Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

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Ron-guteleute
Posts: 11
Joined: Thu Oct 06, 2022 1:37 pm

Re: Special procedures for dealing with mCRC mets to the peritoneum

Postby Ron-guteleute » Fri Oct 28, 2022 1:07 pm

Peregrine wrote:Ron -

In case the malignant pelvic ascites actually become peritoneal mets, here are some references to procedures for dealing with peritoneal mets:

Special procedures for dealing with mCRC mets to the peritoneum



Many thanks Peregrine, both HIPEC and CRS are quite major surgeries, both are performed on carefully selected patients, HIPEC itself take 30 days of hospitalization and it is quite hard to recover. While PIPAC sounds like a good option as it looks very safe and well tolerated surgery+chemo.
Age: 63 M,
KRAS/NRAS wt
11/19: Dx gastric cancer, Lap Subtotal Gastrectomy + D2
12/19: Adenocarcinoma G3, T3N0Mx, 0/12 LN
01/20 - 05/20: CAPOX (6 rounds)
05/20 - 06/2022: 2.5 yeas NED
07/24/22: PET all clear, CEA 1.8 + min ascites
09/20/22: CT scan, 8cm mass in cecum+ ascites ,no peri mets visible, CEA 1.7
09/27/22: Extended Right Hemicolectomy,
10/19/22: Signet Ring Cell Carcinoma G3 of colon, T4N3Mx 6/11 LN, malignant ascites
11/29/22: FOLFOX+Cetuximab

Ron-guteleute
Posts: 11
Joined: Thu Oct 06, 2022 1:37 pm

Re: Removal of ileocecal valve ?

Postby Ron-guteleute » Fri Oct 28, 2022 1:10 pm

Another question: Did they remove the ileocecal valve when they did the extended right hemicolectomy? If so, other digestive problems are likely to emerge and require specialized treatments.

Permanent SIBO due to removal of ileocecal valve
https://connect.mayoclinic.org/discussion/permanent-sibo-due-to-removal-of-ileocecal-valve/


The tumor was also infiltrating some part of the ileocecal valve, so it had to be removed. SIBO is something that I was not aware about, thank you for referencing it, much appreciated!
Age: 63 M,
KRAS/NRAS wt
11/19: Dx gastric cancer, Lap Subtotal Gastrectomy + D2
12/19: Adenocarcinoma G3, T3N0Mx, 0/12 LN
01/20 - 05/20: CAPOX (6 rounds)
05/20 - 06/2022: 2.5 yeas NED
07/24/22: PET all clear, CEA 1.8 + min ascites
09/20/22: CT scan, 8cm mass in cecum+ ascites ,no peri mets visible, CEA 1.7
09/27/22: Extended Right Hemicolectomy,
10/19/22: Signet Ring Cell Carcinoma G3 of colon, T4N3Mx 6/11 LN, malignant ascites
11/29/22: FOLFOX+Cetuximab

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Peregrine
Posts: 131
Joined: Tue Mar 01, 2022 1:18 am

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Peregrine » Sat Oct 29, 2022 12:46 pm

ron-guteleute wrote: ... I have asked for a 2nd opinion in one the top 10 Hospitals, Comprehensive Cancer Center (CCC) which is NCI alike. Hopefully I'll get an appointment next week. I'll also ask on another CCC well known University Hospital a week or two weeks later...

Ron -

It's good that you're getting some second opinions from Comprehensive Cancer Centers. Hopefully you will get some good information that will help specify the best way forward.

Please let us know what you find out.

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Peregrine
Posts: 131
Joined: Tue Mar 01, 2022 1:18 am

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Peregrine » Mon Oct 31, 2022 10:48 pm

Ron-guteleute wrote:
5. Is your mother available to give your father some emotional support?

My mother is a born optimist.

Ron -
It's great to hear that your mother has such a positive attitude. As you might imagine, it's very important for caregivers to reduce their own stress in these uncertain times.

