In need of metastasis education

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O Stoma Mia
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Re: In need of metastasis education

Postby O Stoma Mia » Wed Oct 20, 2021 3:28 am

Claudine wrote:...
Take my husband, who’s a bit if an oddity on this forum. He may not even have CRC but small bowel adenocarcinoma, which is rare and treated like CRC; as far as i know he’s the only one (of active members) who had no primary. His oncologist’s theory is that it invaginated = was tiny and got destroyed by his immune system, but not before it had a chance to « spawn » and send cancer cells in his blood stream, one of which settled in his spine. Possibly by traveling through the Batson venous system. Radiation plus 6 rounds of adjuvant Xelox didn’t do their job and next thing we know, he’s got a large met in his adrenal gland - quite an uncommon site (compared to liver and lungs, although he also had multiple tiny lung nodules at the same time).

Why this spread pattern? Why no primary but mets? So many questions we’ll probably never get answers to! ...

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THE FUNCTION OF THE VERTEBRAL VEINS AND THEIR RÔLE IN THE SPREAD OF METASTASES
Oscar V. Batson (1940)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1387927/


Image

I'm re-posting the 1940 Batson article on this thread because it is more relevant here. But I also want to add a couple of things possibly related to the mystery of the spread pattern.

If you look at the text in the image above, you will see that the Batson venous system is mostly concerned with male/female gender primary tumors -- in males this is prostate cancer; and in females it is breast cancer, endometrial cancer, etc.

What is interesting and possibly relevant in the current context is that primary prostate cancer tumors generally metastasize first to the bone, and then later maybe to the lungs, or to the adrenal glands, etc. You can read the details in the article below.

    Distribution of metastatic sites in patients with prostate cancer: A population-based analysis
    https://pubmed.ncbi.nlm.nih.gov/24132735/
    Conclusions: Although the majority of patients with metastatic Prostate Cancer experience bone location, the proportion of patients with atypical metastases is not negligible.

The implication, I think, is this: for male patients above a certain age, they should be sure to have a Prostate Specific Antigen (PSA) prostate test annually to check on two things: (1) if the PSA value has gone out of normal range, and (2) if the value has more than doubled in the previous year. If so, then it is time to schedule an appointment with a urologist to see if the current elevation is something to worry about.

According to current literature, the best non-invasive test for checking on prostate cancer is a specialized multi-parameter MRI scan called mpMRI. This kind of scan is designed to look specifically for abnormal blood flow in the prostate, which would be indicative of an emergent cancer. If it is caught early enough, then this would be before the cancer has had a chance to metastasize to the bones. In prostate cancer, metastasis to the bones is generally the first, and primary metastasis site. Other metastases come later.

You can read about it in this primer:

A PROSTATE CANCER PRIMER
https://prostatecancer2020vision.org/wp-content/uploads/2020/12/ProstatePrimer_V3.pdf

Website: https://prostatecancer2020vision.org

claudine
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Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: In need of metastasis education

Postby claudine » Wed Oct 20, 2021 11:48 am

Thanks OSM; I just want to add that although spread through the Batson system is not common for CRC, I found a few articles pointing to it as a possibility, especially when there are only spinal mets (as was the case for my husband).
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22

Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24


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