Examples where size doesn’t equal stage?

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TiredandTroubled
Posts: 27
Joined: Sat Jul 10, 2021 7:11 am

Examples where size doesn’t equal stage?

Postby TiredandTroubled » Wed Jul 28, 2021 8:22 am

Hi everyone,

I’m currently recovering from my robotic laparoscopic sigmoid resection. I’m still waiting on my staging. But of course, I’m driving myself crazy with what I do know: my tumor was 7cm, which seems huge. Everything on google says size isn’t a good for survival…

Strangely, I’ve been googling the diameter of a sigmoid colon and it seems it’s only 5cm wide? I didn't have a blockage and from the pictures from my colonoscopy, the tumor only seemed to protrude about halfway into the sigmoid. Perhaps they were measuring laterally?

Anyway, can anyone share examples of large sized colon tumors that didn’t necessarily mean late stage? I don’t think I’m stage 4 since the CT scan of liver and lungs was clear.

I know I’ll know soon enough but it would provide some much needed comfort at this time.

Thanks everyone and hope you’re well.
29F DX 7/19
CC Sigmoid Colon
Adenocarcinoma
5.2 cm x 2.4 cm
G2
T3N2aM0
Stage III
5/15 positive LN
Baseline CEA: 16
LVI, PNI present
Clear margins
MSS
Sigmoid Colectomy

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

Re: Examples where size doesn’t equal stage?

Postby catstaff » Wed Jul 28, 2021 9:57 am

They use the longest dimension. Many, but not all, tumors are roughly spherical so it's often a good proxy for volume.

Really, the key for staging is whether it's penetrated into the wall of the colon. If it had extended beyond it they should have been able to see that on MRI, so I assume it has not done that.
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-

User avatar
Jacques
Posts: 678
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: Examples where size doesn’t equal stage?

Postby Jacques » Wed Jul 28, 2021 10:11 am

Size is not what matters most. What really matters is how deep the tumor has grown into the colon wall, i.e., through how many layers it has grown. This will no doubt be documented in the pathology report of your resection.

In your case, the 7cm most likely refers to the length of the tumor -- and as others have suggested already, the tumor might be a flat (i.e., sessile) tumor that measures 7cm from the lower, distal, end (near the recto-sigmoid junction) to the upper, proximal end (near the descending colon). Apparently your colonoscopy report gave no indication as to the tumor's width or depth. All of this will likely be documented more clearly in the pathology report, so you will just have to wait and see.

Almost all colon cancer tumors come from polyps, but there are two main kinds of polyps -- flat (sessile) polyps, and pedunculated polyps (ones with a stalk like a mushroom). You would need to know what kind of polyp your tumor originated from. This might make a difference as to how deep the tumor has grown into the colon wall, but it's hard to say without extra information such as an MRI scan with contrast which would be able to outline the 3-dimensional layout of the tumor, including any root extending into or through the colon wall. But they didn't do a scan with contrast before your surgery, so they wouldn't have this kind of detail on record. Once the pathologist has the resected specimen in hand the true dimensions can be determined. However, keep in mind that after a specimen has been removed from the body and put in preservative solution it will shrink in size.

In your earlier post you mentioned that a small polyp was also removed during your colonoscopy procedure. Did the report say what type of polyp it was?

Has your surgeon talked to you since your surgery? If so, what did he have to say? Did he have any comments about your gall bladder?

TiredandTroubled
Posts: 27
Joined: Sat Jul 10, 2021 7:11 am

Re: Examples where size doesn’t equal stage?

Postby TiredandTroubled » Wed Jul 28, 2021 10:41 am

Jacques wrote:Size is not what matters most. What really matters is how deep the tumor has grown into the colon wall, i.e., through how many layers it has grown. This will no doubt be documented in the pathology report of your resection.

In your case, the 7cm most likely refers to the length of the tumor -- and as others have suggested already, the tumor might be a flat (i.e., sessile) tumor that measures 7cm from the lower, distal, end (near the recto-sigmoid junction) to the upper, proximal end (near the descending colon). Apparently your colonoscopy report gave no indication as to the tumor's width or depth. All of this will likely be documented more clearly in the pathology report, so you will just have to wait and see.

Almost all colon cancer tumors come from polyps, but there are two main kinds of polyps -- flat (sessile) polyps, and pedunculated polyps (ones with a stalk like a mushroom). You would need to know what kind of polyp your tumor originated from. This might make a difference as to how deep the tumor has grown into the colon wall, but it's hard to say without extra information such as an MRI scan with contrast which would be able to outline the 3-dimensional layout of the tumor, including any root extending into or through the colon wall. But they didn't do a scan with contrast before your surgery, so they wouldn't have this kind of detail on record. Once the pathologist has the resected specimen in hand the true dimensions can be determined. However, keep in mind that after a specimen has been removed from the body and put in preservative solution it will shrink in size.

In your earlier post you mentioned that a small polyp was also removed during your colonoscopy procedure. Did the report say what type of polyp it was?

Has your surgeon talked to you since your surgery? If so, what did he have to say? Did he have any comments about your gall bladder?


Thank you Jacques - the other polyp they found (and removed) was 12mm I believe, I think pedunculated (still at the hospital and don’t have my report near me).

The colonoscopy report did say the tumor was “hemicircumferential” if that means anything?


