So, what is the deal with perineural invasion (PNI)?

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I_will_fight
Posts: 40
Joined: Mon Jun 29, 2020 3:38 pm

So, what is the deal with perineural invasion (PNI)?

Postby I_will_fight » Thu Jul 23, 2020 4:43 am

Hi all,

I am kind of a newbie, so please correct me if I say something incorrect.

I understand Colon Cancer is typically graded based on TNM criteria and this grade is mapped into a more simplistic "Stage"

As part of TNM they take into account the tumor growth, the invasion of nearby areas, organs, lymph nodes and distant metastases.

I was personally pretty happy when my doctor told me my TNM was T3N0M0, in fact I almost cried from joy during the appointment when I learnt I had no limphatic Nodes involvement, no limphatic invasion and no spread to the spleen. Doctor said, that my case would be looked into in the committee session, but it was not certain that chemo would be recommended.

But then, upon reading my report I see "perineural invasion present".... I googled it and it appears it is a predictor of poor prognosis, not different from limphatic invasion, in fact according to a few studies, it is a risk factor and enough to recommend chemo in Stage II patients.

Do you guys know much about this perineural invasion? I see many people don´t have any mentiont to it in their signature, also most studies about it are fairly recent.

Is it that bad? Have people here managed to remain NED (or cured) even with PNI present?

Thanks to all, BR

JC
Last edited by I_will_fight on Thu Jul 23, 2020 12:49 pm, edited 1 time in total.
46 yo male at DX from Spain
June 2020 - 6 cm T3N0M0 cancer on left colon
No evidence of liver mets, two milimetric dots in lung, 3 and 4 mm (currently not considered mets)
lymph nodes 0/37
MSH6 non expressed, other MMR proteins present
KRAS mt G13D
Vascular invasion: absent
LNI: absent
PNI: present
July 8th 2020 - 50 cm colon and spleen removed, clean margins, optimistic surgeon.
Aug 2020 - start of XELOX regime, four cycles.

Beckster
Posts: 421
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: So, what is the deal with perineural invasion (PNI)?

Postby Beckster » Thu Jul 23, 2020 5:28 am

I am a T3N0M0, Stage 2A. I did not have PNI, but I did have LVI. Because of this risk factor, I was on chemo for 6 months. I took Xeloda, which is a pill form of 5FU. I have not regrets and wanted to do everything possible to make sure the cancer did not come back. My onc is part of MD Anderson, and I went by his suggestion. If you have any questions, feel free to message me. I have been NED for almost 4 years and my chance of recurrence is now less than 5%.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3 (path) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction
1/2/17 to 6/9/17- Xeloda monotherapy
6/17,12/17,6/18,12/18, 6/19, 12/19 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0
Clear Colonoscopy 10/17, 11/19 :D

I_will_fight
Posts: 40
Joined: Mon Jun 29, 2020 3:38 pm

Re: So, what is the deal with perineural invasion (PNI)?

Postby I_will_fight » Thu Jul 23, 2020 6:26 am

Thanks for your reply Beckster,

I am very glad you did so well!

I think they will also recommend chemo for me. Not sure which one.

Apparently since I am MSH6- deficient Platinum-based chemos are not very effective, so I might well end up on Xeloda, as you did.

Let see if someone with PNI can share an equally uplifting story. :D

Best Regards,

JC
46 yo male at DX from Spain
June 2020 - 6 cm T3N0M0 cancer on left colon
No evidence of liver mets, two milimetric dots in lung, 3 and 4 mm (currently not considered mets)
lymph nodes 0/37
MSH6 non expressed, other MMR proteins present
KRAS mt G13D
Vascular invasion: absent
LNI: absent
PNI: present
July 8th 2020 - 50 cm colon and spleen removed, clean margins, optimistic surgeon.
Aug 2020 - start of XELOX regime, four cycles.

Carboxo
Posts: 25
Joined: Sat Nov 02, 2019 5:10 pm

Re: So, what is the deal with perineural invasion (PNI)?

