CT scans on lungs

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CT scans on lungs

Postby ktex » Tue Feb 28, 2023 9:04 pm

I just had my 2nd 6 month CT exam and noticed they haven’t been scanning my lungs. They only scan my pelvis/abdomen. I thought this was odd. I have a follow appointment in 3 weeks and will ask my oncologist about it but I’m curious if one of you knows if it’s common not to scan the lungs as well.
M 44yo DX 10/21
Stage IIIb CC, G2, 2/29 LN +
Sigmoid recection 10/21
Start Folfox 6 cycles on 12/1/21
6/22 CEA 2.3 (3.2 pre-resection)
8/22 scans clear
2/23 scans clear
8/23 scans clear
As of 1/24 still NED!

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Re: CT scans on lungs

Postby roadrunner » Wed Mar 01, 2023 1:03 pm

In general, I think the literature sets the risk of “skip” pulmonary metastases (lungs but not liver) at a relatively low level in a Stage 3 patient with colon—not rectal—cancer (which goes to the lungs first at roughly 2x the rate of colon cancer). That said, the risk, while comparatively low, is sometimes termed “significant” (this should be thought of in context, so more like 3% than 6% for all colon cancer vs. rectal cancer patients—though you are 3b, which likely increases risk somewhat from the broader context). Location (country), insurance considerations (if applicable), and your team’s protocol can be factors (you didn’t say where you are). Sometimes, however, you need to advocate for yourself to make certain the appropriate monitoring protocol is being followed in your case.

Overall, I would want at least some monitoring of the lungs for Stage 3b colon cancer. Thus, I would ask your team whether you should have it, and if not, why not? If they agree, you should ask what their perspective on the appropriate schedule is.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (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 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

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Re: CT scans on lungs

Postby CRguy » Wed Mar 01, 2023 4:16 pm

I won't say a lot here ... BUTT ... you should probably be having some type of imaging on the lungs for a while.

my posts describing lymphatic/vascular drainage from the rectosigmoid to the chest

My lung met was picked up on survey Xray, not CT, SO ... just saying somebody should be doing some looking at your lungs !
IME ... IMO ... been there done THAT !

Cheers and best wishes
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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Re: CT scans on lungs

Postby rp1954 » Wed Mar 01, 2023 5:16 pm

I think there are several issues about risks and costs.

One article that referenced NCCN 4.2020 on stage II/III colon cancer, recommended a CT chest scan for lungs every 12 months.

Of course many insurers would like to skimp and influence drs in their networks.
What's your insurance situation, especially insurer type and out of pocket cost?

Figure a CT scan vs plain xray or pair is 50 - 250 times more radiation. Small but non zero risk.

Undetected mCRC ,
finding the first met anywhere sets the stage....
Dr's and insurers wrangle over sensitivity, specificity, false negatives and false positives but I'm not seeing cur rent US literature on plain x-rays for CRC. In developing countries plain xray is often the starting point. Perhaps an insurer will offer it without deductible.

Skipping over a lot. If low risk stage 3 patient lung met is a hypothetical 7% and some or most mCRC cases are picked up with pelvic mets too, what's the net % exposure?
Then you might have a choice of instruments with different sensitivities
Plain Xray. Vs single detection CT vs multispectral CT.
Throwing hazy numbers at the wall let's say 62% vs 71% vs 75% sensitivity some years ago
Of you might have a radiologist screwup and simply miss something, like our CT#2.
(being suspicious of an escalating CEA series I got an outside second reading)

I'm similar to CRguy I'd get something, especially a first scan, to at least get some cover for most of any mets, and the "Oh my god" case.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

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