Solitary lymph node metastasis: treatment options

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

Re: Solitary lymph node metastasis: treatment options

Postby skb » Wed Aug 25, 2021 12:27 pm

Sevilla2023 wrote: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?


Sevilla2023,
Before the PET and biopsy confirmed cancer, I was thinking that the rising CEA could be something triggered by Covid vaccine or it could be because of lab test assay getting old and recording erroneous values. I was wrong. Did your mother get a Covid vaccine early this year? Was there some other infection or sickness? All those could raise CEA.
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

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 1:10 pm

skb wrote:Sevilla2023,
Before the PET and biopsy confirmed cancer, I was thinking that the rising CEA could be something triggered by Covid vaccine or it could be because of lab test assay getting old and recording erroneous values. I was wrong. Did your mother get a Covid vaccine early this year? Was there some other infection or sickness? All those could raise CEA.


The problem is that this is not one-time spike, CEA has been rising since January and until now. And while CT is clear, our oncologist is also trying to find some explanations, for example she saw some small things in lungs CT and made an assumption that my mom had COVID pneumonia and that's the reason of high CEA. But still CEA is rising and the real reason not found.
Also my mom's glucose level started to rise at a time CEA started to rise also, I found some info about diabetes influence on CEA but it's not very common and she has not that high values... So I'm preparing myself for the worst while hoping for the best.

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


Sorry to hear that. I don't know much info about lymph node mets, seems like it's a rare case. So what statistics says?
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..

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 1:22 pm

skb ,
I saw your direct message but as I'm a new user I'm not allowed to send private messages yet.
Anyway I'll answer here that we are from Russia and had a treatment in Moscow. We have one of the best colorectal surgeon and oncologist in our country so I rely on them so much but still didn't get why they hadn't requested to do a PET in such a situation
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..

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

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Wed Aug 25, 2021 10:03 pm

skb wrote: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


I wouldn’t put too much stock in survival rates for this situation as it is so rare there isn’t great data. The isolated case studies show a good survival rate with surgery and chemo. Stay positive and 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 » Sun Aug 29, 2021 1:39 am

Sorry to hear that. I don't know much info about lymph node mets, seems like it's a rare case. So what statistics says?


Hi Sevilla,

Good to know that your mother is getting care from some of the best doctors in your country. She is very fortunate in that regard.
I wanted to point out that in some very rare situations, rising CEA is difficult to explain. The paper listed below was published this year from the Netherlands. A patient's CEA has been rising for a year and the doctors dont know the cause yet.

https://www.sciencerepository.org/a-rem ... 2020-1-104

There is another forum https://csn.cancer.org/ where I have found couple of people whose CEA has risen for a long time with no evidence of disease.
One such person has the id, zx10guy

Regarding my specific situation (metachronous isolated retroperitoneal lymph node metastasis), there is not a lot of data available. This is because such metastasis is very rare and studies regarding that are probably not helpful for a lot of people and are therefore not funded.

The following paper provided some poor statistics that has been bothering me.
https://www.annalsofoncology.org/article/S0923-7534(19)30783-5/fulltext#relatedArticles


This paper also did not have a great survival story-
https://onlinelibrary.wiley.com/doi/10. ... 09.01821.x

There are some anecdotal stories. Some are good, some bad.

In this story from Japan, a man has survived for long after the metastatic lymph node surgery.
https://surgicalcasereports.springerope ... 016-0177-y

In this other story, lung metastasis developed at the same time and the patient's disease became systemic.
https://www.sciencedirect.com/science/a ... 1221007057

I have heard that cancer is personal and different for everyone and we should not be discouraged by poor statistics.
Last edited by skb on Sun Aug 29, 2021 10:47 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

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

Re: Solitary lymph node metastasis: treatment options

Postby skb » Sun Aug 29, 2021 1:42 am

I wouldn’t put too much stock in survival rates for this situation as it is so rare there isn’t great data. The isolated case studies show a good survival rate with surgery and chemo. Stay positive and good luck!


