Rise in CEA

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ecretriever6
Posts: 16
Joined: Fri Oct 22, 2021 5:48 pm

Re: Rise in CEA

Postby ecretriever6 » Tue Jul 26, 2022 8:12 pm

It grew 1-1.5 mm since April. Then it was very small, less than 1mm if I remember. MD Anderson is using a different CT scan, and a lot better of one than the previous oncologist. I don’t know if this better scan just picked it up better when comparing it to previous scan.
So sorry for any confusion. As previously stated, some spots have disappeared since first observed in October 2021.

I am just concerned that they could get anything in a biopsy if it is so small.
Wife: 47 at time of DX
Diagnosed: 05/20
Surgery: 06/20
Left Sigmoid
Lymph Nodes: 18/37
Chemo: 07/20 - 12/20 (12 rounds 5fu/oxi)
Clear CT: 12/20, 07/21 (CEA1.2)
CEA pre-surgery: 2
CEA post: 1.2 - 1.9
Stage: 3c
Colonoscopy: 05/21 - 1 polyp removed

ecretriever6
Posts: 16
Joined: Fri Oct 22, 2021 5:48 pm

Re: Rise in CEA

Postby ecretriever6 » Tue Jul 26, 2022 8:30 pm

I’m sorry if this is confusing. Just a little worried about this “spot” on the lung as the oncologist described. All other areas were clear in scan. I will try to be clearer. New to this and Al terms. Prayers to all
Wife: 47 at time of DX
Diagnosed: 05/20
Surgery: 06/20
Left Sigmoid
Lymph Nodes: 18/37
Chemo: 07/20 - 12/20 (12 rounds 5fu/oxi)
Clear CT: 12/20, 07/21 (CEA1.2)
CEA pre-surgery: 2
CEA post: 1.2 - 1.9
Stage: 3c
Colonoscopy: 05/21 - 1 polyp removed

skb
Posts: 96
Joined: Tue Mar 28, 2017 2:00 pm

Re: Rise in CEA

Postby skb » Wed Jul 27, 2022 11:30 am

ecretriever6 wrote:It grew 1-1.5 mm since April. Then it was very small, less than 1mm if I remember. MD Anderson is using a different CT scan, and a lot better of one than the previous oncologist. I don’t know if this better scan just picked it up better when comparing it to previous scan.
So sorry for any confusion. As previously stated, some spots have disappeared since first observed in October 2021.

I am just concerned that they could get anything in a biopsy if it is so small.


It depends on the location of the nodule in the lung. I had a 1cm wide nodule in my right lung (lower lobe) and it was biopsied at Mayo.
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation- Xeloda and daily radiation (25 doses)
6/28/17: clean biopsy, clean scans
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: adjuvant chemo with Folfox
8/19 VATS wedge on 1cm lung nodule
7/17/21- Clean CT, MRI, CEA 15.6 !
8/24/21- PET , biopsy finds metastasis along obturator lymph nodes
10/1/21- Surgery to remove metastasis , 12 rounds of FOLFIRI
4/15/22- Clean scan, normal CEA

roadrunner
Posts: 272
Joined: Sun Jan 12, 2020 8:46 pm

Re: Rise in CEA

Postby roadrunner » Wed Jul 27, 2022 11:55 am

ecretriever6:

I’m still not sure this picture is clear. It *sounds* like your wife had a 1mm (or so) nodule in April which grew “1-1.5mm” by July. Thus, it would now be 2-2.5mm.

There are several things that make me wonder there. First, MD Anderson is apparently contemplating a “biopsy”? That seems curious. If the above is accurate, this is so tiny it would be very hard to find. The procedure would almost certainly be a resection, but even that might be very challenging at this size. Also, while growth of a pulmonary nodule is generally concerning, the growth pattern above doesn’t suggest CRC metastasis. It’s likely too quick (maybe a 30-day doubling time could get you close, but that’s all at the margin). But that suggests more that the data is wrong rather than anything else. At that size, growth evaluations are really difficult, as different observers see different things, contrast/no contrast has a potential material effect, the quality of the scanner can affect results, etc. (You even noted that the most recent scan was done on a more accurate scanner.)