Here are some additional tips on how to minimize caregiver stress as you continue giving support and helping in whatever ways you can:


Ron-guteleute
Posts: 11
Joined: Thu Oct 06, 2022 1:37 pm

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Ron-guteleute » Mon Nov 14, 2022 3:15 pm

Thank you so much Peregrine!
Age: 63 M,
KRAS/NRAS wt
11/19: Dx gastric cancer, Lap Subtotal Gastrectomy + D2
12/19: Adenocarcinoma G3, T3N0Mx, 0/12 LN
01/20 - 05/20: CAPOX (6 rounds)
05/20 - 06/2022: 2.5 yeas NED
07/24/22: PET all clear, CEA 1.8 + min ascites
09/20/22: CT scan, 8cm mass in cecum+ ascites ,no peri mets visible, CEA 1.7
09/27/22: Extended Right Hemicolectomy,
10/19/22: Signet Ring Cell Carcinoma G3 of colon, T4N3Mx 6/11 LN, malignant ascites
11/29/22: FOLFOX+Cetuximab

Ron-guteleute
Posts: 11
Joined: Thu Oct 06, 2022 1:37 pm

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Ron-guteleute » Mon Nov 14, 2022 3:37 pm

Ron -

It's good that you're getting some second opinions from Comprehensive Cancer Centers. Hopefully you will get some good information that will help specify the best way forward.

Please let us know what you find out.


I've got some feedback from the Tumor Board (after reviewing all the docs, CT and PET-CT): Because of malignant ascites, they recommend to do the biomarkers tests (MSI, RAS, BRAF..) and an additive chemotherapy taking into account the molecular examination. Restaging should be carried out after 2 months and to be re-presented to the Tumor Board for the evaluation of a relaparotomy with HIPEC. In case of a second metachronous adenocarcinoma is found, then Human Genetic testing are also recommended.

The other University Hospital, said that they would need the patient to meet the tumor board in order to give a recommendation, so I asked the front office just to contact the oncologist for a second opinion about the therapy. Non-officially the oncologist confirmed that at this time they would also do the same FOLFOX+Cetuximab.

I believe we will receive the KRAS results this week, and we have also order a full panel of biomarkers (NRAS, MSI, TMB MMR, NTRK1/2, PD-L1, around 400 genes).
Last edited by Ron-guteleute on Mon Nov 14, 2022 3:43 pm, edited 1 time in total.
Age: 63 M,
KRAS/NRAS wt
11/19: Dx gastric cancer, Lap Subtotal Gastrectomy + D2
12/19: Adenocarcinoma G3, T3N0Mx, 0/12 LN
01/20 - 05/20: CAPOX (6 rounds)
05/20 - 06/2022: 2.5 yeas NED
07/24/22: PET all clear, CEA 1.8 + min ascites
09/20/22: CT scan, 8cm mass in cecum+ ascites ,no peri mets visible, CEA 1.7
09/27/22: Extended Right Hemicolectomy,
10/19/22: Signet Ring Cell Carcinoma G3 of colon, T4N3Mx 6/11 LN, malignant ascites
11/29/22: FOLFOX+Cetuximab

Ron-guteleute
Posts: 11
Joined: Thu Oct 06, 2022 1:37 pm

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Ron-guteleute » Mon Nov 14, 2022 3:41 pm

Unfortunately, placing a port-a-cath was not possible because my dad's blood INR was pretty high (1.61) and he could be at high risk of hematomas. His oncologist was not sure about using a PICC line or Midline, therefore the oncologist decided to go for CAPOX/XELOX. She said both FOLFOX and CAPOX have the same efficacy.
Age: 63 M,
KRAS/NRAS wt
11/19: Dx gastric cancer, Lap Subtotal Gastrectomy + D2
12/19: Adenocarcinoma G3, T3N0Mx, 0/12 LN
01/20 - 05/20: CAPOX (6 rounds)
05/20 - 06/2022: 2.5 yeas NED
07/24/22: PET all clear, CEA 1.8 + min ascites
09/20/22: CT scan, 8cm mass in cecum+ ascites ,no peri mets visible, CEA 1.7
09/27/22: Extended Right Hemicolectomy,
10/19/22: Signet Ring Cell Carcinoma G3 of colon, T4N3Mx 6/11 LN, malignant ascites
11/29/22: FOLFOX+Cetuximab

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Peregrine
Posts: 131
Joined: Tue Mar 01, 2022 1:18 am

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Peregrine » Tue Nov 15, 2022 1:38 pm

Ron-guteleute wrote:Unfortunately, placing a port-a-cath was not possible because my dad's blood INR was pretty high (1.61) and he could be at high risk of hematomas. His oncologist was not sure about using a PICC line or Midline, therefore the oncologist decided to go for CAPOX/XELOX. She said both FOLFOX and CAPOX have the same efficacy.

