Colon cancer diagnosed July 2019

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helenef
Posts: 4
Joined: Mon Oct 07, 2019 4:50 am

Colon cancer diagnosed July 2019

Postby helenef » Mon Oct 07, 2019 7:49 am

Hello,

I'm glad I found this forum to share my journey and exchange with other CRC fighters.
I have a locally advanced sigmoid adenocarcinoma diagnosed in July, most likely stage 3 cancer. I had a loop colostomy done in August to avoid any blockage during neoadjuvant chemotherapy. I'm about to start round 3 of 6 cycles of FOLFOXIRI + Avastin. The plan if all goes well is to have the tumour removed by the new year and colostomy reversed.

I have a couple of questions, mainly to understand the oncologist report and the type of treatment I'm given.
- Histology report says the cells are poorly differentiated and this does not look like a good prognosis to me. Are there any statistics published about survival taking into account both stage and grade of the cancer?
Questions about pre-op staging (T3dN1Mx):
- there's no spread visible on the scans, so it's more likely T3dN1M0?
- What's the difference between T3a and T3d?
- N1 does it mean 1 lymph node involved? I supposed they see that on the scans but the real staging will be confirmed after the op.
Questions about neoadjuvant chemo
- FOLFOXIRI with Avastin is a tough treatment. I see they usually give it to stage 4 patients. However this is a neoadjuvant treatment with the aim to shrink the tumour before op because it is bulky at the moment, and kill any micro-metastases not visible on scans in the process. Anyone had the same treatment? It seems a bit unusual to me but seems like a good treatment plan.

Overall, while I want to get the best chances at getting rid of the cancer, I can't stop getting worried about my staging, grading, and maybe the possibility of this being worst than what it is already?
Lost my dad to brain cancer 3 years ago, he was gone in 5 months while I was pregnant :( now I have another baby, 9 months old. I have all the good reasons to fight. I feel I can go through anything, like I'm not scared of side effects, surgeries, etc. but I have a hard time not worrying about the cancer coming back at some point. I know it's stupid in a way, I'm having treatment to be able to remove the tumour, so why worry about that now?

Thank you for reading, I'm going to try to update my signature now.
37 F
sigmoid colon 17cm from anal verge, 7cm from rectosigmoid junction
Adenocarcinoma
not known, bulky
G3, Poorly differentiated
T3dN1M0 (pre-op)
Stage 3
Lymph nodes: 1 ?
Mets: 0
CEA, LVI, PNI: not known
Surgical margins: NA
MSI, Lynch, KRAS/BRAF: not known
Primary surgery type: NA
Loop colostomy (laparoscopic)
Radiation therapy: NA
Chemotherapy: neoadjuvant FOLFOXIRI + Avastin for 3 months

Claudine
Posts: 131
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Colon cancer diagnosed July 2019

Postby Claudine » Mon Oct 07, 2019 9:45 am

Welcome helenef, hopefully this forum will be able to bring you as much comfort and useful information as it has others! I can't really answer your questions, but I read that Folforixi gives better results than Folfiri. Hopefully it'll shrink your tumor nicely and you can get surgery soon! Good luck with treatment.
Wife of Dx 04/2018 (51 yo). MSS, KRAS mutated G12A
No primary, lytic tumor L4 vertebrae, CEA 10
Radiation 04/2018
Resection small intestine 05/18 (no cancer found - Crohn's)
Xelox * 6, 05/2018 to 10/2018
6.7 cm left adrenal mass 03/14/2019, 4.4 cm 05/21, 4.1 cm 09/16
SBRT L4 02/2019
Folfiri + Avastin
CEA since 03/15: 58, 17, 10, 6.4, 5, 4.8, 4.2, 3.6, 3.2, 3.3, 3.2, 3.7, 4.3, 4.2, 4.2, 5.0
Scan 03/14: Multiple small lung nodules
Scan 05/21: shrinking
Scan 09/16: lungs show no abnormalities (YAY!!!)

