent studies indicate significantly better results from MMC. Might also be a topic for discussion with whomever is planning the surgery.

Cheers
Rob

Hi Rob
Thanks for all your advice and input. I really appreciate everything you've said, and your though into it.
Definitely will chat about the type of HIPEC, and any reasoning the surgeon/ oncologist has as to their choice esp with recent study finding. Even whether HIPEC is recommend? Maybe CRS on its own to reduce morbidity?
The pelvic Exenteration surgery ive also been suggested does also sound like and option, but I'm really hoping they can make CRS a good feasible choice. PE sounds such a drastic terrible surgery.
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery


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