A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

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CancerWarrior_23
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Joined: Sun Mar 26, 2023 8:40 pm

A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby CancerWarrior_23 » Sun Mar 26, 2023 8:44 pm

Hi Everyone,

I hope this message finds you well. I am reaching out to this community on behalf of my brother, who has been diagnosed with metastatic colon cancer. We are seeking advice or insights from those who have experienced a similar journey, either personally or through their loved ones.

Patient Background:

Age: 36

Sex: Male

No prior chronic medical illnesses

Symptoms: Anorexia, weight loss (over 10 kg), rectal bleeding mixed with stool

Medical History:

Colonoscopy: Sigmoid mass detected 20 cm from the anal verge

Histopathology: Moderately differentiated adenocarcinoma of the sigmoid colon

Imaging: CT and MRI scans revealed extensive hepatic metastases and suspicious lung nodules

Staging: T2/3, N1, M1

Treatment Plan:

Genetic testing for KRAS and MSI

Palliative chemotherapy: FOLFOX + bevacizumab, followed by evaluation



As we navigate this challenging time, we would greatly appreciate any advice, insights, or personal experiences that you may have to offer. Specifically, we are interested in the following:



How did you or your loved one cope with the emotional and physical challenges of metastatic colon cancer and its treatment?

What side effects did you or your loved one experience during treatment, and how were they managed?

Were there any complementary therapies or lifestyle changes that helped during the treatment?

How did you navigate discussions with the healthcare team, and what questions did you find most important to ask?

Are there any resources, such as informative websites, that you found particularly helpful during your journey?


We understand that every individual's experience is unique, but hearing your stories will help us better prepare for the challenges ahead and make informed decisions about my brother's care. Thank you in advance for your support and for taking the time to read and respond to our inquiry.

Sincerely,

CancerWarrior_23
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

skimom
Posts: 76
Joined: Fri Mar 17, 2023 12:24 pm
Location: Oregon USA

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby skimom » Mon Mar 27, 2023 12:01 pm

Hello - I am so sorry to hear of another young person dealing with such shocking news. Although not as young as your brother (I’m 47) I feel young and healthy and had no precious serious health issues.

I do not have much advice to give you at this point as I’m still trying to figure out what to do myself. I am on the same treatment plan you mention and have completed 6 rounds so far with pretty mild side effects. My hair is thinning severely and I get neuropathy and cannot eat or touch cold things for about 5 days following treatment. Other than that it hasn’t been too bad for me, thanks be to God!

There is a lot of good information here if you search through other posts you’ll find answers to most of your questions. I am so grateful for the knowledgeable people willing to share with the rest of us. This forum has given me so much more hope for a good outcome.

Prayers for you and your brother
~Sara~
47yo F at DX
DX 12/11/22 Stage IV (liver & lung mets) KRAS PIK3CA
12/15/22 Primary tumor removed from Transverse Colon (4.3x4.0x0.6cm G2 3/15 lymph nodes. Clear margins)
01/06/23 started Folfox (10 cycles)
Initial CEA 5608
CEA after 4 rounds 1319
CEA after 6 rounds 427
CEA after 9 rounds 95
HAI pump installed 06/20/23
Start FOLFIRI and FUDR 07/05/23
CEA down to 37
31
21
18
9/2023 Switch back to FOLFOX due to new lung nodules
11/23 FOLFOX fail CEA up to 62

aquarian_asian
Posts: 48
Joined: Wed Jul 07, 2021 7:07 am

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby aquarian_asian » Mon Mar 27, 2023 1:08 pm

focus on anti-cancer food to support his treatments & mental health. Pls watch "How to starve a cancer" video in youtube (Dr William Li). Dont believe anything blindly as you will get lot suggestions (including mine),but at the same time - keep looking for right ideas/suggestion to judge the best , what suits best for your brother etc.

Veggies, Fruits, Nuts, Supplements (Vit D, Omega 3, Curcumin tabs), Dark chocolate 100% - these things I follow regularly and it helps .