MeAndMine
Posts: 123
Joined: Mon Aug 05, 2019 2:40 pm

Re: Colon cancer diagnosed July 2019

Postby MeAndMine » Mon Oct 07, 2019 11:33 am

My treatment is different for rectal cancer and I started out with radiation and chemo which I'm doing right now. It's also with the idea of shrinking the tumor. I don't really have the answers as I'm still new at all of this and on the first leg of my treatment but hopefully you'll get some good advice from others on the forum. I'm glad you found us!
F 56 non-smoker
8/5/2019 - Colonoscopy - 4-5 cm rectal mass, 2-3 cm proximal to anal verge and 6mm polyp
8/13/2019 - CT - No mets
8/19/2019 - Rectum: Adenocarcinoma arising from tubulovillous adenoma. Descending colon: tubular adenoma
8/23/2019 First visit with surgeon
8/26/2019 First visit with oncologist
8/26/2019 MRI
CEA 8/19/19=3.9, 8/26/19=7.1
9/6/2019 - T3N2a
9/11/2019 - Radiation begins - 5.5 weeks along with oral capecitabine

NHMike
Posts: 2272
Joined: Fri Jul 21, 2017 3:43 am

Re: Colon cancer diagnosed July 2019

Postby NHMike » Mon Oct 07, 2019 11:33 am

N1 means 1-3 lymph nodes involved. N1a is 1 lymph node. N1b is 2-3 lymph nodes. N1c has some other features involved.

I use this webpage for staging definitions:

https://cancerstaging.org/references-to ... Medium.pdf
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

NHMike
Posts: 2272
Joined: Fri Jul 21, 2017 3:43 am

Re: Colon cancer diagnosed July 2019

Postby NHMike » Mon Oct 07, 2019 11:36 am

URMC / Encyclopedia / Grading and Staging of Cancer
Search Encyclopedia
Grading and Staging of Cancer

After cancer is diagnosed, healthcare provides need to learn as much as they can about it. This helps them to plan the best treatment and look at overall outcomes and goals. For many types of cancer, part of this process includes figuring out the cancer grade and stage.
What does the grade of a cancer mean?

Histologic "grade" is used to describe what the cancer cells look like using a microscope. Most cancers are graded by how much they look like normal cells. Low grade or grade I tumors are well-differentiated. This means that the tumor cells are organized and look more like normal tissue. High grade or grade III tumor cells are poorly differentiated. This means that the tumor cells don't look like normal cells. They're disorganized under the microscope and tend to grow and spread faster than grade I tumors. Cancer cells that do not look well-differentiated or poorly differentiated are called moderately differentiated, or grade II. In general, cancer cells are graded using this scale. (Be aware that some may use grade 3 as the highest grade):

Grade X: grade isn't known
Grade 1: Well differentiated, low grade
Grade 2: Moderayely differentiated, intermediate grade
Grade 3: Poorly differentiated, high grade
Grade 4: Undifferentiated, high grade

https://www.urmc.rochester.edu/encyclop ... tid=p00554
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

NHMike
Posts: 2272
Joined: Fri Jul 21, 2017 3:43 am

Re: Colon cancer diagnosed July 2019

Postby NHMike » Mon Oct 07, 2019 11:41 am

Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398112/

I was curious about the results of the research too:

The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).
---------------------

Hmmm. I think that I had cT3 - maybe that's what the c is for - I have wondered about that for a while.
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

helenef
Posts: 4
Joined: Mon Oct 07, 2019 4:50 am

Re: Colon cancer diagnosed July 2019

Postby helenef » Mon Oct 07, 2019 2:12 pm

Claudine wrote:Welcome helenef, hopefully this forum will be able to bring you as much comfort and useful information as it has others! I can't really answer your questions, but I read that Folforixi gives better results than Folfiri. Hopefully it'll shrink your tumor nicely and you can get surgery soon! Good luck with treatment.


