Solitary lymph node metastasis: treatment options

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skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Solitary lymph node metastasis: treatment options

Postby skb » Mon Aug 16, 2021 11:03 am

Hi,
My latest PET scan lit up a lymph node in pelvic region (retroperitoneal lymph node along right obturator chain). The lymph node in question is 1.2 cm x 1.6 cm (SUVmax=5.8 ). There were no other findings in the PET scan. It has been four years since my first rectal cancer was fully treated. The radiologist calls this a recurrence unless proven otherwise. I have no symptoms.

Has anyone been treated for a solitary lymph node metastasis? If yes, please share details.

Online scientific papers do not have a clear recommendation. Some predict poor prognosis. Some predict good prognosis. My oncologist is still evaluating my results with an interdisciplinary team

skb
Last edited by skb on Sun Aug 29, 2021 10:45 pm, edited 2 times in total.
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

prayingforccr
Posts: 158
Joined: Sun Jun 28, 2020 4:44 pm

Re: Solitary lymph node metastasis: treatment options

Postby prayingforccr » Mon Aug 16, 2021 1:46 pm

Get it zapped out if you can.
Nov 2019: colonoscopy
Dec 2019: diagnosed with stage 3 rectal cancer 6+cm tumor
Jan-mar 2020: 20 sessions of radiation, mon-fri capecetibine, mon-fri clinical trial drug m3814
Apr 2020: tumor/scar 3.7cm
July 2020: began 8 treatmentsFOLFOX
August 2020: ct scan reveals scarbed reduced to 2.7cm CEA is 1.5
Nov 2020: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
May 2021: Multiple lung nodules (3-6mm) on ct scan

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Mon Aug 16, 2021 8:24 pm

zap meaning surgical removal? Ablation?
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

prayingforccr
Posts: 158
Joined: Sun Jun 28, 2020 4:44 pm

Re: Solitary lymph node metastasis: treatment options

Postby prayingforccr » Mon Aug 16, 2021 8:54 pm

100%
Nov 2019: colonoscopy
Dec 2019: diagnosed with stage 3 rectal cancer 6+cm tumor
Jan-mar 2020: 20 sessions of radiation, mon-fri capecetibine, mon-fri clinical trial drug m3814
Apr 2020: tumor/scar 3.7cm
July 2020: began 8 treatmentsFOLFOX
August 2020: ct scan reveals scarbed reduced to 2.7cm CEA is 1.5
Nov 2020: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
May 2021: Multiple lung nodules (3-6mm) on ct scan

stu
Posts: 1518
Joined: Sat Aug 17, 2013 5:46 pm

Re: Solitary lymph node metastasis: treatment options

Postby stu » Tue Aug 17, 2021 3:15 am

Hi ,
I would start by trying to find out the best surgeons / radiologist within your area . Consult with them both and hear what they have to say then work out what options give you the best approach to removing it .
Your oncologist should be able to help identify them for you ! Then you are fully informed and part of the decision making process . It is also very informative and reassuring to hear what both are achieving in their fields !
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 .

rp1954
Posts: 1574
Joined: Mon Jun 13, 2011 1:13 am

Re: Solitary lymph node metastasis: treatment options

Postby rp1954 » Tue Aug 17, 2021 3:53 am

skb wrote:Online scientific papers do not have a clear recommendation. Some predict poor prognosis. Some predict good prognosis.

It all depends on the metastatic qualities of your cancer, situation and prior treatment. 4 years is a positive aspect.

A solitary node, or even a single site, has statistical odds of curative surgical success if more metastases are not occurring and/or circulating. Basically, conventional chemo has a very limited range of control for cancer in the lymph nodes, with mostly eventual failure. So surgery, while potentially curative alone or in combination, is conventionally considered useless if there is metastatic circulation, or spread beyond one site.

In 2011, recognition of curative surgery for solitary or confined lymph nodes was a brand new thing. In 2010 I had realized this possible situation at the outset - she had what turned out to be a conglomerated, para-aortic lymph node cluster, eager to spread. So we kept my wife on the most active daily chemo we could conjure up for her cells for the first year after her first surgery, and thus, hopefully, no additional escape and mets. In 2011, I encouraged surgeons to consider that her lymph nodes were a controlled, single site (controlled but maybe not so single a met site) but most weren't very interested LN dissection. Finally, I turned one "no" to a "yes" with an ex-MDA thoracic surgeon, then went upscale hospital-wise, and got a better offer from another surgical team.

Her second surgery was not really curative but still great progress; the pathology showed the cancer filaments were bursting out of the lymph node walls as well as shot through the chain of lymph nodes. The surgeon was so alarmed that he was insisting on her restarting chemo 5 days after surgery (vs the usual 2-6 weeks).