Best wishes to you both.
Feb 2021 - Dx Stage3B - rectal cancer (Age is 48, Male)
April 2021 - Radiation - for a week (5 mins x 5 days)
May 2021 - LAR surgery
Pathology: G2, LN+ PVI+, Lymph Nodes 5 out of 22
Temporary Ileostomy
Jun-Aug 2021 - Chemo 4 cycles 3 months (CAPOX)
Feb 2022 - Ileostomy reversal

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby claudine » Mon Mar 27, 2023 4:49 pm

Welcome to the forum; it is a great source of information. A diagnosis like this is like getting the earth vanishing from under one's feet, but with time, it does get better.

How did you or your loved one cope with the emotional and physical challenges of metastatic colon cancer and its treatment?
It was very challenging at first, and is still at every relapse. But (as you can see from my signature), we're soon to enter the 6th year since diagnosis; what has been helpful for me has been to see cancer as a chronic disease, akin to diabetes, for example. Because my husband has very tenacious bone mets, he will never be cured, but that doesn't mean that we can't have some wonderful moments together! Some days are better than others, and I'm still grieving for the life we wanted but will never have. I do my best to have a "let's focus on the positive" attitude: not say "we used to ski together, now we can't", say instead "we didn't cycle much together, now we do!". Obviously the situation is very different for your brother, he's not stage 4, doesn't have bone mets, so there's high hopes that he can get completely cured :D

What side effects did you or your loved one experience during treatment, and how were they managed?
The 6 Xelox cycles were hell for my poor husband, who developed incurable neuropathy in his feet; by comparison, Folfiri/Avastin was easier, his hair thinned a lot but grew back, his nails broke (annoying for a guitar player!) but that got better too once treatment was over. I know my husband is in constant, low-grade pain, and he suffers from LARS since his rectum surgery; but he puts a brave face on it, hiding a lot from me. With regard to your brother's treatment, I would say be on the lookout for signs of neuropathy (which is common with Oxaliplatin), as it can lead to permanent problems. had we known at the time, I think DH would have stopped after 4 cycles instead of doing all 6 (they didn't work anyway!).

Were there any complementary therapies or lifestyle changes that helped during the treatment?
My husband does not want to try anything beyond what his docs recommend. It's his choice... And eating/drinking "like a normal person" also helps him maintain normalcy in his daily life. He's always been physically active, and has continued cycling through all of it; that's helped him a lot.

How did you navigate discussions with the healthcare team, and what questions did you find most important to ask?
Like I said, my husband tends to go with whatever the local team suggests. I'm the one who pushes a bit more. For example, we traveled twice to Portland (OHSU) to receive SBRT there. it could be done at our local hospital, but they have more experience in a larger place. I am good friends with the neurosurgeon's PA, so I know my husband was in good hands for his back surgeries. Same for the rectum surgery, the local surgeon is highly regarded. If you do not feel that you can totally trust your team, I wouldn't hesitate to seek second opinions!

Are there any resources, such as informative websites, that you found particularly helpful during your journey?
This one :D
And scientific publications, although a lot of studies have to be taken with perspective - they're often based on small sample sizes.

Good luck to you both, and let's hope it all goes well and your brother can be cured - it's happened to quite a few people in this forum, some with much more advanced disease!
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22

Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24

CancerWarrior_23
Posts: 10
Joined: Sun Mar 26, 2023 8:40 pm

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby CancerWarrior_23 » Mon Mar 27, 2023 7:13 pm

skimom wrote:Hello - I am so sorry to hear of another young person dealing with such shocking news. Although not as young as your brother (I’m 47) I feel young and healthy and had no precious serious health issues.

I do not have much advice to give you at this point as I’m still trying to figure out what to do myself. I am on the same treatment plan you mention and have completed 6 rounds so far with pretty mild side effects. My hair is thinning severely and I get neuropathy and cannot eat or touch cold things for about 5 days following treatment. Other than that it hasn’t been too bad for me, thanks be to God!

There is a lot of good information here if you search through other posts you’ll find answers to most of your questions. I am so grateful for the knowledgeable people willing to share with the rest of us. This forum has given me so much more hope for a good outcome.

Prayers for you and your brother
~Sara~



Thank you so much Sara for sharing your experience with us. It's reassuring to hear that the treatment has been manageable for you, and I'm glad that you've found support and hope on this forum.
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

zephyr
Posts: 363
Joined: Thu Aug 18, 2016 7:31 am

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby zephyr » Tue Mar 28, 2023 1:47 pm

I'm chiming in on the complementary and alternative therapies, with the understanding that everyone reacts differently. These are some of the things that have most helped me:

Vitamin C IVs kept me alive when I was so beaten up from treatment that I was mentally giving up. It brought me back off the edge. As an aside, there's evidence that Vitamin C IVs help boost the effectiveness of 5FU (part of what's in Folfox and Folfiri) and it targets KRAS (if that turns out to be your brother's mutation). Vitamin C in pill form won't do the trick because you can't take enough orally to make a difference (well, you ~can~ take enough but you'll be sorry).

