The Colon Club

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.

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.

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.

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

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

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,

So not so good news update. Biopsy shows 11mm lung nodule was positive. Doing a final check to see what type of treatment, therapeutic Or chemo. Most likely chemo and for live every 2 weeks. Onc is wanting to prevent anything from spreading. Other spots on lung are extremely small so Onc is not too concerned with these. Other than this, wife feels great. Any words of advice or experience are always welcomed. As always, prayers continue for all.

I'm sorry to hear about the biopsy being positive for cancer, ecretriever6. It's nice to hear that your wife feels great, though. My husband had multiple small lung mets, for which he did Folfiri + Avastin (he also had a large adrenal met so the goal was to reduce its size as well, prior to surgery). His lungs have been fine since (I'm losing track of time, we are nearing on 3 years now I think?); some small "specks" but they seem unchanged from scan to scan. Compared with his first line of chemo (Oxaliplatin/Xeloda), this was a lot easier to handle (his hair did thina lot, and he had to take blood pressure medication, but that all returned to normal once treatment was over).
What therapeutic treatments are being considered? This wasn't an option for us, since there were so many small mets.

Best of luck to you and your wife,

Claudine

I don’t know the name of the therapeutics but Onc is pretty sure it would be chemo. If I recall, little distracted at the time, it would be through her port and come home with the pump. Also not getting whatever caused the neuropathy like the first round when she had the oxy and 5fu. It is encouraging to hear that the side effects were a little easier. Thank you so much

ecretriever6 wrote:So not so good news update. Biopsy shows 11mm lung nodule was positive. Doing a final check to see what type of treatment, therapeutic Or chemo. Most likely chemo and for live every 2 weeks. Onc is wanting to prevent anything from spreading. Other spots on lung are extremely small so Onc is not too concerned with these. Other than this, wife feels great. Any words of advice or experience are always welcomed. As always, prayers continue for all.

Sorry to hear about your wife's recurrence. My sister had a recurrence a couple a years ago in her liver, with some lung spots. She had an excellent response to Folfori+Avastin. She has been NED for almost two years, but we are now worried about some lungs spots with slightly elevated CEA. She had a PET a few weeks ago and since the spots are small (larger 6 mm) did not light up. Onc is not too worried and wants to wait and repeat the scan in a few weeks. I am wondering what is your wife CEA number right now? The original topic of the post was related to her elevated CEA.
God luck with everything.
Best wishes,

Honestly she didn’t ask for it. Hers was never a good result anyway. Sorry for the lack of info. No symptoms at all. Just saw the spots on routine ct scan.

So after doublechecking, last CEA was 13. Thank you for the information.

Was the metastasis removed?

ecretriever6 wrote:So after doublechecking, last CEA was 13. Thank you for the information.

Thank you very much for the information. I wish the best for your wife on treating this lung nodule. My sister had folfiri+Avastin before with very good results. She tolerated well the sides effects, the only thing is that her hair fell out a lot (almost completely). I know this may be different for other people.
Best wishes,