I feel like after 4 months I still don’t understand some to the basics about what causes metastasis. There seem to be different approaches regarding treatment, and I would like to get a better understanding of the rationale behind those decisions. I understand why treatment depends on “stage” and has to be re-evaluated if it isn’t working or isn’t well tolerated
I would like to open a discussion that might help others who are also confused to better understand what is going on in their bodies. I know it’s another important aspect, however I am not as much concerned with mutations or specific differences, but “metastasis 101”. The other variables make it more complex than it already is. I’m interested in knowing what are the most likely causes of new tumors and how to minimize the risk.
In my case, there is a primary tumor and 2 (known) liver mets. There has been no surgery, but surgery is forthcoming.
The liver mets both had “clear margins” and after a month of preparation for chemo no new mets were discovered, although both mets had grown considerably.
Does “clear margins” mean they are less likely to generate new mets? Is the “source” of the liver mets most likely / definitively the primary tumor? I always wondered if/when a liver met might generate another met.
6 rounds of FOLFOX has been effective. One liver met has disappeared. The remaining liver met is at 10%, and the primary tumor is at 10%. Does that mean the margins are most likely at least as “clear” as from the beginning? I’m wondering if I can count on new mets forming being less likely. This question is another way of asking “why didn’t they remove the mets earlier?Did they know that if chemo worked they would immobilize them so they could resect them later?” In my case surgical removal was always on the table.
The primary tumor had lymph node activity but on the recent PET scan it no longer shows up. Has chemo “locked it down” so that it is incapable of creating new mets? I understand there are most likely cancer cells floating freely, but my question is “have new ones been minimized/ eliminated for the most part since the neoadjuvant chemo has been so effective?” Is it “stem” cells that emerge from a tumor? cancer cells? Or either/both? I feel like “stem” cells are the biggest danger since chemo doesn’t target them and they can become a cancer cell later down the road. Since FOLFOX has been effective, can I expect its same effectiveness to apply to the freely circulating cancer cells as it did on the tumors?
How effective is a strong immune system? After chemo it seems to be the only defense. A lot of people are NED, and a recurrence shows up later. Might not a stronger immune system have prevented that?
Another question is that I have read surgery is risky even if it’s not originally stage IV because it can cause a tumor to “leak” and spread cancer cells, I guess because it can pop open like a cyst spilling into the bloodstream, and this is the main reason for adjuvant chemo. I feel like it’s the main reason for neoadjuvant chemo: to reduce this risk.
In my case the primary tumor has been set aside for the most part, and the approach seems to be working from the “outside in”. For many others it seems to work in reverse order: they remove the primary tumor at the onset of treatment. But for me, they want to control the spread, and then come back and remove the original source. That seems to make a lot of sense, if my understanding is valid and the neoadjuvant has been keeping it in check.
A second opinion oncologist called this approach “sandwiching”, where they basically press the “spread” back toward the primary tumor.
So, after 6 rounds of FOLFOX, liver resection is after a 6 week break, followed by a 3 week recovery, followed by 6 more rounds along with radiation (it’s rectal), followed by surgery.
Another question I have is about lymph node involvement. I know it’s worse than no lymph node involvement, but does it just mean a way to spread? Or is that just a different way to spread? It seems like you can have a met at a distant organ with no lymph node involvement.
Thanks for reading all this and any input.
8/23 C-scopy, 5+cm mass. CEA:4.1
8/26 CT ~1cm lvr met?
9/6 PET: liver spot
9/16 MSS. MRI: 2 liver mets: 2.7 & 7mm
9/30 Start FOLFOX
10/4 Lg lvr met ~3.7cm (raised concern), pri tmr stable.
CEA: 10/13,12.5;10/27,4.7;11/10,3.3; 11/24,3.1;12/8,3.3
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: sm lvr met gone, remaining tmrs @10% of orig sz & actvty
Chemo break: Lap srgry 1/29