Consider getting a liquid biopsy. Guardant is one used a lot and another good source is Tempus. Guardant ~might~ be covered by insurance. Tempus has a financial assistance program that's very patient-centered and affordable.
Click here ---> https://access.tempus.com/?_gl=1*1boefr5*_ga*NjYwMDAzMTEwLjE2ODAwMjcyMjM.*_ga_4QP781F35H*MTY4MDAyNzIyMy4xLjEuMTY4MDAyNzI2My4yMC4wLjA.

If your brother is in a State that licenses naturopathic doctors, consider making an appointment with one who has FABNO after the name. That means they are board-certified in oncology and will know what works with different chemos and what should be avoided. Start here:
Physician Directory ---> https://oncanp.org/directory/?su=fabno

Not an alternative therapy but ... stay as active as possible. It makes a difference mentally as well as physically. Even on my bad days, I try to do 20-30 minutes of walking around in circles inside the house, resting along the way if need be.

There's a traditional Chinese medicine doctor in New York who seems to have a lot of success treating cancer. He's also a traditional cancer researcher formerly with MSK, among others. He's mentioned in the books Radical Remission and Hope Never Dies: How 20 Late-Stage and Terminal Cancer Patients Beat the Odds, among others. His name is George YC Wong. He's not a fan of chemo but he'll still help you if you stick with chemo.

It might sound corny but meditation really helps a lot, especially in managing the anxiety of the lows and there will be lows. MSK has some meditations designed for different issues:
Meditations page ---> https://www.mskcc.org/cancer-care/diagn ... editations

Check out Commonweal's website, especially the audio and video library. Some of the presentations will be so packed with information on CAM therapies that you'll want to watch them more than once:
Audio & Video Library ---> https://tns.commonweal.org/audio-video-library/

Also from Commonweal, this audio/video might be the best place to start: https://tns.commonweal.org/audio-video-library/?_sft_speaker=donald-abrams

Search this form for rp1954 and read his posts. Lots of helpful information there.
Nov-2009 Early stage CRC, routine colonoscopy
2010-2014 F/U colonoscopies, all clear
Jun-2016 CRC during F/U colonoscopy, surgery, Stage 4, KRAS, MSS
Aug-2016-May-2018 Folfox, 5FU, Folfiri & Avastin
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Mar-2021 Forfiri/Avastin
Mar-2022 Ablation & Thoracotomy
Feb-2023 Folfiri & Avastin
Nov-2023 Xeloda & Avastin

User avatar
Jacques
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Location: Occitanie

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby Jacques » Tue Mar 28, 2023 6:12 pm

skimom wrote:....
There is a lot of good information here if you search through other posts you’ll find answers to most of your questions....

Yes, that's true. But to find the older posts that might be relevant requires quite a lot of work and a lot of experience with using the Advanced Search function here.

Best wishes to your brother on his journey.

Take care ...
Last edited by Jacques on Fri Mar 31, 2023 7:07 am, edited 2 times in total.

CancerWarrior_23
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Joined: Sun Mar 26, 2023 8:40 pm

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby CancerWarrior_23 » Tue Mar 28, 2023 10:04 pm

zephyr wrote:I'm chiming in on the complementary and alternative therapies, with the understanding that everyone reacts differently. These are some of the things that have most helped me:

Vitamin C IVs kept me alive when I was so beaten up from treatment that I was mentally giving up. It brought me back off the edge. As an aside, there's evidence that Vitamin C IVs help boost the effectiveness of 5FU (part of what's in Folfox and Folfiri) and it targets KRAS (if that turns out to be your brother's mutation). Vitamin C in pill form won't do the trick because you can't take enough orally to make a difference (well, you ~can~ take enough but you'll be sorry).

