Stg 4 para aortic and Iliac Lymph Nodes

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Internal1
Posts: 8
Joined: Fri Aug 07, 2020 10:58 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Internal1 » Fri Sep 11, 2020 4:38 pm

Hi All,

Today I had my 8th cycle of folfox and avastin and I had a hypersensitivity reaction to oxaliplatin just 15-20 minutes after infusion started. They had to stop chemo and I was given Benadryl and steroids. The fellow who came to see me called my oncologist who decided to only continue with Leucovorin and they connected the 5fu to come home with it. The fellow is not sure what the oncologist will do for my next cycle. Did anyone have an allergic reaction to oxaliplatin and if they did what did your oncologist do? Did they pre-medicate you with Benadryl and steroids? Or did they slow down the infusion? Or did they stop it completely? Thank you all!

msusta
Posts: 3
Joined: Mon Mar 02, 2020 11:13 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby msusta » Sun Sep 13, 2020 1:10 am

Internal1 wrote:Hi AT,

I could see that most of the olymphian’s on the forum have only para-aortic node disease. In my situation, on top of para-aortic, I have lower posterior mediastinal lymph nodes that had decreased from 1.2 cm to 7 mm. Also, I have small scattered retrocrural lymph nodes. Also, I have left supraclavicular lymph nodes that went down from 9 mm to 7 mm. Maybe in my situation a surgery isn’t feasible. I’m not sure if anyone on this forum has a similar situation like me with nodes other than para-aortic which were melted by chemo and could answer this question as well. I’m glad I found this forum! I read your story and the story of others and they are truly inspirational!!



My mom has similar situation. She has mediastinal and subcarinal lymph nodes which showed FDG activity in PET scan last July. I found that all the lymph nodes except one in mediastinal and subcarinal region can be removed by Transcervical extended mediastinal lymphadenectomy (VEMLA). There is also Video-assisted mediastinoscopic lymphadenectomy (VAMLA) which removes less lymph nodes but laparoscopic. I have met with some surgeons who can do these surgeries but they did not want to operate because these techniques are for staging the cancer in chest area not for treatment. But this is ridiculous because patient gets rid of metastasized lymph nodes causing the cancer to regress. Cancer may spread to other lymph nodes in future. But who knows. It may not spread too. I am trying to find some publications that supports removing these lymph nodes not only help staging but also has long term positive effect on overall survival.

For more information:
https://pubmed.ncbi.nlm.nih.gov/17409815/
https://pubmed.ncbi.nlm.nih.gov/12895606/

lovelife789
Posts: 160
Joined: Thu Aug 24, 2017 5:28 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby lovelife789 » Mon Sep 14, 2020 6:00 am

Internal1 wrote:Hi All,

Today I had my 8th cycle of folfox and avastin and I had a hypersensitivity reaction to oxaliplatin just 15-20 minutes after infusion started. They had to stop chemo and I was given Benadryl and steroids. The fellow who came to see me called my oncologist who decided to only continue with Leucovorin and they connected the 5fu to come home with it. The fellow is not sure what the oncologist will do for my next cycle. Did anyone have an allergic reaction to oxaliplatin and if they did what did your oncologist do? Did they pre-medicate you with Benadryl and steroids? Or did they slow down the infusion? Or did they stop it completely? Thank you all!


Hi,

I did have a severe allergic reaction to oxi. What they did was not stopping it altogether. They gave me a break with Benadryl and steroids. Then, slow drip for the rest of the infusion. From that time onwards, they gave me steroids to take before the infusion, during and for the 3 days 5FU infusion just in case. It went well, I finished all 12 at last without any issue.

Hope it helps.

Lovelife
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

Siti
Posts: 177
Joined: Thu Aug 01, 2019 10:58 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Siti » Tue Sep 15, 2020 2:05 pm

Achilles Torn wrote:I’m in recovery from surgery today. The PET scan just before showed the maintenance chemo had held me stable
For three months. The surgeon said it went well and they removed a lot of nodes. I was reading up on surgical options for lymph nodes and found this example of a patient with multiple lymph node surgeries who did well.


https://pubmed.ncbi.nlm.nih.gov/26640350/


Very pleased to hear that your surgery went well! I hope you’re recovering well post surgery. How did they access the nodes in multiple locations — did they make multiple incisions?
Wife of DH (54) DX on 5/7/19
Sigmoid | Adenocarcinoma | Grade: G3 | 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 7
6/11/19 CT Scan after 3rd cycle, all nodes have shrunk! Yay!! 20/12/19 Last round of Ox (NED)
1/2020 Maintenance: Cap + Avastin
4/2020 Maintenance: switch to Teysuno (S-1) + Avastin due to bad HFS side effects.

