SED wrote:... Looking for experiences and suggestions from anyone that may have a similar journey.
SED wrote:... Looks like he has a few markers (APC, KRAS, PIC3CA). With appointments next week we want to make sure all the questions are lined up for the surgeon and oncologist. Looking for experiences and suggestions from anyone that may have a similar journey ... We know little about the markers that came back on the genetic mapping (APC, KRAS, PIC3CA) . It would be nice to have some knowledge in the pocket to discuss with oncologist. He suggested the possibility of maintenance chemo if certain markers were present. Should know more about that after the upcoming appointment.
"We know little about the markers that came back on the genetic mapping (APC, KRAS, PIC3CA) . It would be nice to have some knowledge in the pocket to discuss with oncologist"
SED wrote:... Meet with surgeon tomorrow. Plan to discuss approach, new lung clot, and prevention methods from spread to peritoneum.
You can ask the oncologist what he knows about PIK3CA mutations and see what he says. He might not have had the time right now to go through all of the relevant PIK3CA articles, but at least he might know something about PIK3CA in the Western world and be able to propose a chemo regimen that would work better than the standard 1st line chemos that have been used so far. Note: There are many possible PIK3CA mutations, not just one. Similarly for KRAS: There are many possible KRAS mutations. It would be important to look closely at the genetic mapping report to see exactly what kinds of KRAS and PIK3CA mutation(s) were found, because it could make a difference in the decision-making process.
Here are references to a couple of old articles on PIK3CA and colorectal cancer.
- PIK3CA mutations confer resistance to first-line chemotherapy in colorectal cancer
https://www.nature.com/articles/s41419-018-0776-6#ref-CR40
"Our study investigated the PIK3CA gene mutation and first-line chemotherapy resistance in CRC, which provide further insight in chemotherapy options. We provided evidences that PIK3CA mutation was correlated with lower histological grade, late clinical stage and poor prognosis. .. The patients with PIK3CA mutant CRC showed significant worse prognosis. Collective data suggested a potential role of mutant PIK3CA in CRC progression, which may be correlated with enhanced abnormal cell proliferation and invasive ability."
.- Prognostic role of PIK3CA mutation in colorectal cancer: cohort study and literature review
https://pubmed.ncbi.nlm.nih.gov/22357840/©2012 AACR.
"Conclusion: Coexistence of PIK3CA (the PI3K p110α subunit) exon 9 and 20 mutations, but not PIK3CA mutation in either exon 9 or 20 alone, is associated with poor prognosis of colorectal cancer patients."
SED wrote:... Meet with surgeon tomorrow. Plan to discuss approach, new lung clot, and prevention methods from spread to peritoneum.
Jacques wrote:- You need to post at least 5 to 10 posts here before they will promote you to "Registered User" status with expanded privileges. Your posts are now delayed by a number of hours because you are now only a "Newly Registered User" with just 3 posts, so your new posts still have to go through the Moderator review process and that takes time. When you finally get promoted to "Registered User" status your posts will appear on the main board as soon as you successfully Submit them. So, it is to your advantage to post messages more frequently so that you can be promoted soon and have more posting privileges here.
Jacques wrote:-- Baseline CEA value, if you have it.
Jacques wrote:--Location of the primary rectal tumor (i.e., cm. fom the anal verge, or low/middle/high rectum, etc.)
-- What type of LAR surgery was it - Open surgery, laparascopic surgery, or robotic surgery?
-- Did the surgery also involve a temporary ileostomy while the anastomosis was healing?
--Did the LAR pathology report mention anything about clear surgical margins?
Jacques wrote:-- What kind of CT scans were they? with contrast? without contrast?
--Does your new hospital have access to the original baseline CT scans from the first hospital?
Jacques wrote:--What kind of genetic profiling was done? Was it based only on the primary tumor biopsy? Did they ever consider doing a test of DH's inherited DNA (hereditary genetic profiling based on blood sample, etc.)
Jacques wrote:Also, some other points of information:
-What kind of surgeon did the original LAR surgery? Was he a board-certified colorectal surgeon or only a general surgeon?
-What kind of surgeon is the new surgeon and what are his qualifications and experience?
-For the Signatera test, does the oncologist have a lot of experience with this test, and will he be able to explain how the test comes up with its personalized 16 reference oncogenes? And will he be able to tell whether the DNA fragments being tracked have any relation to the mutations found in the genetic profiling report? See this post for more information:
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65557&p=509082#p509082
SED wrote:...The original LAR surgery was done at our local hospital by a surgeon who was referred to us by the facility that did the original screening colonoscopy. He was a surgeon in an office of colorectal surgeons. When I look, I do not see him listed on the ASCRS website but I do see another surgeon in that office listed. Is there another site to check for this certification?
SED wrote:...With three recurrences in less than three years it’s been quite a whirlwind. I am open to any thoughts and impressions from others with experience. I feel like learning as much as I can about all of this is the only way I can help him...
...Tumor deposits, alongside the ancillary finding of extramural venous invasion (EMVI), are increasingly recognized as being the most important predictors of distant metastatic disease, overall survival and disease-free survival for patients with rectal cancer ...
...Unfortunately, a substantial number of tumors behave poorly despite being categorized as low risk [e.g.Stage II-A] based on their TNM stage.2 Thus, the search for additional prognostic factors in the assessment of colorectal carcinoma has been a major research focus. Of the histopathological factors studied to date, the most promising include extramural venous invasion (EMVI), the nature of the advancing front (pushing vs infiltrative), an inflammatory infiltrate, microsatellite instability (MSI), and tumor budding (TB) —the presence of small discrete clusters of tumor cells at the invasive edge (Figure 1). There is now overwhelming evidence that tumor budding is an independent prognostic factor in colorectal carcinoma, particularly in node-negative (N0) disease..
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