Lung recurrence update- good news

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Beccaschocked
Posts: 40
Joined: Mon Oct 30, 2017 7:33 pm
Facebook Username: Becca Fender schock

Re: Lung recurrence update- good news

Postby Beccaschocked » Fri Jan 27, 2023 5:38 pm

Just jumping on here to say I had another clean scan! Nearly 8 years since dianosis, 7 years out from chemo, 5 years from lung recurrence/lobectomy.

I always appreciated reading success stories. There is hope to be had. Keep on keepin' on.
Dx @ 32, mom to 6 week old and 2 year old (now 3 & 5)
3/2015 stage IV colon cancer Mets to liver. CEA > 8,000.
4/2015- June 15; 3 infusions folfoxiri +avastin, 4 infusions folfox
7/2015 colon & liver resection; 6 infusions of folfiri
1/2016-5/2017 NED (5mm lung nodule stable)
10/2017- growing lung nodule 12mm from 5mm-Confirmed recurrence - CEA 2.5
11/2017- lobectomy- no chemo
1/2018- CT & PET back to NED. CEA 1.3; 1.4; 1.2; 1.2.; 1.0; 1.1; 1.1; 0.9......
7/18-2023 - Clean Scans

skb
Posts: 100
Joined: Tue Mar 28, 2017 2:00 pm

Re: Lung recurrence update- good news

Postby skb » Tue Nov 07, 2023 8:39 pm

Hi,
My latest CT scans shows a lower right bilobed nodule that grew from 3mm in June 2023 to to 7-8mm in Oct 2023. Three other nodules are mentioned in the scan- all below 5 mm. two are located at the edge - peripheral/juxta-pleural. My oncologist has has asked me to start Xeloda and continue for 6 months.

I went to Mayo for a second opinion. The Mayo pulmonologist ordered a PET-CT and the PET does not show hypermetabolic activity in any of these lung nodules or anywhere else in the body. The FDG uptake in the largest nodule is 0.9. Given this, I wonder whether I should start Xeloda right away. My Mayo appointment is not until Nov 16th. My CEA is 1.0

Does the PET result mean anything? Has anyone had this experience?

Thanks,
skb
3/21/17: Dx T3N0M0-mid rectal 4.5cm
4/18 to 5/22/17: chemoradiation- Xeloda and daily radiation (25 doses)
6/28/17: clean biopsy, clean scans
8/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17 to 12/17: Folfox
8/19 VATS - 1cm lung nodule
7/17/21- Clean CT, CEA 15.6 !
8/24/21- PET , biopsy finds met along obturator lymph nodes
10/1/21- Surgery , 12 rounds of FOLFIRI -ended 4/22
4/15/22, 9/6/22. 1/20/23- Clean scan, normal CEA
10/23- four sub-centimeter lung nodules, all PET negative

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung recurrence update- good news

Postby roadrunner » Tue Nov 07, 2023 9:45 pm

The challenge here is that PET sensitivity for pulmonary nodules <1cm is not ideal. I’ve seen a 27% fail rate in one study. Most of yours are very small, and I suppose that the fail rate would be higher as the size decreases. Though I haven’t read that, it’s just speculation. Your scan history matters, as well. Were any of the nodules seen before other than the one you mentioned? If so, what were their sizes? The doubling time of the largest nodule is fast, but seems potentially consistent with CRC. Have you relayed the PET result to your original oncologist? I think you can wait until you talk to the Mayo Clinic folks on the 16th, in any case. That should bring clarity as to the scan.

What’s your onc’s theory on the Xeloda? If he/she thinks these are disease, why not hit it with the big guns (FOLFIRI) to try to knock out any micromets and reduce existing disease to potentially set up metasectomy or ablation? The goal with pulmonary mets (if that’s what you have here) is to remove surgically or destroy with ablation (RFA, cryoablation, or SBRT). Systemic therapies are rarely curative, though there are some cures with FOLFIRI (including some reported on this forum) and Prayingforccr has had great success with a TILs trial. [Edited to add: Saw your signature, perhaps the choice was due to your prior treatment with FOLFIRI?]

You did the right thing getting the second opinion here. Pulmonary mets present very challenging strategic decisions, and what you do now may be very impactful down the road.

Also, location of any suspect nodules should be considered. Are they in different lobes? Lungs? Peripheral location is generally good, central tougher.

You likely have these questions already, but if not they may be useful for your Mayo appt. or ongoing discussions with your original oncologist.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

skb
Posts: 100
Joined: Tue Mar 28, 2017 2:00 pm

Re: Lung recurrence update- good news

Postby skb » Tue Nov 07, 2023 10:21 pm

Hi roadrunner,
Thanks for your detailed answer. The oncologist's preference for Xeloda might be because of past success with it (initial diagnosis) and my recent challenges with Folfiri (was harder to tolerate, full hair loss, was off work). The four nodules are reported in four lobes and therefore not surgically curable according to my oncologist. If anyone does that, he says that is medical malpractice. So he is suggesting systemic therapy.