Consider getting a liquid biopsy. Guardant is one used a lot and another good source is Tempus. Guardant ~might~ be covered by insurance. Tempus has a financial assistance program that's very patient-centered and affordable.
Click here ---> https://access.tempus.com/?_gl=1*1boefr5*_ga*NjYwMDAzMTEwLjE2ODAwMjcyMjM.*_ga_4QP781F35H*MTY4MDAyNzIyMy4xLjEuMTY4MDAyNzI2My4yMC4wLjA.

If your brother is in a State that licenses naturopathic doctors, consider making an appointment with one who has FABNO after the name. That means they are board-certified in oncology and will know what works with different chemos and what should be avoided. Start here:
Physician Directory ---> https://oncanp.org/directory/?su=fabno

Not an alternative therapy but ... stay as active as possible. It makes a difference mentally as well as physically. Even on my bad days, I try to do 20-30 minutes of walking around in circles inside the house, resting along the way if need be.

There's a traditional Chinese medicine doctor in New York who seems to have a lot of success treating cancer. He's also a traditional cancer researcher formerly with MSK, among others. He's mentioned in the books Radical Remission and Hope Never Dies: How 20 Late-Stage and Terminal Cancer Patients Beat the Odds, among others. His name is George YC Wong. He's not a fan of chemo but he'll still help you if you stick with chemo.

It might sound corny but meditation really helps a lot, especially in managing the anxiety of the lows and there will be lows. MSK has some meditations designed for different issues:
Meditations page ---> https://www.mskcc.org/cancer-care/diagn ... editations

Check out Commonweal's website, especially the audio and video library. Some of the presentations will be so packed with information on CAM therapies that you'll want to watch them more than once:
Audio & Video Library ---> https://tns.commonweal.org/audio-video-library/

Also from Commonweal, this audio/video might be the best place to start: https://tns.commonweal.org/audio-video-library/?_sft_speaker=donald-abrams

Search this form for rp1954 and read his posts. Lots of helpful information there.


Hi zephyr,
Thank you so much for sharing your experiences and suggestions. I really appreciate all the information you provided about Vitamin C IVs, liquid biopsies, naturopathic doctors, staying active, Dr. George Y.C. Wong, meditation, Commonweal's website, and the forum user rp1954. I'll definitely look into these ideas and discuss them with my brother. Your advice is so helpful and I'm grateful for your support.

Take care!
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

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Jacques
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Location: Occitanie

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby Jacques » Thu Apr 13, 2023 7:39 am

CancerWarrior_23 wrote:...Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023)..

This new entry in your signature requires an explanation... How high is your brother's PSA right now? Or is this just a case of BPH (Benign Prostate Hyperplasia)? Does your brother have any information on this?

rp1954
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Joined: Mon Jun 13, 2011 1:13 am

Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby rp1954 » Thu Apr 13, 2023 6:21 pm

zephyr wrote:It brought me back off the edge. As an aside, there's evidence that Vitamin C IVs help boost the effectiveness of 5FU (part of what's in Folfox and Folfiri) and it targets KRAS (if that turns out to be your brother's mutation). Vitamin C in pill form won't do the trick because you can't take enough orally to make a difference (well, you ~can~ take enough but you'll be sorry).

Actually IV vitamin C can reach vitamin C blood levels far beyond any oral nutrition.
Most acute or advanced cancer patients are going to be in the 0.1 - 0.4 mg C/dL range without much supplements.
Normal healthy people will be mostly 0.6 - 1.5 mg C/dL, depending on diet
Those playing around with multigram oral supplements will achieve transient ascorbate levels in the 2-3 mg/dl range.
Limited absorption, kidneys dumping to pee, and a laxative effect limit oral intake and blood levels to ca 3 mg/dL.
Linus Pauling and Irwin Stone noted one IBM chemist with prostate cancer managed to achieve 4.2 mg.dL, the highest oral value they had found. He had used various mixtures 85+ grams per day, sometimes as high as 130 grams per day (IIRC).
-----
During the WuFlu, Chinese drs recorded levels of ca 15 mg/dL at 1 gram per hour with IV vitamin C.
some doctors achieve vit C blood levels of 200 - 700 mg / dL in cancer patients with large infusions.

after 3/4 of a century, conventional medicine is slowly "discovering" the Klennerian range of (IV) vitamin C therapy e.g. Some drs in Oz poured 150 grams of IV vitamin C in a 40 kg (small) person over 7 hours to break their patient's sepsis.
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

CancerWarrior_23
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Re: A Brother's Heartfelt Plea: Seeking Guidance and Support for Metastatic Colon Cancer Journey

Postby CancerWarrior_23 » Thu Apr 13, 2023 8:24 pm

Jacques wrote:
CancerWarrior_23 wrote:...Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023)..

