Lung Recurrence Treatment Plan

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nova17
Posts: 8
Joined: Sat Apr 17, 2021 3:22 pm

Lung Recurrence Treatment Plan

Postby nova17 » Fri Apr 30, 2021 12:39 pm

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

zephyr
Posts: 316
Joined: Thu Aug 18, 2016 7:31 am

Re: Lung Recurrence Treatment Plan

Postby zephyr » Fri Apr 30, 2021 3:25 pm

After the recurrence in my lungs, I went on Xeloda and Avastin.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 F/U colonoscopies, all clear
Jun-2016 CRC during followup colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Dec-2020 Progression, considering all options
Mar-2021 Forfiri/Avastin

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CRguy
Posts: 10317
Joined: Sun Feb 10, 2008 6:00 pm

Re: Lung Recurrence Treatment Plan

Postby CRguy » Fri Apr 30, 2021 9:41 pm

Welcome to the forum.

In reply to your request for info regarding your Dad's treatment,
I refer you to my catch all "JOURNEY " topic post here
Review of my Journey so far -> ⓊⓟⒹⒶⓉⒺ April 30/2021

After Dx of a single confirmed lung met, I chose FOLFOX after having only been on Xeloda,
for both neoadjuvant chemoradiation and adjuvant therapy, post CRC resection.

Best wishes
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
14 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

User avatar
Green Tea
Posts: 421
Joined: Mon Oct 24, 2016 10:48 am

Re: Lung Recurrence Treatment Plan

Postby Green Tea » Sun May 02, 2021 3:41 am

nova17 wrote:...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?

Hello Nova17 and welcome to the Forum.

I'm sorry to hear about your father. This is really disappointing news, given that your father has done so well up to now.

I did some checking on the NCCN 2021 Rectal Cancer Guidelines for first-line treatment of recurrent CRC, and this is what I found in the guidelines:

There are two first-line treatment tracks for mCRC listed in Section on page 41 . The first track is called, "Patients with advanced or metastatic CRC who are appropriate candidates for intensive therapy " and the second track is called "Patients with advanced or metastatic CRC who are not appropriate candidates for intensive therapy ".

The first track is the one that lists the "heavy hitting" regimens like FOLFOX+Avastin(bevacizumab), FOLFOXIRI, etc. Almost all of the regimens in this track are combination regimens that usually contain powerful drugs like Eloxatin(oxaliplatin), or Avastin(bevacizumab), or targeted therapy drugs like Erbitux(cetuximab) or Vectabix(panitumumab) etc. This track doesn't have any recommended single-drug regimens like 'Xeloda monotherapy', except for several new immunotherapy options like Keytruda.

The second track has a number of options, including the one that your oncologist is recommending (Xeloda monotherapy), as well as several other single-drug regimens, including immunotherapy options, and a few combination regimens, too. This is a track of "softer" chemo options that might be called something like "chemo light".

So it looks like the oncologist has decided that your father falls in the second category, but I'm not sure why. It suggests that your oncologist considers your father to be a "Patient who is an inappropiate candidate for intensive therapy."

The second track obviously exists because there are indeed some patients who either cannot tolerate the stronger regimens or who don't need such strong regimens to control their situation.

I would suggest that your father have another discussion with the oncologist to ask for further clarification on the matter. The oncologist may be able to specify exactly what constraints make the second track the preferable one at this time.

It should be mentioned that if your father's tumor was tested for micro satellite instability (MSI) just after surgery and if the tumor was classified as MSI-High, then he would qualify now for a powerful first-line mCRC immunotherapy option like Keytruda(pembrolizumab). You might want to ask the oncologist if the resected tumor could be retrieved from storage and tested now for MSI if it has not yet been tested.

It would also help if you could get clarification on exactly where the troublesome nodules are located, because it might make a difference for the long-term treatment strategy.

Image

nova17
Posts: 8
Joined: Sat Apr 17, 2021 3:22 pm

Re: Lung Recurrence Treatment Plan

Postby nova17 » Sun May 02, 2021 9:21 am

Green Tea wrote:
nova17 wrote:...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?

Hello Nova17 and welcome to the Forum.

