is this odd ?

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MadMed
Posts: 79
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

is this odd ?

Postby MadMed » Thu Dec 16, 2021 12:36 pm

I had a chest + Pelvis CT this morning. While there was no evidence of metastatic disease (awesome!) There was no mention of the organ itself. No mention of the rectum at all.
Why the hell not ? Presumably this was a restaging. Did that happen to anybody ?
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
surgery postponed until after 2/23 sigmoidoscopy

Nor Cal
Posts: 49
Joined: Sun Dec 06, 2020 8:18 pm

Re: is this odd ?

Postby Nor Cal » Thu Dec 16, 2021 2:12 pm

The area of my primary tumor hasn't been mentioned on the last three scans at least. Nothing to see or report.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. BRAF mutation. CEA 39.5
July 2020 - January 2022: 25 cycles chemo (FOLFOXIRI x9, FOLFIRI x12, 5-FU x4) + Avastin (discontinued Nov 2021)
January 2022 - Present: Xeloda
December 2020 - February 2021 Radioembolization, Chemoembolization x2

MadMed
Posts: 79
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: is this odd ?

Postby MadMed » Thu Dec 16, 2021 3:22 pm

Thank you, that’s reassuring.
Best wishes.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
surgery postponed until after 2/23 sigmoidoscopy

JJH
Posts: 352
Joined: Mon Apr 24, 2017 7:26 am

Re: is this odd ?

Postby JJH » Fri Dec 17, 2021 12:37 pm

MadMed wrote:I had a chest + Pelvis CT this morning. While there was no evidence of metastatic disease (awesome!) There was no mention of the organ itself. No mention of the rectum at all.
Why the hell not ? Presumably this was a restaging. Did that happen to anybody ?

No, I don't think this is odd at all. It probably happened that way because the prescribing doctor did not check the check-box for "Treatment Monitoring" or for "Radiation Therapy Treatment Monitoring", or he did not mention this in the box required for describing the purpose of the CT exam.

I think that all CT request forms have a place at the top of the form for the prescribing doctor to specify the purpose of the exam. In some cases, the doctor may even be required to specify the precise ICD-9 code or the precise CPT code for the specific type of exam requested.

It should also be noted that a pelvic CT scan can also show images of the bladder, prostate, ovaries, etc., but if these organs are not listed specifically in the purpose of the exam, then the radiologist has no obligation to comment on them.

Image
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

MadMed
Posts: 79
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: is this odd ?

Postby MadMed » Fri Dec 17, 2021 2:22 pm

I see! thank you for the detailed reply. I’ll ask, maybe they can take another look. Since this is the first after radiation, I’d like to have an idea.
We’ll, I was starting to think they were hiding bad news from the website.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
surgery postponed until after 2/23 sigmoidoscopy

Rock_Robster
Posts: 620
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: is this odd ?

Postby Rock_Robster » Fri Dec 17, 2021 7:41 pm

All good responses above. The only other comment I’d make is that CT is not a particularly good modality for imaging the rectum itself - generally the most that might be visible in the case of recurrent local disease could be a bit of wall-thickening (which can be quite nonspecific, particularly at the anastomosis site after surgery). So it’s very likely there was nothing of note to report in the rectum (which some radiologists will still mention, others don’t).

So if this was truly a “restaging” process then you might expect either a PET-CT or MRI be included to stage the rectum properly. In my experience however, checking on the rectum has been done through a combination of PET and annual colonoscopies.

Also… while there’s no reason you couldn’t do a Chest+Pelvis CT, my experience is they’re usually Chest+Abdo+Pelvis (CAP), to include the liver, abdominal nodes, etc (not to mention that the abdomen is in the middle of the scan anyway!).

Cheers,
Rob
39M Australia
2018 Dx RC, 12cm from AV
Mod diff, EMVI+, LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then 2.0-3.1. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection #1
5/19 25x pelvic IMRT radiation
07/19 ULAR w ileo, 1/27 LN+
08/19 Liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileo reversed
03/20 NED since Dec ‘19
11/21 35mm liver lesion; celiac LN. Some v. small (<2-3mm) lung things
12/21 PVE
1/22 Planned liver & node resection (TBC)

JJH
Posts: 352
Joined: Mon Apr 24, 2017 7:26 am

Re: is this odd ?

Postby JJH » Sat Dec 18, 2021 1:34 am

In June 2021, MadMed wrote:... If all goes well, i'll know in september/october what my surgery options are...

