The Colon Club

Hi All you great people out there. I have on and off come on to this forum and learnt so much from all your stories I first just wanted to thank you for the inspiration you have given me over the last one year.

As my username states, my Dad (64) was diagnosed with rectal Cancer. T3N1M0 and had RadioChemo, followed by a surgical resection (Temp Ileostomy), Rounds of CAPOX/XELOX, which was then moved to Folfox after he had two severe reactions to the CAPOX.

During this time he was in an out of the hospital for CINV and then a severe cellulitis infection in his right hand requiring skin removal and grafts.

Post his switch to Folfox he was doing really great and had his ilesotomy reversal. Since then he's been doing great, and weight is up (from 46KG in the worst part of CINV) to 65KG now. Last chemo was in June.

In his recent CT, abdomen was clear, but they saw small nodules (biggest one 6mm) in his lungs. These were there 10 months ago as well (Period between last CT), and showed minimal growth. His MMR was negative for Lynch.

Oncologist is not overly concerned, asked to take a wait and watch approach and redo CT in Jan. His primary Gastro surgeon though recommended another meeting with the Doc to follow up sooner than Jan. As of now, Oncologist has sent the tissue sample (from resection) for KRAS and NRAS. He said perhaps do a PET CT.

The hospital does not have the facility, and dad is on Holiday back in our homecountry where this is available, and affordable. My questions as follows :
1. For nodules this small, is it worth doing this ? I've read both Flase Positive/False negatives on nodules this small
2. Given these nodules were there in prior CT (before resection) and the CT report stated no concern on lungs, am i missing something ? Maybe the radioligist missed M1 prior to surgery ?

I am utterly confused now and through all he has been over the last year, im dead worried this is now in his lungs.

Thank you all - and god bless all of you who are figthing out there, and to all the caregivers (I know how anxiety can wreck you)

No expert here but I don’t think super small modules can light up on a PET...I think it’s gotta be like 1cm at least?

On the report, does it say there was minimal growth and actually compare a previous scan to the current? What is the “impression” of that finding? Usually on the report if they are concerned they say so.

Dealing with something similar right now with my mom so I can definitely empathize with your anxiety level right now.

HI,

Thank you for the response.

Yes, it says "Concern for Metastatis - Several nodules, biggest 6mm. Minimal growth vs previous Scan (Dec 2018), New ground glass opacity - most likely imflammation, No Size signifcant mediastinal, hilar or axillary lymphaedenopathy"

Other stuff mentioned as "Unremarkable" such as bony Thorax etc which i wont quote here as i think insignificant ?

Doctor reviewed CEA which was lower than prior to surgery. Also asked for any symptoms (Cough/shortness of breath) and i know he doesnt have any - So he said to go home. Its only the surgeon who has developed a good rapport with my dad (with whom he may have shared a concern) who i guess asked the Onc for a second look.

On his previous CT Scan it says " Small focal area of thickening in relation to left oblique fissure, no clinical significance, lungs otherwise clear"

Hence my confusion, if the second scan is comparing nodules to prior scan with some(minimial/limited whatever) growth, and the prior report says theres nothing to look at here, did a radiologist in Dec miss this ?

I want him to take a scan if it will help his treatment, i don't want him to take unnecssary/anxiety inducing tests.

Also, i dont know how relevant this is - but during his XELOX cycle and cellulitis infection, he also got Chemo induced mucusitis which caused painful swallowing and maybe that had an effect on the lungs ? Just adding as it might help people with more experience to help me out here.

Firstly, it is very common for people to have small harmless lung nodes as a result of current or prior infection or other reasons. Unless there is some other reason for concern, watch and wait is thus the usual response. Sounds like they think these nodes are probably harmless. If the largest one is 6mm, it seems doubtful that they would light up on a PET. And if they do, doesn't inflammation light up as well as cancer?

ETA: I had one show up the first time I had a thoracic CT. Watch and wait. Nothing happening. They seem to think it is granulated, non-threatening.

That’s a good question—I would call the care team and ask why the verbiage in the original CT mentions nothing but the verbiage in the recent CT seems to suggest that when another radiologist compared images he saw something to compare.

It is true that small lung nodules are very common and usually doctors watch them. If no change is seen for some time then I believe they are considered non cancerous. However if significant change is detected (growth or even shrinkage in response to chemo) then there will be more concern.

He's had the test. Results in 2 days. Need a collective prayer please.

I'm someone who struggles with a lot of anxiety and I've been having a really hard time lately with work stress and a baby on the way.

Thought writing this out and putting it out in the universe may help

Sending prayers your way!

Report in today, metabolically inactive across the lungs.

It was a full body scan and nothing unusual noted otherwise.

So relieved but also clear that this is something to keep an eye on over serial CTs.

Great news!

They will just continue to keep an eye on them going forward.

Awesome news!