This new entry in your signature requires an explanation... How high is your brother's PSA right now? Or is this just a case of BPH (Benign Prostate Hyperplasia)? Does your brother have any information on this?



Hi Jacques
Thank you so much for you help.

I wanted to address your comment asking for clarification on my brother's PSA levels and whether his condition is related to BPH (Benign Prostate Hyperplasia). Although my brother has undergone several tests at different hospitals, I would like to provide you with the results of his most recent scan, performed on April 10, 2023, after completing his first cycle of FOLFOX chemotherapy with Avastin (20%).

Here is a summary of the scan results:

Clinical indication new diagnosis of colon cancer with liver and possible liver mets Technique New postcontrast enhanced CT of the chest at the portal venous phase. Technique Postcontrast enhanced CT of the abdomen and pelvis at the portal venous phase Comparison No previous exams for comparison. Findings Chest: No pathologically enlarged axillary, mediastinal, or hilar lymph nodes. The mediastinal vessels are unremarkable. There is no evidence of pleural or pericardial effusion. The cardiac chambers are normal in size. The trachea and main bronchi are patent. No pulmonary parenchymal airway process is present. Multiple lung micronodules are seen considered nonspecific for follow-up. The largest is seen at the right upper lobe measuring 6 mm (image 52). No aggressive bone lesions. Abdomen and pelvis: The liver is enlarged measuring 22.9 cm in height at the mid clavicular line. Multiple large innumerable hypodense liver lesions are seen compatible with metastasis. For example at hepatic segment II. There is a hypodense lesion measuring 7.1 cm. Another example, there is a hypodense liver lesion at hepatic segment III measuring 6.8 cm. Patent portal and hepatic veins. The gallbladder is not seen. No intra or extrahepatic biliary ductal dilatation. The spleen is normal in size. No focal splenic lesions. The pancreas is normal. The pancreatic duct is not dilated. No adrenal masses. Both kidneys are normal in size. No focal lesions. No hydronephrosis. The the abdominal aorta is normal in calibre. No pathologically enlarged mesenteric, retroperitoneal, or pelvic lymph nodes. Mild amount of free fluid in the pelvis. The small bowel is not dilated. There is circumferential wall thickening involving the mid part of the sigmoid colon measuring up to 10 mm in thickness and spanning approximately a segment that measures 6 cm in length, probably corresponding to the known colon cancer. Multiple regional lymph nodes are seen. The largest measures 6 mm in short axis. Multiple mesenteric lymph nodes are also seen. The largest measures 50 mm in short axis (image 242). The remaining parts of the colon appear grossly unremarkable within the limits of the lack of bowel preparation and opacification. No pathologically enlarged retroperitoneal or pelvic lymph nodes. The urinary bladder is unremarkable. No signs of peritoneal carcinomatosis. No aggressive bone lesions. Conclusion Multiple lung micro nodules considered nonspecific for follow-up. Sigmoid colon mass with multiple pathologically enlarged regional and mesenteric lymph nodes. Hepatomegaly with innumerable large size liver metastases.



I wanted to ask for your thoughts on these recent scan result, Please
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

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Jacques
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Stage4 mCRC with liver mets -- CT scan

Postby Jacques » Wed Apr 26, 2023 4:35 am

CancerWarrior_23 wrote:.
    Here is a summary of the [April 10th] scan results:

    Clinical Indication: New diagnosis of colon cancer with liver and possible [lung] mets

    Technique.Postcontrast enhanced CT of the [chest], abdomen and pelvis at the portal venous phase.

    Comparison: No previous exams for comparison.

    Findings:
    Chest: No pathologically enlarged axillary, mediastinal, or hilar lymph nodes. The mediastinal vessels are unremarkable. There is no evidence of pleural or pericardial effusion. The cardiac chambers are normal in size. The trachea and main bronchi are patent. No pulmonary parenchymal airway process is present. Multiple lung micronodules are seen considered nonspecific for follow-up. The largest is seen at the right upper lobe measuring 6 mm (image 52). No aggressive bone lesions.

