Spontaneous expulsion of primary tumor

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jsbsf
Posts: 39
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Spontaneous expulsion of primary tumor

Postby jsbsf » Sun Mar 08, 2020 8:38 pm

Sorry for being a bit graphic, but wanted to put this out there for two reasons. In case someone else experiences this in the future, you are not alone; and in case someone has already experienced this, maybe you have an explanation for what has happened.

FOLFOX started 9/30/2019. On 11/2/2019, a fleshy mass was expelled with a bowel movement. It was about an inch long, grayish, and almond shaped. The original tumor was 5+cm, and I felt like this was part of the tumor.

The 6th infusion was on 12/10, and a 12/17 a Pet scan showed that the primary tumor was 10% of its original size and activity.

There was a 3 month chemo break with a liver ablation and resection 9 and 10 weeks in. On 1/14/2020 an endoscopy and physical examination showed that the primary tumor was about the size of a pea. The surgeon was shocked at how small it was.

FOLFOX was restarted on 3/2, just this past Monday. The plan is to complete a 2nd set of 6 rounds, with radiation, followed by robotic surgery. Yesterday, 3/7, there was another occurrence similar to the one on 11/2/2019. But this time there was a notable difference. The mass was shaped similar to the end of a q-tip. The “bulb” was the same grayish color, however the “stalk” was darker. It resembled a polyp that had broken off the rectal wall. I am convinced this is the remainder of the tumor that somehow broke off.

FOLFOX tends to result in constipation and hard stool, and after three months of regular bowel movements, this week they started back a couple days ago, and I think the bowel movement may have removed a dying tumor with friction that wasn’t previously available. Does that make sense or sound rational?
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 1-6
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
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1,2.3; 3/15, 2.1
3/2 start FOLFOX 7-12

Claudine
Posts: 298
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Spontaneous expulsion of primary tumor

Postby Claudine » Mon Mar 09, 2020 10:02 am

Did you save the masses and submit them for biopsy?
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 7.6
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule

Siti
Posts: 138
Joined: Thu Aug 01, 2019 10:58 am

Re: Spontaneous expulsion of primary tumor

Postby Siti » Mon Mar 09, 2020 4:29 pm

Good point claudine!

Our oncologist told us that the bowel actually “sheds its lining” during chemo. It’s apparently normal because it has happened to my husband as well and we asked our oncologist about it. Also, our surgeon told us that sometimes, chemo can result in the tumour being disintegrated in chunks. Who knows! The good news is your husband is doing really well! :)
Wife of DH (54) DX on 5/7/19
CEA value: 1.2
T loc: Sigmoid
T type: Adenocarcinoma
T grade: G3
Pos LNs: 30/31
Wild Type for KRAS, NRAS and BRAF
19/7/19 PET-CT Scan: Distant lymph nodes (para-aorta, neck & hip), est. size 0.5-1.5cm.
22/7/19 Surgery: Laparoscopic Colon Resection
26/8/19 Chemo: CAPEOX + Avastin x 9
6/11/19 CT Scan after 3rd cycle, all nodes have shrunk! Yay!!

jsbsf
Posts: 39
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: Spontaneous expulsion of primary tumor

Postby jsbsf » Mon Mar 09, 2020 4:54 pm

Hi Claudine,

Unfortunately, no. Both times I was told after the fact. I barely found out yesterday about the bowel movement from the previous day, and all I really have to go by was what he told me.

I recall reading that others have experienced this, but I couldn’t find much information and eventually stopped thinking about it.

The appearance on December’s scan showed how it had decreased in size over time, similar to the circles you see on a tree trunk that each represent a year. Oddly the innermost circle was all dark, surrounded by a “halo”. We feel like the tumor receded, but the underlying tissue still contained cancer activity. I think this activity may represent some amount of the area that “broke off” in November.

The endoscopy in January showed something that appeared to be about the size of the innermost circle, which is very close to the size of what “broke off” yesterday. So, the latest theory is that the remainder of the tumor died and fell off.
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 1-6
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
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1,2.3; 3/15, 2.1
3/2 start FOLFOX 7-12

jsbsf
Posts: 39
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: Spontaneous expulsion of primary tumor

Postby jsbsf » Mon Mar 09, 2020 5:03 pm

Thanks Siti. Yes he is doing well, and this did happen very shortly after he restarted his chemo. So it is very possible the chemo is destroying the tumor. It’s very good because it’s a very low rectal tumor and he was told he has a very rare chance to avoid a permanent colostomy. He’s doing surprisingly well. Now we just need to keep from getting Coronavirus for the next few months, I guess. :) . The things you worry about a lot more as a caregiver.

Different subject, but this is the first time he felt like there was sand in his shoes.