lovelife789
Posts: 160
Joined: Thu Aug 24, 2017 5:28 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby lovelife789 » Tue Sep 15, 2020 2:13 pm

Siti wrote:
Achilles Torn wrote:I’m in recovery from surgery today. The PET scan just before showed the maintenance chemo had held me stable
For three months. The surgeon said it went well and they removed a lot of nodes. I was reading up on surgical options for lymph nodes and found this example of a patient with multiple lymph node surgeries who did well.


https://pubmed.ncbi.nlm.nih.gov/26640350/


Very pleased to hear that your surgery went well! I hope you’re recovering well post surgery. How did they access the nodes in multiple locations — did they make multiple incisions?


Hi Siti,

Was about to ask you how are you handling Teysuno? I was offered this drug some months ago after my lung VATS surgery but I was told by my second opinion it was not necessary.

I was starting a new job then so I didn't take it. How does it work out for you?

Lovelife
F/38 - Dx 8 Mar 17, CEA 189.5
Stage IV Sig. Colon, Liver mets, T3N0M1a, KRAS NRAS Wild
3/17- 6/17 - 6 x FOLFOX + Erbitux
7/17 - 1st & 2nd Liver resec
9-12/17' - 13 x FOLFOX
1-6/18 - NED
6/18 - PET SCAN showed a 0.8mm lung nodule, VATs
8/18 - 4/19 - NED
5/19 - recurrence 1 x PALN, 1x common iliac
FOLFIRI + Avastin x 12 - complete response, SBRT
12/19-5/20 - NED
5/20 - recurrence in LNs, tiny liver spots x 2, W n W due to COVID
8/20 - LNs very slightly increased, liver stable, one new liver spot

Siti
Posts: 177
Joined: Thu Aug 01, 2019 10:58 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Siti » Wed Sep 16, 2020 12:48 pm

lovelife789 wrote:Hi Siti,

Was about to ask you how are you handling Teysuno? I was offered this drug some months ago after my lung VATS surgery but I was told by my second opinion it was not necessary.

I was starting a new job then so I didn't take it. How does it work out for you?

Lovelife


My husband suffered from bad HFS and it was really affecting his daily life so his oncologist switched to TS-1. It has only been a few cycles so I don’t really know how effectively it would be long term (my husband’s CT scan results will be out this Friday) but in terms of side effects it’s a lot more tolerable compared to Cap. He can finally feel his hands and feet again, but do suffer from occasional diarrhoea which he manages with loperamide + psyllium husk.

I hope this information is useful.
Wife of DH (54) DX on 5/7/19
Sigmoid | Adenocarcinoma | Grade: G3 | 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 7
6/11/19 CT Scan after 3rd cycle, all nodes have shrunk! Yay!! 20/12/19 Last round of Ox (NED)
1/2020 Maintenance: Cap + Avastin
4/2020 Maintenance: switch to Teysuno (S-1) + Avastin due to bad HFS side effects.

Achilles Torn
Posts: 127
Joined: Fri Dec 16, 2016 2:41 pm

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Achilles Torn » Wed Sep 16, 2020 2:16 pm

Siti wrote:
Achilles Torn wrote:I’m in recovery from surgery today. The PET scan just before showed the maintenance chemo had held me stable
For three months. The surgeon said it went well and they removed a lot of nodes. I was reading up on surgical options for lymph nodes and found this example of a patient with multiple lymph node surgeries who did well.


https://pubmed.ncbi.nlm.nih.gov/26640350/


Very pleased to hear that your surgery went well! I hope you’re recovering well post surgery. How did they access the nodes in multiple locations — did they make multiple incisions?


It was one big incision in my case as they were the whole chain from Para-aortic to Illiac. The paper I linked to was about a patient with multiple different sites. Just to show it was possible.

Recovery has been tough but I’m getting back on my feet. Time will tell if this leads to a survival benefit for me. But I’m optimistic.

AT
Diagnosed as 40 yo Male. BC Canada. Sigmoid Colectomy Dec. 2016
Pathology T3N2bM1 19 of 24 Nodes Positive + tumour deposits
PET scan - Para-Aortic and Iliac Lymph node spread. Stage VI.
Moderately differentiated. MSS. KRAS/BRAF Wild.
Mutations: TP53, ERBB4, MLL3, PDCD1LG2, PRKDC, SMAD3
FOLFOX + Bevacizumab Commenced Jan 9/2017 PET Scan July 2017 - on maintenance 5FU/Bev every 2 weeks.
Progression after Covid19 induced break June 2020. Resume Maintenance chemo of Capecitabine and Bev

Internal1
Posts: 8
Joined: Fri Aug 07, 2020 10:58 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Internal1 » Wed Sep 16, 2020 3:43 pm

Hi Msusta,

I completely agree with you and apparently there are different schools of thought when it comes to lymph node removal. Some believe that it increases survival benefit while others do not. My surgeon believes that there is a survival benefit and mentioned that if the chemo works and there are only a few lymph nodes in a certain place then it might be possible to remove them to increase survival benefit. Thank you so much for sending the links!