Thank you Claudine :)
37 F
sigmoid colon 17cm from anal verge, 7cm from rectosigmoid junction
Adenocarcinoma
not known, bulky
G3, Poorly differentiated
T3dN1M0 (pre-op)
Stage 3
Lymph nodes: 1 ?
Mets: 0
CEA, LVI, PNI: not known
Surgical margins: NA
MSI, Lynch, KRAS/BRAF: not known
Primary surgery type: NA
Loop colostomy (laparoscopic)
Radiation therapy: NA
Chemotherapy: neoadjuvant FOLFOXIRI + Avastin for 3 months

helenef
Posts: 4
Joined: Mon Oct 07, 2019 4:50 am

Re: Colon cancer diagnosed July 2019

Postby helenef » Mon Oct 07, 2019 2:16 pm

MeAndMine wrote:My treatment is different for rectal cancer and I started out with radiation and chemo which I'm doing right now. It's also with the idea of shrinking the tumor. I don't really have the answers as I'm still new at all of this and on the first leg of my treatment but hopefully you'll get some good advice from others on the forum. I'm glad you found us!


Thank you MeAndMine. I understand rectal cancer treatment involve radiotherapy and chemotherapy. I recognise a lot of rectal cancer treatment and diagnosis features in mine while it is a colon cancer. My oncologist said we could not do radiotherapy because of the localisation of the tumour.
All the best with your treatment!
37 F
sigmoid colon 17cm from anal verge, 7cm from rectosigmoid junction
Adenocarcinoma
not known, bulky
G3, Poorly differentiated
T3dN1M0 (pre-op)
Stage 3
Lymph nodes: 1 ?
Mets: 0
CEA, LVI, PNI: not known
Surgical margins: NA
MSI, Lynch, KRAS/BRAF: not known
Primary surgery type: NA
Loop colostomy (laparoscopic)
Radiation therapy: NA
Chemotherapy: neoadjuvant FOLFOXIRI + Avastin for 3 months

helenef
Posts: 4
Joined: Mon Oct 07, 2019 4:50 am

Re: Colon cancer diagnosed July 2019

Postby helenef » Mon Oct 07, 2019 3:25 pm

NHMike wrote:Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398112/

I was curious about the results of the research too:

The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).
---------------------

Hmmm. I think that I had cT3 - maybe that's what the c is for - I have wondered about that for a while.



Thank you for the links NHMike. This is an interesting study.

I think c before TNM means clinical (from the scans and biopsies, before surgery). see here:

http://oncolex.org/Colorectal-cancer/Background/Staging
cTNM is based on all available information from:
Clinical examination
Endoscopy
Radiology
The final stage is given after the evaluation of the pathology specimen, and is given prefix “p”. Pathological TNM (pTNM) is based on pT, pN and the apprehension of M (operation/ radiology).
37 F
sigmoid colon 17cm from anal verge, 7cm from rectosigmoid junction
Adenocarcinoma
not known, bulky
G3, Poorly differentiated
T3dN1M0 (pre-op)
Stage 3
Lymph nodes: 1 ?
Mets: 0
CEA, LVI, PNI: not known
Surgical margins: NA
MSI, Lynch, KRAS/BRAF: not known
Primary surgery type: NA
Loop colostomy (laparoscopic)
Radiation therapy: NA
Chemotherapy: neoadjuvant FOLFOXIRI + Avastin for 3 months

NHMike
Posts: 2272
Joined: Fri Jul 21, 2017 3:43 am

Re: Colon cancer diagnosed July 2019

Postby NHMike » Tue Oct 08, 2019 6:46 am

helenef wrote:I think c before TNM means clinical (from the scans and biopsies, before surgery). see here:

http://oncolex.org/Colorectal-cancer/Background/Staging
cTNM is based on all available information from:
Clinical examination
Endoscopy
Radiology
The final stage is given after the evaluation of the pathology specimen, and is given prefix “p”. Pathological TNM (pTNM) is based on pT, pN and the apprehension of M (operation/ radiology).


Thank-you for that note. So I guess I don't know what sub T3 designation I had. Or maybe it's somewhere else in an MRI report. I will go digging for it one of these days.

That T number certainly shows why so much has to be removed.
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: 360
Joined: Fri Apr 06, 2018 11:40 am

Re: Colon cancer diagnosed July 2019

Postby boxhill » Wed Oct 09, 2019 10:12 am

helenef, very glad to hear that you will not be having radiation. The side effects for women can be nasty and permanent. I hope folfoxiri does the trick for you.

Did they biopsy the tumor? If so, they may have done the tests required to determine BRAF, KRAS, and MSS/MSI 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


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