Thank you DennyP

Would you remember how big was your lymph node when it was surgically removed? Was only one node removed?
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 » Sun Aug 29, 2021 10:26 am

skb wrote:
I wouldn’t put too much stock in survival rates for this situation as it is so rare there isn’t great data. The isolated case studies show a good survival rate with surgery and chemo. Stay positive and good luck!


Thank you DennyP

Would you remember how big was your lymph node when it was surgically removed? Was only one node removed?



It was 2.3 x 1.5 cm at diagnosis 1.7 x 1.2 after chemo, before surgery, I had3 lymph nodes removed, the other 2 were negative. Both my surgeon and oncologist are optimistic about survival, so I’m going with that!
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

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

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Sun Aug 29, 2021 10:44 am

skb wrote:
Sorry to hear that. I don't know much info about lymph node mets, seems like it's a rare case. So what statistics says?


Hi Sevilla,

Good to know that your mother is getting care from some of the best doctors in your country. She is very fortunate in that regard.
I wanted to point out that in some very rare situations, rising CEA is difficult to explain. The paper listed below was published this year from the Netherlands. A patient's CEA has been rising for a year and the doctors dont know the cause yet.

https://www.sciencerepository.org/a-rem ... 2020-1-104

There is another forum https://csn.cancer.org/ where I have found couple of people whose CEA has risen for a long time with no evidence of disease.
One such person has the id, zx10guy

Regarding my specific situation (metachronous isolated retroperitoneal lymph node metastasis), there is not a lot of data available. This is because such metastasis is very rare and studies regarding that are probably not helpful for a lot of people and are therefore not funded.

The following paper provided some poor statistics that has been bothering me.
https://www.annalsofoncology.org/article/S0923-7534(19)30783-5/fulltext#relatedArticles

This paper also did not have a great survival story-
https://onlinelibrary.wiley.com/doi/10. ... 09.01821.x

There are some anecdotal stories. Some are good, some bad.

In this story from Japan, a man has survived for long after the metastatic lymph node surgery.
https://surgicalcasereports.springerope ... 016-0177-y

In this other story, lung metastasis developed at the same time and the patient's disease became systemic.
https://www.sciencedirect.com/science/a ... 1221007057

I have heard that cancer is personal and different for everyone and we should not be discouraged by poor statistics.


The link for the study with poor statistics didn’t work. I didn’t read the other studies as particularly bad. I don’t think the study with the lung recurrence applies to us since that situation is significantly different than our situation. The Japanese case study is one I have seen and seems most analogous to us.
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

catstaff
Posts: 138
Joined: Wed Mar 03, 2021 11:37 am

Re: Solitary lymph node metastasis: treatment options

Postby catstaff » Sun Aug 29, 2021 12:21 pm

I have mixed feelings about the requirements for internal physician notes to be accessible to patients. On the one hand, it may reduce misunderstandings. On the other hand, the technical jargon is not always easy to understand and the patient may become confused or discouraged.

Any treatment not "curative" is "palliative" pretty much by definition, of course. And we also have too many examples of "curative" treatment that isn't. So that terminology shouldn't be as intimidating as it seems, but of course it is.

My husband is (so far) among the "Olymphians" with lymph-only spread. You are fortunate it was only one node, since he's had several now plus a bone met. (We don't know whether one of the nodules on the PET is a lymph node or a local recurrence, it wasn't obvious radiographically.) With only one metachronous met it seems likely it can be treated. Surgery or radiation, whatever they offer. Then just make sure they watch carefully going foward since once it's in the lymph system, recurrence is a risk.
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
O Stoma Mia
Posts: 1654
Joined: Sat Jun 22, 2013 6:29 am

Re: Solitary lymph node metastasis: treatment options

Postby O Stoma Mia » Sun Aug 29, 2021 12:50 pm

Dennyp wrote:...The link for the study with poor statistics didn’t work.

Here is a better link:
The following paper provided some poor statistics that has been bothering me.
https://www.annalsofoncology.org/article/S0923-7534(19)30783-5/fulltext#relatedArticles

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

Re: Solitary lymph node metastasis: treatment options

Postby skb » Sun Aug 29, 2021 10:34 pm

It was 2.3 x 1.5 cm at diagnosis 1.7 x 1.2 after chemo, before surgery, I had3 lymph nodes removed, the other 2 were negative. Both my surgeon and oncologist are optimistic about survival, so I’m going with that!


