Hi everyone, unfortunately I am here to make my first post in order to get some clarification/opinions on my dad’s treatment. I’ll make a comprehensive signature eventually but for now i’ll just give a summary of his situation thus far:
He was diagnosed November 2018 at a routine colonoscopy (age 51) with very low rectal cancer and received radiation and Xeloda prior to his LAR procedure. The tumor shrunk a good amount from treatment and the ileostomy was reversed in November 2019. From what I can tell rectal cancer doesn’t get properly staged until the surgery, and after surgery they found no positive nodes and the tumor wasn’t as deep as initially thought. Stage 1! Even given this great news he still had FOLFOX mop up which he tolerated well besides some minor neuropathy. He has little to no side effects from his LAR and considers himself extremely fortunate in this area. All follow up colonoscopies have looked “beautiful” and the outlook seemed very positive.
Fast forward almost 2 years after his surgery to remove the primary and several small lung nodules up to 5-6mm showed up on his December 2020 routine CT. They may have been present in previous scans but were “significantly smaller at the time” per the report. Scans got bumped up to 3 months instead of 6 in order to be cautious and sure enough this past March he had 4 lung nodules with interval growth. The nodules are pretty much located in 4 quadrants of both lungs. Three only grew 1mm and one grew 4mm making his largest 1cm (still pretty small). He had a PET scan to follow up this CT and all the spots show very low activity, but the oncologist and his team don’t take this to mean much and regard CT as being superior. The only difference in the PET scan was the 1cm nodule measured 9mm and had an intake of 1.8 (the rest were much lower). It also picked up another small nodule making the total 5. I should mention that his liver has scanned clear the entire time and no lymph nodes have looked suspicious on the scans at any point. His CEA was always low and remains low. Everything is fine and dandy except these tiny growing nodules.
His oncologist declined a biopsy because to him there’s no doubt this is a recurrence. The strategy now is systemic therapy to clear out microdisease before going forward with surgery or ablation which are both on the table (Both a surgeon and radiologist have been consulted). The onc’s philosophy is that this is a chess game and he doesn’t want to exhaust options too fast considering how small and slow growing these spots are. The rationale for not plowing ahead with surgery or ablation before doing chemo is that he doesn’t want to tear up healthy tissue just to get a pretty scan for 6 months and have a quick recurrence, which is the likely scenario with 5 bilateral nodules. The plan is certainly not chemo for life and NED is the goal, but a lasting NED with healthy lung tissue is what they want.
The plan now is daily Xeloda because it worked well with the primary. Obviously the more heavy hitting chemo regimens are still options but the onc wants to start with this and see where it goes. He wasn’t even adamant about starting chemo immediately due to the slow growth. Is only daily Xeloda for this situation appropriate? Or is this strategy too relaxed? I’m shocked I’m even in this position considering how good his prognosis was for the primary tumor, and part of me wants these nodules to just be some random allergy thing or something, but I know that’s not likely. None of the reports on his scans have ever mentioned the word “metastasis” or implied disease spread, but what else could this really be? Sorry for the lengthy first post, and if I left out any key points feel free to ask.
Thanks a lot everyone