I'm sorry to hear about your father. This is really disappointing news, given that your father has done so well up to now.

I did some checking on the NCCN 2021 Rectal Cancer Guidelines for first-line treatment of recurrent CRC, and this is what I found in the guidelines:

There are two first-line treatment tracks for mCRC listed in Section on page 41 . The first track is called, "Patients with advanced or metastatic CRC who are appropriate candidates for intensive therapy " and the second track is called "Patients with advanced or metastatic CRC who are not appropriate candidates for intensive therapy ".

The first track is the one that lists the "heavy hitting" regimens like FOLFOX+Avastin(bevacizumab), FOLFOXIRI, etc. Almost all of the regimens in this track are combination regimens that usually contain powerful drugs like Eloxatin(oxaliplatin), or Avastin(bevacizumab), or targeted therapy drugs like Erbitux(cetuximab) or Vectabix(panitumumab) etc. This track doesn't have any recommended single-drug regimens like 'Xeloda monotherapy', except for several new immunotherapy options like Keytruda.

The second track has a number of options, including the one that your oncologist is recommending (Xeloda monotherapy), as well as several other single-drug regimens, including immunotherapy options, and a few combination regimens, too. This is a track of "softer" chemo options that might be called something like "chemo light".

So it looks like the oncologist has decided that your father falls in the second category, but I'm not sure why. It suggests that your oncologist considers your father to be a "Patient who is an inappropiate candidate for intensive therapy."

The second track obviously exists because there are indeed some patients who either cannot tolerate the stronger regimens or who don't need such strong regimens to control their situation.

I would suggest that your father have another discussion with the oncologist to ask for further clarification on the matter. The oncologist may be able to specify exactly what constraints make the second track the preferable one at this time.

It should be mentioned that if your father's tumor was tested for micro satellite instability (MSI) just after surgery and if the tumor was classified as MSI-High, then he would qualify now for a powerful first-line mCRC immunotherapy option like Keytruda(pembrolizumab). You might want to ask the oncologist if the resected tumor could be retrieved from storage and tested now for MSI if it has not yet been tested.

It would also help if you could get clarification on exactly where the troublesome nodules are located, because it might make a difference for the long-term treatment strategy.

Image



Here’s the location of his nodules per the PET CT:

There is a 7mm nodule in the left upper lung with maximum SUV 1.3
There is a 5mm nodule in the right upper lung with maximum SUV 0.9
There is a 4mm juxta fissural anterior left lower lobe nodule with maximum SUV 0.4
There is a 9mm nodule in the medial right lung base with maximum SUV 0.8
There is a 5mm juxtapleural right lung base nodule with maximum SUV 1.0

His mediastinal blood pool has an uptake of 2.5, don’t these spots seem pretty inactive? I suppose the low numbers are associated with their small size.

The reason why his oncologist is starting with Xeloda monotherapy is because my dad does have some residual neuropathy (albeit fairly minor) from his previous mop up treatment with FOLFOX. Quality of life is the concern with starting off with this chemo, and the onc wants to give Xeloda a chance before getting into heavier stuff again. Again, the surgeon is willing to operate but stable or reduced disease is the goal first.

Thanks everyone for the responses.

catstaff
Posts: 101
Joined: Wed Mar 03, 2021 11:37 am

Re: Lung Recurrence Treatment Plan

Postby catstaff » Tue May 04, 2021 8:39 am

My husband has lingering neuropathy from folfox but is on folfiri+bev right now. Folfiri should not cause or exacerbate neuropathy. Are there perhaps other health issues? So far DH is tolerating folfiri much better than folfox, though he hasn't had that many rounds yet.
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-

nova17
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Joined: Sat Apr 17, 2021 3:22 pm

Re: Lung Recurrence Treatment Plan

Postby nova17 » Tue May 04, 2021 8:59 am

catstaff wrote:My husband has lingering neuropathy from folfox but is on folfiri+bev right now. Folfiri should not cause or exacerbate neuropathy. Are there perhaps other health issues? So far DH is tolerating folfiri much better than folfox, though he hasn't had that many rounds yet.