Thanks a lot for your response DennyP
I admire your positive attitude.
Your responses help me reduce my anxiety.
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

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

Re: Solitary lymph node metastasis: treatment options

Postby Sevilla2023 » Mon Aug 30, 2021 1:31 pm

skb wrote:Hi Sevilla,

Good to know that your mother is getting care from some of the best doctors in your country. She is very fortunate in that regard.
I wanted to point out that in some very rare situations, rising CEA is difficult to explain. The paper listed below was published this year from the Netherlands. A patient's CEA has been rising for a year and the doctors dont know the cause yet.

https://www.sciencerepository.org/a-rem ... 2020-1-104

There is another forum https://csn.cancer.org/ where I have found couple of people whose CEA has risen for a long time with no evidence of disease.
One such person has the id, zx10guy

Regarding my specific situation (metachronous isolated retroperitoneal lymph node metastasis), there is not a lot of data available. This is because such metastasis is very rare and studies regarding that are probably not helpful for a lot of people and are therefore not funded.

The following paper provided some poor statistics that has been bothering me.
https://www.annalsofoncology.org/article/S0923-7534(19)30783-5/fulltext#relatedArticles


This paper also did not have a great survival story-
https://onlinelibrary.wiley.com/doi/10. ... 09.01821.x

There are some anecdotal stories. Some are good, some bad.

In this story from Japan, a man has survived for long after the metastatic lymph node surgery.
https://surgicalcasereports.springerope ... 016-0177-y

In this other story, lung metastasis developed at the same time and the patient's disease became systemic.
https://www.sciencedirect.com/science/a ... 1221007057

I have heard that cancer is personal and different for everyone and we should not be discouraged by poor statistics.


Hi skb, thank you so much for provided info! Regarding to my mom's case I thought I've read all of false positive CEA rises stories in the Internet but you gave me some new info! That helps a bit. But still all these stories are unique and you know.. until PET is not done I just can't be relaxed.

As for these links related to your LN met, they not seemed to me that bad. In that very first article most of the patients had other mets which affected prognosis, however you obviously have all the factors to cure it entirely. I believe it will be so. Please keep us updated!
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 » Tue Aug 31, 2021 9:20 am

I met with my oncologist yesterday and he asked about my openness to strong chemo (FOLFOXIRI) for about three months and follow up with maintenance chemo. I responded that I am open to everything.

He believes that the chemo can kill cancer cells in the lymph node and will provide systemic therapy. He was not an advocate for surgery. He said that removing the lymph node is an extensive surgery with potential complications, you might feel better if you remove it but it does not guarantee that cancer does not come back. If we go for surgery, he would like me to do surgery first , recover from it and then do the chemo. He also talked about potentially adding few doses of radiation to the area but was not sure of someone would be willing to do that for me.
I am being referred to a surgeon to see what options I have. And also a radiologist.

I would like the treatment to start as soon as possible but the oncologist says I have time and I should meet with surgeon and come up with treatment plan. Overall I am uneasy and anxious
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

catstaff
Posts: 138
Joined: Wed Mar 03, 2021 11:37 am

Re: Solitary lymph node metastasis: treatment options

Postby catstaff » Tue Aug 31, 2021 9:46 am

Yeah, we were told they only do surgery on lymph nodes if it's a particular node that is "causing a problem." It's a more difficult surgery than one might think.

But why not SBRT? Is this node in a previous radiation field or is the intestine at risk? Radiation was very effective on my DH's retroperitoneal nodes at diagnosis.

But chemo may be very effective as well, and I would agree that there's a substantial chance of other lymph node involvement at some point.
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-

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

Re: Solitary lymph node metastasis: treatment options

Postby skb » Tue Aug 31, 2021 10:17 am

Hi catstaff, this node is not in a previous radiation field or near intestine. My oncologist did not bring up SBRT but I will ask about it when I meet the 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


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