Postby Carboxo » Fri Jul 24, 2020 7:09 pm

My sister has slight perineural invasion. Her cancer was first thought to be early stage 1 but was upgraded to stage 3A upon surgical path. She did chemo first then chemoradiation. She just did her reversal May. She just had her first clear colonoscopy but has diversion colitis and rectosigmoid colitis along with 2 ulcers at the anastomosis site.
Good luck
DS: caregiver
48, female
DX: RC, Adenocarcinoma
G2: Moderately differentiated
pT1N1bM0 Stage IIIA
Positive lymph’s:, 2/15
Baseline CEA value 2.5
Tumor invades submucosa
Perineural invasion (PNI) present
Surgical margins: clear
MSS,KRAS/BRAF status: WT
LAR robotic, colectomy, with Ileostomy 9/4/19
Radiation therapy (if any): Chemo/rad scheduled next
Chemotherapy:XELODA,CAPEOX, started 10/28/19

I_will_fight
Posts: 40
Joined: Mon Jun 29, 2020 3:38 pm

Re: So, what is the deal with perineural invasion (PNI)?

Postby I_will_fight » Sat Jul 25, 2020 5:31 pm

Carboxo wrote:My sister has slight perineural invasion. Her cancer was first thought to be early stage 1 but was upgraded to stage 3A upon surgical path. She did chemo first then chemoradiation. She just did her reversal May. She just had her first clear colonoscopy but has diversion colitis and rectosigmoid colitis along with 2 ulcers at the anastomosis site.
Good luck


Thanks Carboxo,

Did they mention how relevant the perineural invasion was to the staging? Or not at all?

I hope your sister gets well.

Best regards,

JC
46 yo male at DX from Spain
June 2020 - 6 cm T3N0M0 cancer on left colon
No evidence of liver mets, two milimetric dots in lung, 3 and 4 mm (currently not considered mets)
lymph nodes 0/37
MSH6 non expressed, other MMR proteins present
KRAS mt G13D
Vascular invasion: absent
LNI: absent
PNI: present
July 8th 2020 - 50 cm colon and spleen removed, clean margins, optimistic surgeon.
Aug 2020 - start of XELOX regime, four cycles.

I_will_fight
Posts: 40
Joined: Mon Jun 29, 2020 3:38 pm

Re: So, what is the deal with perineural invasion (PNI)?

Postby I_will_fight » Thu Jul 30, 2020 6:58 am

Giving this a little bump, as it is not geetting much attention.

Best regards

JC
46 yo male at DX from Spain
June 2020 - 6 cm T3N0M0 cancer on left colon
No evidence of liver mets, two milimetric dots in lung, 3 and 4 mm (currently not considered mets)
lymph nodes 0/37
MSH6 non expressed, other MMR proteins present
KRAS mt G13D
Vascular invasion: absent
LNI: absent
PNI: present
July 8th 2020 - 50 cm colon and spleen removed, clean margins, optimistic surgeon.
Aug 2020 - start of XELOX regime, four cycles.

I_will_fight
Posts: 40
Joined: Mon Jun 29, 2020 3:38 pm

Re: So, what is the deal with perineural invasion (PNI)?

Postby I_will_fight » Sun Oct 18, 2020 4:54 am

I_will_fight wrote:Thanks for your reply Beckster,

I am very glad you did so well!

I think they will also recommend chemo for me. Not sure which one.

Apparently since I am MSH6- deficient Platinum-based chemos are not very effective, so I might well end up on Xeloda, as you did.

Let see if someone with PNI can share an equally uplifting story. :D

Best Regards,

JC


Just for the sake of correctness and completeness... My previous post was wrong.

5FU appears to be innefective for dMMR cancer cells, but Oxiloplatin makes the tumor sensitive to Capecitabine, or so my oncologist explained to me.

So I ended up taking 4 cycles of CAPOX.

Thank you, BR
46 yo male at DX from Spain
June 2020 - 6 cm T3N0M0 cancer on left colon
No evidence of liver mets, two milimetric dots in lung, 3 and 4 mm (currently not considered mets)
lymph nodes 0/37
MSH6 non expressed, other MMR proteins present
KRAS mt G13D
Vascular invasion: absent
LNI: absent
PNI: present
July 8th 2020 - 50 cm colon and spleen removed, clean margins, optimistic surgeon.
Aug 2020 - start of XELOX regime, four cycles.


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