Postby roadrunner » Sat Mar 11, 2023 11:01 am
I think your plan of multiple consults is great. Take good notes, of course! That will help when/if you get to a surgeon. These are complicated issues and choices, and keep in mind that consults (especially surgical consults) are like a job interview. Best to seem informed, rational, focused, straightforward, etc. My 2 cents is: Channel an airline pilot. Totally fine to freak out later.
As far as my timing is concerned, my team suggested a wedge early based on pretty limited growth. If I recall right, mine were 4-5mm at that point. But one was sub-pleural, and thus an easy wedge. I was concerned about the more central one, and, frankly, may have been hoping the nodules would turn out to be benign given their size and limited/unclear growth. They went through the next scan (3 mo.) cycle with no observed growth, but then the sub-pleural nodule showed growth, so it was definitely time to act.
Generally, yes—CRC pulmonary mets are slow-growing, but that’s all relative. If I recall right, the range is about 30-120 days for volume doubling. That translates to size on a scan as follows: a nodule “doubles” when the scan size increases by .26X. Thus, a 4mm nodule has “doubled” when it reaches 5.04mm. Small nodules like yours are tricky, though—there’s comparatively large inter- (and even intra-) observer variability, machine variables, etc. that are magnified by the comparatively small size. Also, they’re below the PET threshold. I worry a bit that I left them in there for a few months when I “shouldn’t have,“ but it was within a reasonable approach (I think), and metastasis from metastases is not a clear thing, especially with such limited disease. I guess I’ll find out in a few years ; )
And as far as “the worst is behind me” goes, I appreciate the good wishes, but I’m certainly not out of the woods yet. I’ve got a decent shot at continued good health, I hope, but it’ll be a few years before I get comfy at all, and I won’t really breathe easy until I die of something else ; )
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
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)