Ron -

Thanks for the update. If your dad will be starting on a CAPOX/XELOX regimen in the near future, then he will have to pay attention to the likely side effects and do whatever he can in advance to avoid or minimize these effects. I think the main problems would probably be peripheral neuropathy from the oxaliplatin, and hand-foot syndrome (HFS) from the Xeloda -- but there are many other side effects that need to be monitored, too.

When is he due to start this regimen?

Tips on minimizing XELOX (CAPEOX) Side Effects
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=59287&p=469490#p469490

Management of Xeloda (capecitabine) side effects
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=66205&p=512933#p512933

Hand-Foot Syndrome (HFS) under Xeloda
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60725&p=480859#p480859

Mouth sore treatments while on chemo
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=50402&p=386196#p386196

Oxaliplatin and Capecitabine (XELOX)
https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/oxaliplatin-capecitabine

Ron-guteleute
Posts: 11
Joined: Thu Oct 06, 2022 1:37 pm

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Ron-guteleute » Wed Nov 23, 2022 12:16 pm

Thank you Peregrine.

My dad had the portacath placed yesterday, and he will start on Tuesday FOLFOX+Cetuximab, (biomarkers resulted KRAS/NRAS wild type, a full panel of biomarkers is still in process).

In light of current events, the Monday's ultrasound revealed bladder wall thickening. The urologists suggested a rigid cystoscopy for taking biopsy samples from the bladder, which is done under general anesthesia and 24 hours hospitalisation, it might also cause some hematoma for several days. Considering that he will start chemo pretty soon, I'm not sure if the timing is right, also it will take 2 weeks for the biopsy results.

Assuming that it's a tumor, I am not sure which is the right course of action, starting chemo and checking its progress or delaying chemo in favor of surgery (which may increase the risk of a new metastatic spot on another organ, if not already).
Age: 63 M,
KRAS/NRAS wt
11/19: Dx gastric cancer, Lap Subtotal Gastrectomy + D2
12/19: Adenocarcinoma G3, T3N0Mx, 0/12 LN
01/20 - 05/20: CAPOX (6 rounds)
05/20 - 06/2022: 2.5 yeas NED
07/24/22: PET all clear, CEA 1.8 + min ascites
09/20/22: CT scan, 8cm mass in cecum+ ascites ,no peri mets visible, CEA 1.7
09/27/22: Extended Right Hemicolectomy,
10/19/22: Signet Ring Cell Carcinoma G3 of colon, T4N3Mx 6/11 LN, malignant ascites
11/29/22: FOLFOX+Cetuximab

User avatar
Peregrine
Posts: 131
Joined: Tue Mar 01, 2022 1:18 am

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Peregrine » Wed Nov 23, 2022 2:07 pm

Ron-guteleute wrote:...
In light of current events, the Monday's ultrasound revealed bladder wall thickening. The urologists suggested a rigid cystoscopy for taking biopsy samples from the bladder, which is done under general anesthesia and 24 hours hospitalisation, it might also cause some hematoma for several days. Considering that he will start chemo pretty soon, I'm not sure if the timing is right...

Ron -

I'm sorry to hear about the recent bladder developments with the ultrasound and the planned cystoscopy. Actually, I tend to agree with you about the timing. It seems to me that any procedure likely to cause bleeding should be separated from chemo by several weeks or so, otherwise the onset of chemo could delay or impede the process of healing any cuts or incisions that resulted from the biopsy. At least that's my understanding about the recommended interval between surgeries and chemo.

When are they planning to do the cystoscopy procedure?

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Peregrine
Posts: 131
Joined: Tue Mar 01, 2022 1:18 am

Re: Signet Ring Cell Carcinoma + Malignant Ascites, T4N3Mx - Looking for feedback

Postby Peregrine » Thu Nov 24, 2022 4:34 am

...My father lives in non-EU country in Europe .... However I live in Germany...

Ron –

Since your dad will be starting the FOLFOX+Cetuximab chemo regimen soon, it occurred to me that he might want to make contact with a Naturopath doctor or an Alternative Medicine practitioner to get some advice on how to handle the various side effects that this regimen usually generates.

Apparently, there are Naturopath practitioners licensed in Germany and in parts of Switzerland, but not in most other European countries.

If your dad wants to explore these alternative kinds of therapies, or if he wants to get second opinions, in German, about cystoscopies from other urologists, there are some websites that have search engines to help patients find practitioners in certain areas.

If he’s interested in this, here are some links for finding practitioners in Germany and Switzerland.
.


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