He’s been holding a cup of ice water and sipping on it. He did that during his 6th infusion, and again on Monday. Those are the only two times he didn’t have cold sensitivity as a side effect. I told him to put his foot on an ice pack next time. So he’s going to see if that makes any difference.
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 1-6
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
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1,2.3; 3/15, 2.1
3/2 start FOLFOX 7-12

Siti
Posts: 138
Joined: Thu Aug 01, 2019 10:58 am

Re: Spontaneous expulsion of primary tumor

Postby Siti » Mon Mar 09, 2020 5:18 pm

Tell me about it! I bought a box of face mask, bottles of hand sanitizer and packed a small kit in my husband’s work bag :lol:

For cold sensitivity, I bought a pack of cotton white gloves for him. So he wears them when he’s back home and we could easily wash the gloves like socks. If the cooling trick works, then it should work on this feet too. Let us know how it goes! :)
Wife of DH (54) DX on 5/7/19
CEA value: 1.2
T loc: Sigmoid
T type: Adenocarcinoma
T grade: G3
Pos LNs: 30/31
Wild Type for KRAS, NRAS and BRAF
19/7/19 PET-CT Scan: Distant lymph nodes (para-aorta, neck & hip), est. size 0.5-1.5cm.
22/7/19 Surgery: Laparoscopic Colon Resection
26/8/19 Chemo: CAPEOX + Avastin x 9
6/11/19 CT Scan after 3rd cycle, all nodes have shrunk! Yay!!

boxhill
Posts: 490
Joined: Fri Apr 06, 2018 11:40 am

Re: Spontaneous expulsion of primary tumor

Postby boxhill » Mon Mar 09, 2020 6:13 pm

Wow, that's quite an event! Too bad he didn't save it to be examined, although I can understand a reluctance to fish around in a bowl of poop. :roll:

Glad to hear his liver mets are also responding so well.
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
5/18 FOLFOX
Neulasta 6/28
7/18 CT NED
11/18 CT NED
12/18 MRI 5mm liver mass, 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: many fails before Celebrex helps
12/23/19 CT stable

jsbsf
Posts: 39
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: Spontaneous expulsion of primary tumor

Postby jsbsf » Mon Mar 09, 2020 11:14 pm

Yes, he did a visual exam and flushed it, after observing it floating on the surface :D

The liver mets are now gone, and his liver has NED. It was a big step in the right direction. One met disappeared and was treated with microwave ablation on 2/5. The larger was laparoscopically resected on 2/11. It was small and at the tip on the far left. The surgeon said she was able to remove it with three times the necessary margin. A few days later we were told the margins were 100% clean.

We are thrilled his CEA dropped to 2.3 after being off chemo 3 months. He’s a smoker, so that seems well within average.

So, now all that’s left is the primary tumor, which I’m hoping has floated far, far away. I’m even wondering if the 5 more rounds of full- strength FOLFOX isn’t overkill. But not complaining. I’ll take everything we can get.

I’ll follow up with how the ice packs work on the feet. I learned about the technique mostly on a Facebook group called live wire, where several people are reporting success.
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 1-6
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
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1,2.3; 3/15, 2.1
3/2 start FOLFOX 7-12

jsbsf
Posts: 39
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: Spontaneous expulsion of primary tumor

Postby jsbsf » Sat Mar 21, 2020 5:33 pm

He put ice packs in a cloth bag, and rested his feet on top throughout Tuesday’s treatment. He says it was quite cold and his entire feet were covered.

Yesterday, he did experience the sand in shoes sensation. Overall, he says it was a bit milder, and today he just feels some tingling. He continues to hold a cup of ice water, occasionally drinking it. No cold sensitivity in his hands / fingers at all. This was the 8th round.
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 1-6
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
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1,2.3; 3/15, 2.1
3/2 start FOLFOX 7-12

prs
Posts: 163
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Spontaneous expulsion of primary tumor

Postby prs » Tue Mar 24, 2020 6:25 pm

I'm pretty sure I similarly saw bits of my tumor that had flaked off during chemoradiation. Given your husband's tumor is very low, and there might be a chance of it completely disappearing during the current phase of treatment, it might be worthwhile for you to have a look at this thread.

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=53498
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

Bilbailee
Posts: 4
Joined: Wed Mar 25, 2020 11:43 am

Re: Spontaneous expulsion of primary tumor

Postby Bilbailee » Wed Mar 25, 2020 12:07 pm

Hello. I recently passed a polyp and had my wife take it to my doctors office. They had her give it to the lab. The lab called me and told me they would have to send it off to another lab. I called a week later to ask about it and the lab told me the doctor told them to throw it away because you cant pass a polyp. This made me very upset. It has also caused a delima because shortly after this, i had a colonoscopy which removed a polyp the had adenocarcinoma with possible lymphovascular invasion. I had a sigmoid resection but now i often wonder if the other polyp was cancerous and what part of the colon it came from. I do know for a fact that you can have spontaneously expulsion of a polyp and or tissue mass.


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