Besides the slight neuropathy he doesn’t have any other health issues. From what I understand the oncologist wants to start with Xeloda because as of right now he has very minimal disease and it’ll have the least side effects. Apparently the onc has also had experience with it being effective with other patients. In my mind I’m sort of thinking of this Xeloda monotherapy as a watch and wait period, and the next scans will decide whether to start new chemo or go ahead with surgery. Does this strategy seem reasonable, or are we just beating around the bush?

Also if anyone who’s knowledgeable about PET scans has any insight on my last post I would greatly appreciate any input! I find it odd that the impression just says “continued attention on CT follow up recommended” and makes no indication that this is definitely a recurrence. Do scan impressions usually leave that decision to the oncologist?

Again, thanks to everyone for their responses :)

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Green Tea
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Re: Lung Recurrence Treatment Plan

Postby Green Tea » Tue May 04, 2021 1:17 pm

nova17 wrote:... Also if anyone who’s knowledgeable about PET scans has any insight on my last post I would greatly appreciate any input! I find it odd that the impression just says “continued attention on CT follow up recommended” and makes no indication that this is definitely a recurrence. Do scan impressions usually leave that decision to the oncologist?

In my experience, it has been the radiologist who made the decision. In your case, I think the problem is that the spots are too small for the radiologist to make a determination at this time. He/she needs a larger, more detailed image in order to look at the detail, such as the shape, symmetry of the spot and also to be able to use the software tools that come with the scanner to estimate the spot's density, homogeneity, etc. When the spots are too small all they can really say is that they have noticed something abnormal that is unlike the adjacent tissue, but they cannot recognize any of the standard features that would allow its identity to be verified. In such a case, the radiologist's default response is just to alert the doctor to the fact that something unusual has been seen but that it cannot be characterized until, or if, it increases in size so that they can see more detail. So they just remind the doctor that he/she should submit a requisition for a new scan later on when the spots might become larger and more visible.

Right now it impossible for the radiologist to distinguish between benign granulomas and malignant metastases because they would all look the same at this level of definition.

nova17
Posts: 8
Joined: Sat Apr 17, 2021 3:22 pm

Re: Lung Recurrence Treatment Plan

Postby nova17 » Tue May 04, 2021 1:57 pm

Green Tea wrote:
nova17 wrote:... Also if anyone who’s knowledgeable about PET scans has any insight on my last post I would greatly appreciate any input! I find it odd that the impression just says “continued attention on CT follow up recommended” and makes no indication that this is definitely a recurrence. Do scan impressions usually leave that decision to the oncologist?

In my experience, it has been the radiologist who made the decision. In your case, I think the problem is that the spots are too small for the radiologist to make a determination at this time. He/she needs a larger, more detailed image in order to look at the detail, such as the shape, symmetry of the spot and also to be able to use the software tools that come with the scanner to estimate the spot's density, homogeneity, etc. When the spots are too small all they can really say is that they have noticed something abnormal that is unlike the adjacent tissue, but they cannot recognize any of the standard features that would allow its identity to be verified. In such a case, the radiologist's default response is just to alert the doctor to the fact that something unusual has been seen but that it cannot be characterized until, or if, it increases in size so that they can see more detail. So they just remind the doctor that he/she should submit a requisition for a new scan later on when the spots might become larger and more visible.

Right now it impossible for the radiologist to distinguish between benign granulomas and malignant metastases because they would all look the same at this level of definition.


That makes sense, I know there’s almost no shot at this being anything but a recurrence, I just wondered why no judgment call was made yet on the PET even after interval growth was observed on the previous CT. I also just noticed that the top of the PET report says “enlarging lung nodule seen on previous CT scan”, which implies that only a single nodule definitely grew? I assume the use of singular there is probably a typo since the CT it’s referring to showed the other nodules increasing in size by 1mm.

Bilateral involvement is really disheartening and 5 lung mets sounds like a lot, but I’m trying to stay optimistic at this point in the game.

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Green Tea
Posts: 421
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Re: Lung Recurrence Treatment Plan

Postby Green Tea » Wed May 05, 2021 10:23 pm

nova17 wrote:... I just wondered why no judgment call was made yet on the PET even after interval growth was observed on the previous CT. I also just noticed that the top of the PET report says “enlarging lung nodule seen on previous CT scan”, which implies that only a single nodule definitely grew?

