CRC metastasis to lungs first?

[Jleefitness]

Hi all

This is my very first post but been creeping around the forums for almost a year now. This site and it's members have supplied me with invaluable information and therefore I am very grateful. So without further ado, here is our story.

Diagnosed wife:

6/2/15: Total Colectomy Surgery
6/6/15: Final pathology report: Sigmoid primary colon cancer, 2/18 posting lymph nodes, moderately differentiated T4aN1bMx @28 years old
6/10/15: Genetics testing results showed she has Atypical Familial Adenomatous Polyposs (AFAP)
6/17/15: Second opinion at MD ANDERSON and treatment plan
7/2/15 - 1/16/16: 13 rounds of FOLFOX6
1/23/16: Clean CT, officially NED
4/28/16: 7mm nodule spotted on left medial lobe. Radiologist concerned for possible metastasis. Wants a CT schedule in 1 month to confirm...freaking out now.

So my question is what is the possibility that you get Mets to your lungs first before the liver? I've had everyone tell me to "it could be anything" to possible cancer. To just wait or go get a second opinion, to "its rare to go to the lungs first"etc. How many of you all have experienced this and got a false negative? Thank you all for helping.

[Swimmer22]

Colorectal cancer (CRC) when metastatic will frequently first present in the lung. This is due to the blood vessels in the rectum that also feed blood supply to the lungs. Cancer cells use this pathway to travel to the lungs. On the other hand, Colon cancer typically first presents metastases to the liver. This is not a 100% process; however, there is a significant difference between where colorectal and colon cancer first appear as metastatic disease. It's good your doctor is diligent in follow-up assessments. Single lung nodules are very treatable-- surgical removal is the gold standard in treating lung metastases. Whishing you the best!

[Outdoorsy]

That's not the typical path for colon cancer, rectal is more common to go directly to lungs but anything is possible. When my wife was diagnosed with mets to the liver she had 2 small spots that showed up in the lungs. It's been 5 years since the liver resection and the lung spots haven't changed, lots of stuff in the lungs is benign. I know it's very hard but try to not freak out, there will be lots of ups and downs, hopefully this is just a false alarm. Good luck.

[Jleefitness]

Thank you for your prompt replies. The worst part about this is the waiting. Its terrible. Im trying to be as positive and optimistic as possible but I am scared and worried of course. I just don't understand how 3 months ago there was no nodule but in just 12 weeks they find a nodule thats 7mm already? Isn't that strangely fast?

[JDinNC]

My colon cancer went to my lungs first...it even bypass my lymph nodes....that was three years ago and still NED.

[Nik Colon]

Thank you for your prompt replies. The worst part about this is the waiting. Its terrible. Im trying to be as positive and optimistic as possible but I am scared and worried of course. I just don't understand how 3 months ago there was no nodule but in just 12 weeks they find a nodule thats 7mm already? Isn't that strangely fast?

It does sound strange. All I can say is I hope they just didn't catch it for some reason until now and it's benign. Yes, many people have benign lung spots. I know how you feel. I have lung spots that 2 showed 2mm growth on last scan (no growth for over a yr prior on the 3 i knew of). Just had a combo PET/CT yesterday, have to wait until next Tuesday to see onc, very nerve wracking. Best wishes and hugs.

[crazylife]

My husbands presented in the liver and lungs at the same time. I don't get it. I would've thought the liver would've filled with cancer before it moved to the lungs. But he only had 1 spot to liver (1.0 cm) and 1 spot to lung (8mm). He had a recto-sigmoid tumor so maybe that's why.

[jhocno197]

It is possible. There are several people here with 'just' lung mets.

[Jleefitness]

Doctors are saying waiting is the best option . They don't want to do a biopsy cause they said it might spread the cells if it was metastatic, it's too small for a PET scan and they don't want to resect it in case it is benign and they cut it for no reason. We were thinking about going to a thoracic radiologist for a second opnion but the onc said they were going to tell us to wait too. So me and my wife over here are freaking the F out everyday. We are trying to keep it normal but the reality of the fact is that we are ready for the worst possible scenario and preparing to have a plan if the scans came out bad. This sucks.