    Abdomen and pelvis: The liver is enlarged measuring 22.9 cm in height at the mid clavicular line. Multiple large innumerable hypodense liver lesions are seen compatible with metastasis. For example at hepatic segment II. There is a hypodense lesion measuring 7.1 cm. Another example, there is a hypodense liver lesion at hepatic segment III measuring 6.8 cm. Patent portal and hepatic veins. The gallbladder is not seen. No intra or extrahepatic biliary ductal dilatation. The spleen is normal in size. No focal splenic lesions. The pancreas is normal. The pancreatic duct is not dilated. No adrenal masses. Both kidneys are normal in size. No focal lesions. No hydronephrosis. The the abdominal aorta is normal in calibre. No pathologically enlarged mesenteric, retroperitoneal, or pelvic lymph nodes. Mild amount of free fluid in the pelvis. The small bowel is not dilated. There is circumferential wall thickening involving the mid part of the sigmoid colon measuring up to 10 mm in thickness and spanning approximately a segment that measures 6 cm in length, probably corresponding to the known colon cancer. Multiple regional lymph nodes are seen. The largest measures 6 mm in short axis. Multiple mesenteric lymph nodes are also seen. The largest measures 50 mm in short axis (image 242). The remaining parts of the colon appear grossly unremarkable within the limits of the lack of bowel preparation and opacification. No pathologically enlarged retroperitoneal or pelvic lymph nodes. The urinary bladder is unremarkable. No signs of peritoneal carcinomatosis. No aggressive bone lesions.

    Conclusions:
    1. Multiple lung micro nodules considered nonspecific for follow-up.

    2. Sigmoid colon mass with multiple pathologically enlarged regional and mesenteric lymph nodes.
      .
    3. Hepatomegaly with innumerable large size liver metastases.


"I wanted to ask for your thoughts on these recent scan result, please... CancerWarrior_23."

==============
CancerWarrior_23 -

My thoughts on this scan are as follows:

- This was the first CT scan at your brother's new hospital. It basically confirmed the conclusions of the earlier CT and MRI scans done at the original hospital, namely that there are two main points of concern: (1) the sigmoid colon primary tumor along with its enlarged regional lymph nodes, and (2) the enlarged liver with innumerable mets scattered throughout. Both of these problem areas are still active in your brother's body and need to be dealt with in an effective manner, whatever that might be.

- This scan found that there are no other organs/structures invaded by cancer in the chest-abdomen-pelvis area -- which is a very encouraging finding.

- This was not a full-body scan, so no information was captured about possible mets in the throat, esophagus, thyroid, brain areas, on the one hand, or possible mets in the reproductive organs, or thigh bones, etc. Also, this scan didn't mention anything about possible hepatic cysts or hepatic hemangiomas likely to be found in fatty liver patients. Also, no mention of the appendix or the prostate gland.

- This scan will have to be used as the baseline scan for comparison in any future scans, instead of the real baseline CT scan that was done at a different hospital on a different scanner machine, because the earlier March 2nd initial scan is not available for use by your brother's new hospital.

- This scan will be the first in a series of on-treatment scans to determine the effectiveness and safety of the current "FOLFOX+Avastin" regimen. If any of the future scans find that this regimen is either ineffective (i.e., no reduction in overall tumor burden) or unsafe (i.e., presence of Grade 3 ("serious") or Grade 4 ("life threatening") adverse events, then it will either be suspended or be replaced by another chemo regimen

- At this point in time it appears that the medical team at the new hospital is simply continuing with the earlier "treatment with palliative intent" plan until some future scans show substantial tumor reduction that might suggest that an implementation of a "treatment with curative intent" regimen could be possible.

- If the medical team starts to get serious about exploring "curative intent" options, they may need to use more advanced kinds of scanning, such as PET/CT scans for identifying active mets, special MRI scans that mimic angiograms for visualizing blood flow in the liver, or special MRIs designed for primary liver tumor analysis, such as LI-RADS. Of course, these advanced kinds of imaging usually cost more and are often available only at major cancer centers.

- If your brother wishes to switch the treatment focus from "palliative treatment intent" to "treatment with curative intent" then he could read [a translation of] the first article below and study the decision diagram in Figure 1 of that article so that he can have productive discussions on this topic with his medical team at the new hospital.


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