1) Right lower lobe - irregular bilobed solid pulmonary nodule central cavitation 7-8 mm: this was first seen in a scan in June 2023. This area also had prior surgical removal of a nodule in 2019. The best case is that this is some inflammation is cavitated. But its growth seen in serial CTs is concerning.
2) Superior right middle lobe: Juxta-pleural :nodule with tiny central cavitation , 5 mm nodule with tiny central cavitation , was 4mm 3 months ago
3) 3 mm peripheral left upper lobe nodule
4) Left lower lobe nodule is increased in size from2 to 4 mm

I have resigned to the belief that these are real cancerous growth. However there is a small hope because of PET being negative and I reading somewhere that peripheral nodules are often benign. There was a note in a CT from 2019 that the lower left lung observation was a granuloma. My initial resected lung met was not irregular or cavitated.
3/21/17: Dx T3N0M0-mid rectal 4.5cm
4/18 to 5/22/17: chemoradiation- Xeloda and daily radiation (25 doses)
6/28/17: clean biopsy, clean scans
8/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17 to 12/17: Folfox
8/19 VATS - 1cm lung nodule
7/17/21- Clean CT, CEA 15.6 !
8/24/21- PET , biopsy finds met along obturator lymph nodes
10/1/21- Surgery , 12 rounds of FOLFIRI -ended 4/22
4/15/22, 9/6/22. 1/20/23- Clean scan, normal CEA
10/23- four sub-centimeter lung nodules, all PET negative

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung recurrence update- good news

Postby roadrunner » Wed Nov 08, 2023 1:28 am

Ok, that’s helpful. I just did four cycles of FOLFIRI in April/May, so I know how tough it can be. I lost a lot of hair just in 4. It was tolerable otherwise for me, though. But I just did 4.

For your Mayo appt., I would definitely ask about your original oncologist’s view that resection and or ablation (curative or otherwise) is irresponsible. (You didn’t mention ablation or radiation, but these are potabtial options with or without surgery.) Beach Sunrise just had several nodules resected in Germany using an established laser technique, and that thread might be a useful read. Also, you should at least consider/ask about ablation/radiation/combos. It’s def bad luck that these are in 4/5 lobes, but I’m not certain that that alone means that only systemic therapy is possible.They are all still very small. And subpleural nodules are often easy VATS wedges.

You should be aware that there is a school of thought that believes that no pulmonary met should be resected (an argument is made that because they are generally slow-growing, OS is not greatly increased with resection). However, this is not a majority view, and there are folks just on this forum who have had pulmonary metasectomies and are close to or beyond recurrence-free survival of 10 years. I think you still have what is called oligometastatic disease, a concept you might want to familiarize yourself with (and more so because at least 1-2 of these might not be mets). Plus, I’d ask Mayo about doubling times, as yours seem on the quicker side, which might influence strategy. From what you’ve related, even if these are all metastases I don’t think cure is completely off the table, nor should metasectomy and or ablation/radiation be. At least not without thorough discussion. Another important point is whether to resect one of these to test for mutations. That might optimize any systemic therapy. Of course, all this depends on your preference as well. But now is the time to consider all this.

Sorrry this is a bit rambling. If this is all stuff you know, then you’re in good shape to prepare a question list for Mayo. If not, I’d look into these topics before you go in there. Finally, this looks like it might be a very important decision-point. Even getting a third opinion would not be crazy here.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

skb
Posts: 100
Joined: Tue Mar 28, 2017 2:00 pm

Re: Lung recurrence update- good news

Postby skb » Wed Nov 08, 2023 7:52 am

Roadrunner,
Very helpful and encouraging.
Thank you,
skb
3/21/17: Dx T3N0M0-mid rectal 4.5cm
4/18 to 5/22/17: chemoradiation- Xeloda and daily radiation (25 doses)
6/28/17: clean biopsy, clean scans
8/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17 to 12/17: Folfox
8/19 VATS - 1cm lung nodule
7/17/21- Clean CT, CEA 15.6 !
8/24/21- PET , biopsy finds met along obturator lymph nodes
10/1/21- Surgery , 12 rounds of FOLFIRI -ended 4/22
4/15/22, 9/6/22. 1/20/23- Clean scan, normal CEA
10/23- four sub-centimeter lung nodules, all PET negative

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung recurrence update- good news

Postby roadrunner » Wed Nov 08, 2023 11:29 am

There’s a lot of material in this article that may be pertinent to your situation.

https://www.cancer.gov/news-events/canc ... eans%20few).
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

DarknessEmbraced
Posts: 3816
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Lung recurrence update- good news

Postby DarknessEmbraced » Sat Nov 11, 2023 8:22 am

Congratulations! That's wonderful! :D
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)


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