Yes, the PET scan report does appear to be a bit incomplete or inconsistent. If you are really concerned about this you could request a second opinion from a radiology department at a different hospital. There are some top-rated radiology departments around the world that provide this kind of service --- re-reading and interpreting CD-ROMs from other hospitals. You can check their web-sites for details.

For example,

Massachusetts General Hospital
https://www.massgeneral.org/imaging/patient-resources/second-opinion

Johns Hopkins Hospital
https://www.hopkinsmedicine.org/radiology/patient-information/images-and-reports/

Mayo Clinic - Second Opinion, Radiology
https://www.mayoclinic.org/documents/mc2434-pdf/DOC-20078991

If you decide to seek a second opinion, I would suggest dealing directly with a hospital that provides this service rather than going through one of the many second-opinion service providers.

While I was on active treatment, I requested re-reading of two of my scans, and I got the second-opinion reports electronically within a week from the time they received all my materials.

jts
Posts: 55
Joined: Sat Aug 24, 2019 3:07 pm

Re: Lung Recurrence Treatment Plan

Postby jts » Thu May 06, 2021 8:29 am

Last year I had a PET/CT that discovered a 5-6 mm lung met. It was actually the CT part of the scan that discovered it, because it did not show up on the PET. Going back to my old scans, the radiologist could show it was growing steadily for about 9 months, but had never been formally noted. There was some disagreement about whether to "wait and see what it does" because it didn't show decisive activity on the PET, or take it out right away. Luckily I was able to have it removed, and it turned out to be a met after all. Also luckily, almost a year later my lungs are still clear.

In my case they did not do chemo first, because when they discovered the met, I had just finished with adjuvant FOLFOX. The met had been growing the whole time. There was no point in doing more of that.

Your oncologist's plan, assuming it is most likely disease and making a plan that hopefully gets your dad clean lungs, makes sense to me. I would still be eager to talk to a surgeon to get some idea if the collection of nodes will be operable. Maybe your oncologist already talked about it, or had some feedback from their tumor conference.
Male 42 — stage IV RC
NRAS mutant - KRAS, BRAF wt
08/2019 DX 6 cm long tumor
09-10/2019 Chemo-radiation
12/2019 TME Surgery, clear margins, 7/16 nodes positive
Pathology: ypT3 ypN2b M0
01-06/2020 - FOLFOX
CEA only goes up during chemo: 2.4 --> 6.2
07/2020 6 mm tumor in lung, was growing fast during chemo
09/2020 VATS
01/2021 new 5mm cyst in liver, CEA continues to increase --> 8
06/2021 CEA takes a break - down to 6

nova17
Posts: 8
Joined: Sat Apr 17, 2021 3:22 pm

Re: Lung Recurrence Treatment Plan

Postby nova17 » Thu May 06, 2021 9:03 am

jts wrote:Last year I had a PET/CT that discovered a 5-6 mm lung met. It was actually the CT part of the scan that discovered it, because it did not show up on the PET. Going back to my old scans, the radiologist could show it was growing steadily for about 9 months, but had never been formally noted. There was some disagreement about whether to "wait and see what it does" because it didn't show decisive activity on the PET, or take it out right away. Luckily I was able to have it removed, and it turned out to be a met after all. Also luckily, almost a year later my lungs are still clear.

In my case they did not do chemo first, because when they discovered the met, I had just finished with adjuvant FOLFOX. The met had been growing the whole time. There was no point in doing more of that.

Your oncologist's plan, assuming it is most likely disease and making a plan that hopefully gets your dad clean lungs, makes sense to me. I would still be eager to talk to a surgeon to get some idea if the collection of nodes will be operable. Maybe your oncologist already talked about it, or had some feedback from their tumor conference.


