Lukewarm to positive?

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claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Lukewarm to positive?

Postby claudine » Wed Jun 23, 2021 10:13 am

Merci Sunnycd :D
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

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Lukewarm to positive?

Postby claudine » Fri Sep 17, 2021 5:35 pm

And another stable scan! Lots of "unchanged compared to previous scans" - many small calcified lung mets, a 5mm hypodense lesion in liver, a pancreatic cyst, and of course the mixed lytic/sclerotic L4 lesion. But no apparent recurrence or progression. There was mention of this being a PET rather than a CT scan but that wasn't the case, not sure why, maybe the insurance declined? Follow up appointment with onc next week - CEA will be measured then. I have this wild hope that after slowing its wild increase (25 - 50 - 75 then 81), maybe it'll have gone DOWN?? I know it's unrealistic, but I've got this wild hope DH will be a "one in a million" unexplained case!

Meanwhile - another 3 months' respite :D :D :D
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

catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: Lukewarm to positive?

Postby catstaff » Mon Sep 20, 2021 9:01 am

The stable scan is fantastic but I still worry about lymph nodes. My husband's lymph-node mets were not identified on CT alone. Determining lymphadenopathy radiologically is somewhat subjective since the normal sizes vary with different nodes and even then there are ranges. Even the shape must be determined (if they are too round they could be malignant even if not particularly enlarged--they are supposed to be bean-shaped). For lymph nodes they look at the short axis for pathology.

But we'll hope the CEA rise has stopped.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Lukewarm to positive?

Postby claudine » Mon Sep 20, 2021 10:35 am

Oh believe me, Catstaff, I *do* worry plenty about things that may go unseen on CT scans! Lymph node mets, but also peri mets, things that could be hiding in liver, etc. But I am not the one with cancer, and although I am deeply invested in my husband's well being, it is all his decision, after all. His approach has been to trust his oncologist 100% and not spend a iota of time on personal research - he doesn't have the time, and mental energy for it. I can hint at things, but bringing up his cancer only destroys whatever little mental health bubble he's managing to maintain. And a positive attitude and "strong head" are also very important in this fight, so I'll just let it slide...
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

catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: Lukewarm to positive?

Postby catstaff » Mon Sep 20, 2021 10:48 am

Sounds like that is definitely for the best.

My husband's last CT (a week ago) seemed to show the lymph node mets resolved, and the "butt met" (it was never clear whether that was a local recurrence or another lymph node) is apparently at the resolution limit, at least the radiologist said he couldn't measure a size for it (??). The bone met is of course still there. It is mixed lytic/blastic but the sclerotic part seemed to be entirely around the "rim" (what the radiologist said) so the onc thought it represented bone replacing cancer. Unfortunately the radiologist used a scan from over a year and a half ago as his baseline, not the one from last February, so he thought he discovered that met, and also we have no comparison. Other than that it was the most thorough read I've seen from this radiology practice that the private hospital uses. (We also use the local university hospital since that's where he had his surgery, and those reads are by residents and tend to be thorough since they are motivated.)

He is on his 12th folfiri/bev cycle and is getting pretty worn out. He's currently scheduled for two more, then perhaps a break. After seeming to stall out a bit for two cycles the latest CEA had a slightly larger decline (down from 7.3 to 6.8 ).
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Lukewarm to positive?

Postby claudine » Mon Sep 20, 2021 11:07 am

Other than that it was the most thorough read I've seen from this radiology practice that the private hospital uses.


I almost started a new thread just on that topic - the difference in reading details from one radiologist to another. I need to go back to DH's scans and make a note on who's been doing the reading, because I see a lot of variation in the amount of details provided. For example this last one mentions a 5mm hypodense lesion in segment 4 of liver, "unchanged compared to previous scans", yet it is the first time this is ever mentioned! So it was there before, but either not noticed, or not mentioned. And this is not the first time it has happened.
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

catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: Lukewarm to positive?

Postby catstaff » Mon Sep 20, 2021 12:20 pm

In the past, sometimes there was a more detailed report that was not given to the patient unless the treating physician chose to do so, though that seems not to be the case with reports being fully released automatically now.

Radiology is art as well as science, and different radiologists will give you different interpretations. They are supposed to mostly agree (otherwise this wouldn't be a very useful field) but their readings do vary.

I looked back at the addendum message from the radiologist (I hadn't read it, I have to make my patient log in to his electronic chart) after the onc asked him to look at the "butt met" again. They can't see it very well since it was always an amorphous mass embedded in some generalized, non-malignant edema. They couldn't even see it all that well on the PET, though it was the only thing they biopsied because the lymph nodes were too small. On the initial reading, the radiologist didn't even mention a mass. So on the recheck he just said it's hard to see but it's definitely smaller.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Lukewarm to positive?

Postby claudine » Mon Sep 20, 2021 1:20 pm

So on the recheck he just said it's hard to see but it's definitely smaller.

That's good news :D
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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