Internal1
Posts: 8
Joined: Fri Aug 07, 2020 10:58 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Internal1 » Wed Sep 16, 2020 3:52 pm

I found this article that shows there is a benefit to extended lymphadenectomy for isolated extra regional lymph nodes metastasis. It is also a relatively recent article. There doesn’t seem to be a lot of research on this and perhaps this is the reason for the different approaches by doctors regarding lymphadenectomy.

https://doi.org/10.1016/j.asjsur.2015.10.003
Last edited by Internal1 on Wed Sep 16, 2020 5:03 pm, edited 1 time in total.

Internal1
Posts: 8
Joined: Fri Aug 07, 2020 10:58 am

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Internal1 » Wed Sep 16, 2020 4:04 pm

lovelife789 wrote:
Internal1 wrote:Hi All,

Today I had my 8th cycle of folfox and avastin and I had a hypersensitivity reaction to oxaliplatin just 15-20 minutes after infusion started. They had to stop chemo and I was given Benadryl and steroids. The fellow who came to see me called my oncologist who decided to only continue with Leucovorin and they connected the 5fu to come home with it. The fellow is not sure what the oncologist will do for my next cycle. Did anyone have an allergic reaction to oxaliplatin and if they did what did your oncologist do? Did they pre-medicate you with Benadryl and steroids? Or did they slow down the infusion? Or did they stop it completely? Thank you all!


Hi,

I did have a severe allergic reaction to oxi. What they did was not stopping it altogether. They gave me a break with Benadryl and steroids. Then, slow drip for the rest of the infusion. From that time onwards, they gave me steroids to take before the infusion, during and for the 3 days 5FU infusion just in case. It went well, I finished all 12 at last without any issue.

Hope it helps.

Lovelife


I’m still waiting to see what my oncologist will do for my 9th cycle. I haven’t heard back from him, but I definitely want to continue with oxaliplaton because it looks like the regimen is working. Pre-medicating might work and I’m willing to do that, so hopefully he’ll agree to this!

User avatar
beach sunrise
Posts: 250
Joined: Thu Mar 05, 2020 7:14 pm

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby beach sunrise » Wed Sep 16, 2020 6:22 pm

Hi AT, so very happy it all went well! You are an inspiration to others for being your own advocate! I hope you feel better and better than the day before during recovery.
8/19 RC CEA 86 T3N0M0
Neoadj 5FU/rad 6 wk
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
8 rds 6-10 CEA 11.4 4 more no oxa
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
MHL1+
PMS2+
MSH2+
MSH6+
POLD1
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

Achilles Torn
Posts: 127
Joined: Fri Dec 16, 2016 2:41 pm

Re: Stg 4 para aortic and Iliac Lymph Nodes

Postby Achilles Torn » Tue Oct 27, 2020 2:45 am

Update: Pathology for the removed tissue and nodes showed more extensive spread than was shown on the PET scans. Cancer was still confined to lymph nodes but some para-aortic nodes were matted together and there were signs of extension beyond the node in the tissue. I had a follow up PET scan last week (6 weeks post surgery) which showed some low uptake just below the surgical site. This was inconclusive as it could be inflammation from the surgery. I am feeling good now and scheduled to go back on chemotherapy next week. Overall I am glad I pushed for the surgery and although the recovery was tougher than I anticipated I was lucky I've had no major complications. I remain hopeful.

Cheers
AT
Diagnosed as 40 yo Male. BC Canada. Sigmoid Colectomy Dec. 2016
Pathology T3N2bM1 19 of 24 Nodes Positive + tumour deposits
PET scan - Para-Aortic and Iliac Lymph node spread. Stage VI.
Moderately differentiated. MSS. KRAS/BRAF Wild.
Mutations: TP53, ERBB4, MLL3, PDCD1LG2, PRKDC, SMAD3
FOLFOX + Bevacizumab Commenced Jan 9/2017 PET Scan July 2017 - on maintenance 5FU/Bev every 2 weeks.
Progression after Covid19 induced break June 2020. Resume Maintenance chemo of Capecitabine and Bev


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