The surgeon said removing my gallbladder was not necessary as the gallstone is only half a centimeter and not causing my any pain so I get to keep it for now!
29F DX 7/19
CC Sigmoid Colon
Adenocarcinoma
5.2 cm x 2.4 cm
G2
T3N2aM0
Stage III
5/15 positive LN
Baseline CEA: 16
LVI, PNI present
Clear margins
MSS
Sigmoid Colectomy

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Examples where size doesn’t equal stage?

Postby Rock_Robster » Thu Jul 29, 2021 1:58 am

My tumour was “only” 3.5cm wide, but tumour stage 3b which is relatively advanced (and disease stage 4a, due to liver mets). Fortunately after chemoradiation it was macroscopically gone (only a small amount of local cells remaining, and not PET-avid).
Last edited by Rock_Robster on Thu Jul 29, 2021 5:05 am, edited 1 time in total.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Examples where size doesn’t equal stage?

Postby Rock_Robster » Thu Jul 29, 2021 2:00 am

[duplicate]
Last edited by Rock_Robster on Fri Jul 30, 2021 7:52 pm, edited 1 time in total.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Examples where size doesn’t equal stage?

Postby Rock_Robster » Thu Jul 29, 2021 5:06 am

[duplicate]
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Tueffel
Posts: 15
Joined: Sat May 15, 2021 12:53 pm

Re: Examples where size doesn’t equal stage?

Postby Tueffel » Fri Jul 30, 2021 1:07 pm

The most common systen which they used for my dad is UICC. It has TNM and some numbers after which are now to difficult to explain.
T is the tumor size. In some instances the size matters but in colon cancer they distinguish how many layers of the colon wall the tumor invaded. They give T1 to T4.
N is for the number of lymphnodes. N0 is no tumor cells are found during pathology. Then there is N1 and N2.
I believe the most important is M. M indicates metastases. M0 is no metastases and in this case not stage 4. If it is M1, it is stage 4.
Besides you will find other things in the report but they dont have an affect on the stage.
Example: my dad had T3N1M1. He is stage 4 because of M1. After the M1 was also written (HEP) indicating liver mets.

Hope that helps a little
Tueffel
Papa
Has MS, 18/19 w Alemtuzumab
01/20 dx adeno
pT3, pN1c (0/13; deposits), pM1 liver
Pn1, R0, G2
KRAS G12V
Treated: Germany
4x folfox
05-06/20 liver + colon surgery
08-11/2020 folfox, 60% oxaliplatin
02/21 2nd liver surgery
04/21 recurrence
2 weeks: 50% growth
Since 05/21 5x TACE, 7x Folfiri + bev
08/21 still growth, ileus surgery and peritoneal mets,
10/21 Lonsurf Cyramza, failed
Papa died 26th November 2021

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Examples where size doesn’t equal stage?

Postby Rock_Robster » Fri Jul 30, 2021 7:56 pm

TiredandTroubled wrote:
Jacques wrote:Size is not what matters most. What really matters is how deep the tumor has grown into the colon wall, i.e., through how many layers it has grown. This will no doubt be documented in the pathology report of your resection.

In your case, the 7cm most likely refers to the length of the tumor -- and as others have suggested already, the tumor might be a flat (i.e., sessile) tumor that measures 7cm from the lower, distal, end (near the recto-sigmoid junction) to the upper, proximal end (near the descending colon). Apparently your colonoscopy report gave no indication as to the tumor's width or depth. All of this will likely be documented more clearly in the pathology report, so you will just have to wait and see.

Almost all colon cancer tumors come from polyps, but there are two main kinds of polyps -- flat (sessile) polyps, and pedunculated polyps (ones with a stalk like a mushroom). You would need to know what kind of polyp your tumor originated from. This might make a difference as to how deep the tumor has grown into the colon wall, but it's hard to say without extra information such as an MRI scan with contrast which would be able to outline the 3-dimensional layout of the tumor, including any root extending into or through the colon wall. But they didn't do a scan with contrast before your surgery, so they wouldn't have this kind of detail on record. Once the pathologist has the resected specimen in hand the true dimensions can be determined. However, keep in mind that after a specimen has been removed from the body and put in preservative solution it will shrink in size.

In your earlier post you mentioned that a small polyp was also removed during your colonoscopy procedure. Did the report say what type of polyp it was?

Has your surgeon talked to you since your surgery? If so, what did he have to say? Did he have any comments about your gall bladder?


The colonoscopy report did say the tumor was “hemicircumferential” if that means anything?

This means the tumour encircled approximately half of the internal circumference of the colon. So again suggesting a reasonable wide tumour, but not necessarily deep (which is what is more important).
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

rp1954
Posts: 1853
Joined: Mon Jun 13, 2011 1:13 am

Re: Examples where size doesn’t equal stage?

Postby rp1954 » Sat Jul 31, 2021 8:17 am

After the local penetration for T, staging for spread characterized by N and M reflects mets local and distant is formal pathology. Molecular features can be more informative or determinative about mets than initial size of the primary tumor.

There are various correlations of stage for various blood panels and markers, pre and post surgery, as well as tissue data for KRAS, BRAF and CA199 that may further inform you on risk and potential stage.

Often it takes months for various data to better complete the initial picture. In our case, early blood data was more informative than formal pathology on the surgical pathology because we did unrecognized neoadjuvant treatments that produced a major response surprising to the staff, and destroyed a lot of viable cancer tissue that turned still visible lesions into met mush still in place. Sort of like initial rectal cancer obliterated by radiation that then lowers the apparent staging doesn't well describe what existed before the radiation tx but might be estimated from earlier blood panels.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements


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