Spontaneous expulsion of primary tumor

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jsbsf
Posts: 107
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 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED

claudine
Posts: 809
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

Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22

Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24

Siti
Posts: 269
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! :)
DH (54) DX on 5/7/19
Sigmoid|G3|LN:30/31|MSS|WT KRAS, NRAS, BRAF
7/19 PET distant LN para-aorta neck hip (0.5-1.5cm)
7/19 Lap resection
26/8 to 20/12/19 CAPEOX+Bev 7x
6/11/19 CT 3 cycle LN shrunk
1/20 Cap+Bev
4/20 TS-1+Bev due to bad HFS
NED 4 years
8/23 PET recurrence chest LN growing since Feb. CEA May(4.5>5.1>5.9)
9/23 Stopped Bev, CEA Sept(8.7) Radio 17x
11/23 PET 1+ supraclavicular LN, CEA (3.4>2.5)
12/23 Lymphadenectomy
1/24 Narrow margins, 1/5 +LN, 1.4cm +tissue, TMB (19)

jsbsf
Posts: 107
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 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED

jsbsf
Posts: 107
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 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED

Siti
Posts: 269
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! :)
DH (54) DX on 5/7/19
Sigmoid|G3|LN:30/31|MSS|WT KRAS, NRAS, BRAF
7/19 PET distant LN para-aorta neck hip (0.5-1.5cm)
7/19 Lap resection
26/8 to 20/12/19 CAPEOX+Bev 7x
6/11/19 CT 3 cycle LN shrunk
1/20 Cap+Bev
4/20 TS-1+Bev due to bad HFS
NED 4 years
8/23 PET recurrence chest LN growing since Feb. CEA May(4.5>5.1>5.9)
9/23 Stopped Bev, CEA Sept(8.7) Radio 17x
11/23 PET 1+ supraclavicular LN, CEA (3.4>2.5)
12/23 Lymphadenectomy
1/24 Narrow margins, 1/5 +LN, 1.4cm +tissue, TMB (19)

boxhill
Posts: 789
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 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs 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: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

jsbsf
Posts: 107
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 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED

jsbsf
Posts: 107
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 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED

prs
Posts: 201
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.

jsbsf
Posts: 107
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: Spontaneous expulsion of primary tumor

Postby jsbsf » Sun Mar 29, 2020 5:15 am

Thanks for your responses. Prs, your posts are some I followed early on, and I am aware of the watch-and-wait approach. I even reached out to your doctor in the LA area at one point, but didn’t hear back. DH also has Kaiser, but in San Francisco. Unfortunately, he’s at stage IV and doesn’t qualify, from what I understand. So, I didn’t follow up with your doctor for that reason.

But fortunately, as of late January, he qualifies for a robotic arm surgery, which would make it possible to avoid a permanent colostomy. The colorectal surgeon says his response was so well that he was in a very small group where he could be offered that option. Otherwise he would need a surgery that I believe attaches the colon to a permanent colostomy.

The colorectal surgeon was astonished with his response after 6 rounds of FOLFOX. There was still a small bump, but he could barely feel it at all during a physical exam. And the endoscopy view compared to the original colonoscopy from late August was like night and day. The difference was unbelievable.

His original tumor was large and invaded his lymph nodes. But the pet scan in late December showed that there was no activity in the lymph nodes, which surprised the oncologist. I’m certain that a large piece of the tumor fell off on Nov 2, about a month into treatment.

I feel like there is likely nothing left of the tumor now, especially if the recent observation was in fact what still remained of the original tumor. However, since he had stage IV going in to all this, I think some form of surgery will be required, and am grateful he is eligible for the robotic surgery.
DH 61
2019 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED

jsbsf
Posts: 107
Joined: Sat Aug 24, 2019 6:01 am
Location: San Francisco

Re: Spontaneous expulsion of primary tumor

Postby jsbsf » Sun Mar 29, 2020 5:36 am

Oh siti,

After his 8th round of treatment he still experienced the sand in shoes sensation. It lasted a couple days and was similar to after the 7th round. So, we aren’t sure if the ice packs helped.

He brought this up to the oncologist who told him if that sensation lasts only 2 to 3 days it most likely wouldn’t predict permanent neuropathy. If it lasts 5 to 7 days then it would be much more likely.

So he is reducing the oxaliplatin by 10 to 15 percent in his next infusion. It’s a small amount, and after 8 infusions will hopefully address that potentially permanent side effect.
DH 61
2019 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: significant improv.
2020
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
7/23-29 EBRT
10/2/2020 NED/W&W
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets. APR.
7-12/2023 Xeloda
4/2023 CT/MRI NED


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