In need of metastasis education

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Rock_Robster
Posts: 454
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: In need of metastasis education

Postby Rock_Robster » Wed Feb 12, 2020 11:21 pm

jsbsf wrote:Thanks cured. We have tried fenben too. Husband is doing very well, and we are not sure which treatment or combination of treatments is making the biggest difference. He did a 4 week 3 days on 4 days off regimen once. He started a second 4 week try, but just had surgery yesterday so didn’t do the 4th week.

After yesterday’s surgery, today a nurse told him something interesting, and I’m not sure how many people are aware. I’ve read a lot, but didn’t know this. He had a laparoscopic liver resection where the one remaining met was removed (liver is now cancer free. Yay!). His surgeon wanted to keep him overnight, even though the surgery went very well. There was some miscommunication or misunderstanding, because a (different) nurse told me they noticed what appeared to be a blood clot and wanted to do a ct scan.

This morning, before he was released, he asked about his ct scan and the blood clot. This nurse said there was no blood clot (there never was). The ct scan was a precaution, because cancer patients are more susceptible to blood clots than non-cancer patients. She went on to say the blood has properties that make it “stickier”, and they wanted to rule out any blood clots before sending him home. She said the stickier blood clots more easily, but also provides a mechanism that allows the cancer cells to lodge, clump together and form tumors.

What seems unknown is why the blood is different, and it seems the cancer cells either are the reason, or contribute to it somehow. One thing we are very excited about is that after almost six months of treatment and scans, no new mets have been found.

Hi jsbsf, as someone who had a clot (DVT), I can confirm this is absolutely right!

Actually cancer patients often have multiple factors for clotting risk, aka the 3 “C’s” - Cancer itself, Chemotherapy, and Catheters (ie from a port). Add to this that many ca patients have major abdominal surgery and are then immobile for a period, and you have very high clotting risk. Once you’ve had one clot, the chance of another is higher (the 4th “C”). Clots are the leading cause of death in cancer patients after the cancer itself, so they are not something to muck about with and any symptoms should be taken very seriously.

There is a theory (fairly well established I think) that the clotting mechanism is actually one of the processes in the body that cancer “hijacks” in order to metastasise. Single cells can’t form a solid tumour; they need to bind together somehow, and the clotting process is an ideal method. So by increasingly the “clottiness” of the blood (by making genetic changes which increase production of pro-coagulation factors), cancer makes it easier for it spread. There is some early suggestion that anticoagulation therapy may hence impair metastasis, but not enough to use it as standard (as it has it own risks). It did make me not mind taking all those clexane injections so much though...
Male 37; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+
3 LN; 4 liver mets
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed a liver spot
08-11/19 - FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 - Liver resection #2
02/20 - Ileostomy reversed

jsbsf
Posts: 30
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: In need of metastasis education

Postby jsbsf » Thu Feb 13, 2020 1:48 am

Hi rock_robster,

Very interesting! I was looking at your signature and you both have a lot in common. I believe his tumor is a bit lower, so low that at first, we believe he was destined for a permanent colostomy.

His treatment path seems practically identical to yours. He had only 2 liver mets that were very recently removed after 6 rounds of FOLFOX. One dissolved completely, and since it was deeper, was ablated with MWA. He’s in quite a bit of pain right now, and taking pain meds. His response has been very well, and all the doctors are surprised. The rectal tumor has shrunk so much, it can barely be felt, and showed up as a tiny fraction of what it was, originally. I don’t think it was even the size of a pea when last checked. It was originally over 5cm.

So, he was presented with the option of a robotic surgery which would be after more chemo and radiation. The surgeons agreed that he’s a good candidate for robotic surgery.

Just 4 days after his first chemo infusion his scans showed considerable growth on those 2 liver mets. But the radiologist was pleased (and surprised) to report no new mets were detected. Between the 3rd and 4th round of chemo they shrunk by about two thirds (I think of the largest size), and after the sixth round they were at about 10% in both size and activity of what they were originally. The oncologist seemed more impressed with the much smaller activity than of the much smaller sizes.

I feel like the shrinkage is very important, especially if they can be upgraded to operable from inoperable, but the key seems to be with getting a handle on metastasis.
DH 61
2019
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
9/23 Port
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: MWA 2/5, Lap resection 2/11

Claudine
Posts: 267
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: In need of metastasis education

Postby Claudine » Thu Feb 13, 2020 12:23 pm

The pathology report came in from DH's adrenalectomy. No big surprise, the analysis confirms its nature as a colon cancer met; the adjacent lymph node is clear though, which is a good thing. I really wonder why some mCRC spread to the lymph nodes, or (quite commonly) to the liver, and others don't.
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT radiation 04/18, SBRT 02/19
Resection small intestine 05/18 (no cancer found - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin since 03/19
6.7 cm left adrenal mass 03/19, 3.67 cm 12/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 10.2
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule

Lee
Posts: 6005
Joined: Sun Apr 16, 2006 4:09 pm

Re: In need of metastasis education

Postby Lee » Thu Feb 13, 2020 1:21 pm

My understanding colon cancer tend to metastasis in the liver and rectal cancer tends to metastasis to the lungs. This is not concrete but tends to be a general rule. Guess it has something to do with lymph nodes and blood stream flows.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Claudine
Posts: 267
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: In need of metastasis education

Postby Claudine » Thu Feb 13, 2020 1:34 pm

And since we never found DH's primary tumor we'll never really know! His metastasized to the spine first, then adrenal gland and lungs simultaneously. He's one of the "unusual types".
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT radiation 04/18, SBRT 02/19
Resection small intestine 05/18 (no cancer found - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin since 03/19
6.7 cm left adrenal mass 03/19, 3.67 cm 12/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 10.2
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule

Claudine
Posts: 267
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: In need of metastasis education

Postby Claudine » Thu Feb 13, 2020 1:37 pm

Here's an interesting article, which confirms what you were saying, Lee:

Pattern and Dynamics of Distant Metastases in Metastatic Colorectal Cancer - https://www.karger.com/Article/Fulltext/454687

"Both in colon and rectal cancer, the liver constituted the most frequent metastatic site, albeit the frequency in colon cancer (71%) exceeded the one in rectal cancer (60%). The difference was more pronounced for peritoneal involvement, which occurred six times more frequent in colon cancer. Of the patients with colon cancer, 23% were diagnosed with peritoneal carcinomatosis (vs. 4% in rectal cancer). In contrast, pulmonary metastases were about twice as frequent in rectal cancer compared to colon cancer (30 vs. 17%)."
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT radiation 04/18, SBRT 02/19
Resection small intestine 05/18 (no cancer found - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin since 03/19
6.7 cm left adrenal mass 03/19, 3.67 cm 12/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 10.2
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule

jsbsf
Posts: 30
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: In need of metastasis education

Postby jsbsf » Fri Feb 14, 2020 1:06 am

That is very interesting about the distant sites where mets are more or less likely to occur. DH has very low rectal cancer, and the only mets were liver, one in either side. The first appeared on the far left side, where there’s a “tip”, so relatively easy to resect. The second was below the surface near the top on the right side, which was accessible with a needle down through the rib cage. That one actually disappeared completely after chemo, and was burned out with microwave ablation last week. We’re still waiting for pathology reports on the one that was resected Tuesday. The surgeon says it was so small they could remove three times the normal amount of margin to have better certainty they got everything. Fortunately, he hasn’t had any lung mets, but it’s good to be aware he’s at a greater risk, having rectal cancer.
DH 61
2019
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
9/23 Port
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: MWA 2/5, Lap resection 2/11


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