So, do you know what your options are going to be for your upcoming January 2022 surgery?
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

MadMed
Posts: 79
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: is this odd ?

Postby MadMed » Sat Dec 18, 2021 11:10 am

Rock_Robster wrote:All good responses above. The only other comment I’d make is that CT is not a particularly good modality for imaging the rectum itself - generally the most that might be visible in the case of recurrent local disease could be a bit of wall-thickening (which can be quite nonspecific, particularly at the anastomosis site after surgery). So it’s very likely there was nothing of note to report in the rectum (which some radiologists will still mention, others don’t).

So if this was truly a “restaging” process then you might expect either a PET-CT or MRI be included to stage the rectum properly. In my experience however, checking on the rectum has been done through a combination of PET and annual colonoscopies.

Also… while there’s no reason you couldn’t do a Chest+Pelvis CT, my experience is they’re usually Chest+Abdo+Pelvis (CAP), to include the liver, abdominal nodes, etc (not to mention that the abdomen is in the middle of the scan anyway!).

Cheers,
Rob


You're right Rob, i went back to the DX CT and it was a lot more fuzzy than the MRI. I will have an MRI in a few weeks, i guess that'll be the key one since it will be for planning the surgery.
indeed it was a chest+abdo+pelvis. liver has a cyst, lungs clear so far it was just the pelvis that was very light in the report, just mentioned unremarkable bladder.
Thanks.
Last edited by MadMed on Sat Dec 18, 2021 11:16 am, edited 1 time in total.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
surgery postponed until after 2/23 sigmoidoscopy

MadMed
Posts: 79
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: is this odd ?

Postby MadMed » Sat Dec 18, 2021 11:14 am

JJH wrote:
In June 2021, MadMed wrote:... If all goes well, i'll know in september/october what my surgery options are...

So, do you know what your options are going to be for your upcoming January 2022 surgery?


It's wide open right now, I have an upcoming MRI and sigmoidoscopy that should help clear some things up. The current plan is TME, but the surgeon was very clear that it could be a pelvic exenteration if the prostate is involved. The tumor was very close to the prostate and initially there was only a layer of fat separating them. From the beginning the surgeon was concerned about that, CT and particularly MRIs have repeatedly shown no involvement of the prostate but he wants to see it when he cuts in.
W&W is a remote possibility, i highly doubt it's in the cards for me.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
surgery postponed until after 2/23 sigmoidoscopy

Claudine
Posts: 582
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: is this odd ?

Postby Claudine » Sat Dec 18, 2021 4:58 pm

The only other comment I’d make is that CT is not a particularly good modality for imaging the rectum itself


I had no idea. This makes me even more glad that DH finally had a PET scan instead of the standard CT! If they’d stuck with that procedure, I wonder if it would have been yet another « nothing to report, stable scan » with abnormally high CEA, once more - they may have missed the rectum thickening. As much as it would have been music to our ears, cancer isn’t a disease where you bury your head in the sand. The sooner you track down recurrences, the better!
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT 04/18, SBRT 02/19
Resect small intestine 05/18 (no cancer - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin 03/19 to 01/20
6.7 cm left adrenal mass 03/19, successful resection 02/20
CEA since 03/19: high 81.1, low 3.2, now 51
Scan 03/19: Multiple small lung nodules, now gone/calcified
L3-L4-L5 fusion surgery and partial corpectomy 05/20
PET 12/17/2021: uptake in upper rectum, colonoscopy next

JJH
Posts: 352
Joined: Mon Apr 24, 2017 7:26 am

Re: is this odd ?

Postby JJH » Mon Dec 20, 2021 1:00 am

MadMed wrote:... I have an upcoming MRI and sigmoidoscopy that should help clear some things up...

Have you had an MRI before? If not, you might want to look at some of the MRI prep guides available on the Internet, for example:

http://www.mrisafety.com/images/PreScrnF.pdf

For the MRI, it will be important to follow the instructions closely so that the resulting images are not blurred. The surgeon will need to have clear MRI images for surgery planning purposes.
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

MadMed
Posts: 79
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: is this odd ?

Postby MadMed » Mon Dec 20, 2021 10:16 am

Thanks for the link JJH, the next MRI will be my third. The biggest thing i took away from the previous ones is that I'll need to take an Ativan before :)
MRIs take a while and can be overwhelming if you're claustrophobic.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
surgery postponed until after 2/23 sigmoidoscopy


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