[BBMOM]

My son was treated for Stage III rectal cancer with radiation, followed by surgery, followed by 12 rounds of chemo. He was NED for 14 months post the end of chemo, and 2 years post initial diagnosis. Then a single pulmonary nodule was found in his right middle lobe and was determined to be a metastasis from the rectal cancer. Due to the SPN's location, the entire lobe was removed He then received conflicting advice as to whether follow up chemo was necessary. A consultation at M.D. Anderson produced the opinion that he NOT get the chemo, but rather follow up every 3 months with CT scans. The M.D. Anderson opinion was based on the institution's experience that chemo was not helpful in preventing recurrence. It might delay recurrence, but whether it came back or not, was unaffected by post surgery chemo. He has followed this advice, and has had 2 clean scans. Has anyone in the Club followed this procedure, meaning, surgery to remove the lung nodule, WITHOUT follow up chemo?

[crazylife]

Thank you for your prompt replies. The worst part about this is the waiting. Its terrible. Im trying to be as positive and optimistic as possible but I am scared and worried of course. I just don't understand how 3 months ago there was no nodule but in just 12 weeks they find a nodule thats 7mm already? Isn't that strangely fast?

7mm is very tiny. My husband had a 8mm pop up and disappear with chemo.

[stu]

Hi BBmom,
My mum did not have follow up chemo as it was a slow growing tumour, therefore chemo did not have a role to play.
Where we live they treat visible disease only but my mum is older and comfortable with this and gives her better quality of life. If it kept the cancer at bay for a significant period of time or the tumour grew quickly I would seek a second opinion.
I wish him the very best.
Kind regards
Stu

[NedPlease]

I would (and did) consult with a thoracic surgeon to discuss options- specifically VATS. My single met was 7mm and was successfully removed via VATS just six months after I had completed chemo for liver metastasis.

My onc suggested biopsy first. Surgeon disagreed, as did a radiologist who is a personal friend. Onc said chemo before surgery. Surgeon disagreed wanting to do surgery as soon as possible. The tiny met lit up on a PET scan and pathology confirmed colon cancer. This was Nov 2011.

This particular surgeon is also a cancer researcher at Sloan Kettering so I had no trouble accepting his treatment plan- nor did my oncologist, despite her slightly different opinion.

There will be confusion regarding treatment approach. This annoyed me beyond belief at the time. All one can do is seek opinions, research and commit to a decision.

Again, I would have a thoracic surgeon weigh in on this. I like to know all my options before committing.

Best to you,
N

[skb]

NedPlease,
After you had the lung met and VATS, you had Xeloda it seems for 6 months. Was it just oral pills?

I am waiting to get the verdict from my oncologist for the chemo following VATS

skb

[skb]

My son was treated for Stage III rectal cancer with radiation, followed by surgery, followed by 12 rounds of chemo. He was NED for 14 months post the end of chemo, and 2 years post initial diagnosis. Then a single pulmonary nodule was found in his right middle lobe and was determined to be a metastasis from the rectal cancer. Due to the SPN's location, the entire lobe was removed He then received conflicting advice as to whether follow up chemo was necessary. A consultation at M.D. Anderson produced the opinion that he NOT get the chemo, but rather follow up every 3 months with CT scans. The M.D. Anderson opinion was based on the institution's experience that chemo was not helpful in preventing recurrence. It might delay recurrence, but whether it came back or not, was unaffected by post surgery chemo. He has followed this advice, and has had 2 clean scans. Has anyone in the Club followed this procedure, meaning, surgery to remove the lung nodule, WITHOUT follow up chemo?

BBMOM,
I am waiting to get a verdict from my oncologist at Univ of Minn. on whether additional chemo is needed after the VATS to remove one lung nodule. I had consultation at Mayo recently and the person I met recommended more chemo.