Also, it would seem premature to try to biopsy/resect at the apparent size involved here. If it is a met, it might be very important to have sufficient tissue to do testing. That seems unlikely at this size, at least beyond determination of whether it is in fact adenocarcinoma (which may or may not be possible). VATS surgery to remove it is generally pretty tolerable (depending on location), but it is not something I would do unless I felt strongly that a nodule was a met. At this (apparent) size, very few are, even in a CRC patient.

What I would suggest is an outreach to your wife’s team to understand and discuss the precise history of this nodule (including sizes, types of scans, and timetable), implications thereof, and a specific recommendation on how to proceed.
7/19: Rectal cancer: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Thoracic CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign

roadrunner
Posts: 272
Joined: Sun Jan 12, 2020 8:46 pm

Re: Rise in CEA

Postby roadrunner » Wed Jul 27, 2022 3:23 pm

Should’ve added, this would be a “skip met,” because your wife didn’t have liver disease first. That is much more common in rectal cancer than colon cancer, the latter of which your wife had. It’s not impossible, but pretty uncommon in that context. Just another factor to consider.
7/19: Rectal cancer: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Thoracic CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign

ecretriever6
Posts: 16
Joined: Fri Oct 22, 2021 5:48 pm

Re: Rise in CEA

Postby ecretriever6 » Wed Jul 27, 2022 3:54 pm

Thank you so much for the info and your thoughts. Yes we were concerned that since it is small that a good sample may not be obtained. I really appreciate your information and understanding. Thank you again!
Prayers to all continue
Wife: 47 at time of DX
Diagnosed: 05/20
Surgery: 06/20
Left Sigmoid
Lymph Nodes: 18/37
Chemo: 07/20 - 12/20 (12 rounds 5fu/oxi)
Clear CT: 12/20, 07/21 (CEA1.2)
CEA pre-surgery: 2
CEA post: 1.2 - 1.9
Stage: 3c
Colonoscopy: 05/21 - 1 polyp removed

skb
Posts: 96
Joined: Tue Mar 28, 2017 2:00 pm

Re: Rise in CEA

Postby skb » Wed Jul 27, 2022 11:02 pm

CRC mets to lungs without any metastasis to liver are not uncommon. This usually happens when the primary tumor is in the rectum, not colon. There are several. people in this forum who had lung met and no liver met. I am an example. So is the user Atoq

I think it is important to verify whether your spot is actually few mm in size or few cm in size.
Nodules less than 1cm (as it appears to be your case, you are talking in mm) are rarely a cause for concern.

When my lung met was removed, it was only 1.2 cm in diameter. Such nodules are usually removed. It was growing over time.

People like me are laymen. We are not doctors. We are patients. Follow the advice of your oncologist. And if possible, get a second opinion from another doctor
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation- Xeloda and daily radiation (25 doses)
6/28/17: clean biopsy, clean scans
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: adjuvant chemo with Folfox
8/19 VATS wedge on 1cm lung nodule
7/17/21- Clean CT, MRI, CEA 15.6 !
8/24/21- PET , biopsy finds metastasis along obturator lymph nodes
10/1/21- Surgery to remove metastasis , 12 rounds of FOLFIRI
4/15/22- Clean scan, normal CEA

Luna18
Posts: 9
Joined: Mon Aug 01, 2022 12:22 pm
Facebook Username: piglesias

Re: Rise in CEA

Postby Luna18 » Tue Aug 02, 2022 9:26 am

Hello,
I am new in the forum, and my sister is dealing with the same situation. I am wondering how is your wife's CEA reading right now? I remember you said it went down to 5 a month ago.
Best wishes,
Sister DX July 2017 age 44
T4N2M1 G2/G3
MSS
July 2017- Colonoscopy and primary tumor resection
Aug 2017 Chemo started - Folfox
Nov 2017- Liver resection
March 2017- Chemo ended
November 2018- Recurrence in liver- Liver resection- No chemo
Aug 2019- Recurrence in liver and lungs
Sep 2019- Chemo started- Folfiri +Avastin
Dec 2019 PET showed no activity- fully response to chemo
March 2020 PET showed no activity
2021 NED
2022 May NED


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