Thanks for your response and it’s great to hear that your lungs are still clear! Since my mom is the primary caregiver she goes to the appointments with my dad, but from what she’s told me the surgeon is confident he can get all the spots without fully removing any lobes. The largest nodule that seemed most concerning to us would be a “super easy” wedge resection according to the surgeon. I know I should be feeling good about the feasibility of surgery, no lymph node involvement, clear liver etc. but the statistics about multiple nodules that I’ve read have really bummed me out! The surgeon and radiologist are completely in agreement with the call to do systemic therapy first before tearing into healthy lung tissue, and from what I understand stable/shrinking scans will mean surgery.

nova17
Posts: 8
Joined: Sat Apr 17, 2021 3:22 pm

Re: Lung Recurrence Treatment Plan

Postby nova17 » Sat Jul 17, 2021 11:18 am

Just thought I’d share an update. The 3 month ct scan after starting Xeloda show significant shrinkage of 3 nodules and stability in 1. Additionally, a nodule visible on the last PET scan is not visible anymore. The oncologist is optimistic about his response so far to what he considers are fairly minimal dosage, so no changes to the treatment plan are being made yet. What’s slightly confusing to me is that the ct impression says “no evidence of metastatic disease”, which has to be categorically false since the nodules have shrunk after starting Xeloda. I really can’t think of any benign condition that would mimic that pattern. Regardless, we’re happy that he’s responded to this treatment because he’s had minimal side effects. His oncologist is not in the chemo for life camp, but at this point the nodules are too small to even biopsy.

stu
Posts: 1503
Joined: Sat Aug 17, 2013 5:46 pm

Re: Lung Recurrence Treatment Plan

Postby stu » Sat Jul 17, 2021 3:24 pm

Great news .

I do find that strange regarding the CT scan !! I am have no real
Knowledge on the subject but I always thought shrinkage was a potential sign of chemo shrinking then !!!
Take care ,
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

roadrunner
Posts: 131
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung Recurrence Treatment Plan

Postby roadrunner » Sat Jul 17, 2021 9:42 pm

I am not certain there are definitive and/or comprehensive answers here. There are such things as transient pulmonary nodules, and they can grow or shrink and disappear on their own. I’m also not sure that growth (or reduction) was ever definitively established or well-quantified in some/all of these, at least from what you posted. (The one that showed 4mm growth may be an exception. I don’t think you said if it, or one of the smaller ones, is the “stable” one now.) The differences you mention—for example, 1mm growth (and you don’t give all the growth/reduction values, so it’s hard to judge)—are very small, and in micro-nodules at that. I believe 1mm “growth” would be generally regarded as “stable” in a person without known cancer. (If I remember right, 2mm is the threshold in that context.) Things are different where there is a history of cancer, but this still tells you something.

There are many vagaries when it comes to pulmonary nodules of this size. For example, inter-observer variability is +\- 1.72mm I believe (one study). Also the “slices” used for the CT, respiration at the moment of scan, contrast/no contrast (a significant factor), even electronic caliper factors and software variability can have effects (significant in this size range) that mimic growth or reduction in size. The challenge is that most of the nodules in this case are really small, so the relative impact of those factors may be increased. I wonder if the oncologist was “hedging” this when Xeloda was chosen for that reason. (Though you would presumably have been told that.) I must admit that I’m not sure what the PET results mean in this context, but the oncologist didn’t seem to regard that as definitive either.

All of this may explain (or be behind) the most recent radiologist’s impression, but the situation seems uncertain and potentially complex. Figuring that out would require (at least) a deep dive with your father’s team, and possibly a discussion with a (the?) radiologist. I’d certainly be interested in whether there is another potential etiology, e.g., an infection or prior smoking, especially if such a candidate fell into the period when these first definitively appeared. (You do say they “may” have appeared on prior scans, but the meaning of that is unclear.)

From reading your posts, it’s definitely possible that one or more of these are metastases, but I don’t think that’s certain. Your father’s oncologist thought it was concerning enough to do something, but they chose not to operate (even on the 1cm nodule (which you say would’ve been “easy,” and would likely have yielded enough material to test)). It may be that the treatment was just a conservative approach to observation.

That’s my reaction to your questions, anyway. Hope it helps in some way. But the bottomline appears to be that things are going in a good direction, which is awesome!
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; multiple biopsies negative
TAE 11/20, small amount of tumor removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
Stable in 6/28 scan.


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