Faster on the draw, we had gotten her chemo re-started after 1 day (we were willing to bend the rules, by more technical means). It still took us 7 years of chronomodulated, immunochemo to burn the rest out. Fortunately that personalized approach to chronomodulated, immunochemo allowed less wear and tear on the body (and wallet), with a more cidal action on her cancer cells.
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 to almost nothing mid 2018, mostly IV C

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Tue Aug 17, 2021 7:09 am

Thanks a lot for your detailed response rp1954
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

Dennyp
Posts: 19
Joined: Thu Oct 29, 2020 9:28 pm

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Wed Aug 18, 2021 7:04 am

I had a recurrence to a single common iliac lymph node. My initial tumor was in my sigmoid colon. I had surgery to remove May 2019. Followed by 6 months of FOLFOx. Ct scan picked up the lymph node tumor in June 2020, had 5 rounds of FOLFIRI. CT showed shrinkage of the tumor. I had surgery January 2021 to remove the lymph node. I have had 2 clear scans since my last surgery. There is very little data on recurrences like ours, the few cases I have read indicate a good outcome with surgery. My oncologist and surgeon described my surgery as curative, so the hope is chemo and surgery got it all. Keeping my fingers crossed! Good luck!
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Wed Aug 18, 2021 9:49 am

Thank you DennyP. It was such a welcome thing to see your message.

I hope both of us stay disease free and live longer.

Could you please share details of where you got your surgical treatment and if it was laparoscopic? How long was the recovery? What were the side effects of FOLFIRI?

skb
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

Dennyp
Posts: 19
Joined: Thu Oct 29, 2020 9:28 pm

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Wed Aug 18, 2021 1:44 pm

skb wrote:Thank you DennyP. It was such a welcome thing to see your message.

I hope both of us stay disease free and live longer.

Could you please share details of where you got your surgical treatment and if it was laparoscopic? How long was the recovery? What were the side effects of FOLFIRI?

skb


I was treated at MSK in NYC, I had open surgery. The recover was easier than the recovery from my first surgery. I had a complication during the second surgery that caused me to have to be in the hospital for 5 days. But overall it was easier than the first surgery.

I sailed through FOLFOX easily. FOLFIRI was a little more challenging for me, I had a rare side effect that caused me to feel as if my tongue was swollen although it was not, very strange. They extended the infusion time to one hour which took care of that side effect. However I felt dizzy and Like I was drunk while I was being infused, it was an unpleasant feeling. That side effect persisted for the duration of my treatment.

I’m sure we’ll be fine! Best of luck!
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Thu Aug 19, 2021 9:10 pm

stu wrote:Hi ,
I would start by trying to find out the best surgeons / radiologist within your area . Consult with them both and hear what they have to say then work out what options give you the best approach to removing it .
Your oncologist should be able to help identify them for you ! Then you are fully informed and part of the decision making process . It is also very informative and reassuring to hear what both are achieving in their fields !
take care ,
Stu

Thank you Stu for your advice. I will seek the help of people dear and near to me and get the help of best surgeon/radiologist
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Tue Aug 24, 2021 11:18 am

A biopsy confirmed metastasis to retroperitoneal obturator lymph node :(
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

Dennyp
Posts: 19
Joined: Thu Oct 29, 2020 9:28 pm

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Tue Aug 24, 2021 7:58 pm

skb wrote:A biopsy confirmed metastasis to retroperitoneal obturator lymph node :(



I am very sorry to hear that. Do you have a treatment plan yet?
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED

Sevilla2023
Posts: 4
Joined: Mon Nov 12, 2018 8:32 am
Location: Russia

Re: Solitary lymph node metastasis: treatment options

Postby Sevilla2023 » Wed Aug 25, 2021 7:41 am

Hello, I wish you to start a treatment as soon as possible. I'm following your story for some period because my mom has kind of the same situation but our oncologist do not ask to do a PET yet... CT only and it's clean for 2 times in a row.
I'm worrying so much about it but what makes me think it's not that bad that at least in our and your cases CEA has been rising for long period and met or whatever we have is not that aggressive..
What do your doctors say about this? How your lymph node is going to be treated?
Caregiver to mom 60 yo DX Sept 2018 T4aN2bM0
Rectal cancer, very low (1.4 cm) and advanced, recto-vaginal fistula
Well-differentiated, 4/18 lymph nodes, no mutations
3 Round of chemo, stopped due to fistula complications
Huge open surgery 29 Nov 2018, 2 month in hospital, permanent stoma, no chemo after surgery
CEA 2019-2020 <1, Jan 21 - 2.1, Mar 21 - 3.39, Jul 21 - 11.59
CT clean, waiting for new tests..

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Wed Aug 25, 2021 11:06 am

Thank you Denny and Sevilla for your kind messages. I am yet to hear from my oncologist on a treatment plan.

I am hoping for a curative plan rather than a palliative plan. I have heard that these pelvic lymph nodes are hard to operate upon. I hope my team finds some surgeon who is willing to perform the surgery.

I am spending a lot of time googling my survival chances. I get upset by seeing the statistics.

I truly appreciate the occasional replies in this thread. It gives me hope. Thank you.

skb
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis


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