Tumor calcification?

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nmorgen
Posts: 82
Joined: Sat Nov 05, 2022 10:31 am

Tumor calcification?

Postby nmorgen » Thu May 18, 2023 11:45 pm

The dr thinks the immunotherapy is working well, and my husband will continue with that treatment . The colon tumors have really shrunk. The largest was 8.3 cm and is now 1.4cm. The donut shaped colon tumor was 7cm and it is now 3.2 cm. The liver tumors haven’t decreased that much. 9.8 x 7.0 cm metastasis in the liver dome 10.3 x 6.7 cm previously.

7.3 x 6.1 cm metastasis central liver towards the dome 7.8 x 6.5 cm previously.

They also did a ct w/out contrast, and I just saw the results in the portal. It says that the liver tumors show internal calcification. I haven’t seen that from any of the other ct scans. Does anyone have any idea what that means?
DH age 47
DX 10/22 stage 4
2 tumors in sigmoid colon 2 Mets liver
adenocarcinoma
MSI-H, TMB-H 38, KRAS G13V, ERBB2 neg, BRCA2, Lynch Syndrome
Grade 1 well differentiated
12/1/22 Yervoy and Opdivo CEA 5.4
12/19/22 Yervoy & Opdivo CEA 4.6
01/12/22 Yervoy & Opdivo CEA 3.9
2/13/23 Yervoy& Opdivo CEA 3.4
3/7/23 ct scans no change
3/9/23 Opdivo CEA 3.4
4/4/23 Opdivo CEA 2.3
6/1/23 Opdivo CEA 2.6

Rock_Robster
Posts: 1038
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Tumor calcification?

Postby Rock_Robster » Fri May 19, 2023 8:29 am

My understanding is that calcification is generally a good thing with an improved prognosis - it broadly means that part of the tumour has ‘died’ and has converted to non-malignant/dead calcium-based cells. Often a tumour that has been radiated or ablated may calcify as it does, rather than disappearing from scans entirely. I think it this case it could be taken as a positive sign of response to treatment (in addition to the significant reductions in tumour volume).

Good luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Nor Cal
Posts: 91
Joined: Sun Dec 06, 2020 8:18 pm

Re: Tumor calcification?

Postby Nor Cal » Fri May 19, 2023 5:04 pm

I also began with a pretty heavy burden in my liver, and after lots of treatment my liver guy finds that MRIs are easier for him to interpret. We do a chest/abdomen CT and a liver MRI. It may be worth asking if there are other imaging techniques that could give them a better idea what is happening.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. CEA 120.
BRAF+ TMB 5% MSS TDL1-1%
July 2020 - Present: 57 cycles chemo (All the various 5-FU regimens)
December 2020 - February 2021 Y90 Radioembolization, Chemoembolization x2

nmorgen
Posts: 82
Joined: Sat Nov 05, 2022 10:31 am

Re: Tumor calcification?

Postby nmorgen » Fri May 19, 2023 9:41 pm

Hi Rock Robster, thanks for responding. I tried searching this topic and there was a lot of information that I’m not sure really applied to our situation. I was also thinking that it was a good sign. The oncologist didn’t mention it, but he was really happy with the results so far. The last ct scans didn’t really show the colon tumors and the liver hadn’t changed, so we weren’t sure what was going to happen with these scans. I am so thankful the treatment is working.
DH age 47
DX 10/22 stage 4
2 tumors in sigmoid colon 2 Mets liver
adenocarcinoma
MSI-H, TMB-H 38, KRAS G13V, ERBB2 neg, BRCA2, Lynch Syndrome
Grade 1 well differentiated
12/1/22 Yervoy and Opdivo CEA 5.4
12/19/22 Yervoy & Opdivo CEA 4.6
01/12/22 Yervoy & Opdivo CEA 3.9
2/13/23 Yervoy& Opdivo CEA 3.4
3/7/23 ct scans no change
3/9/23 Opdivo CEA 3.4
4/4/23 Opdivo CEA 2.3
6/1/23 Opdivo CEA 2.6

nmorgen
Posts: 82
Joined: Sat Nov 05, 2022 10:31 am

Re: Tumor calcification?

Postby nmorgen » Fri May 19, 2023 9:53 pm

Hi Nor Cal, Thank you for the information. I’m sorryI didn’t mention in the post, but my husband had an mri with contrast for the abdomen. Honestly, the radiologists couldn’t see my husbands two primary colon tumors from the ct scans. This was the first time we have seen what was going on with them since he started treatment. I think the mri gives a much better picture of what is happening. I can understand why your dr wants to use the mri.

The chest ct scan they did picked up the calcification in the liver Mets. The thing that worried me was that he has two rather large Mets, and from what I have researched the large liver Mets don’t seem to shrink much with immunotherapy. I will definitely push for an mri next time as well.

I hope your treatment is going well for your liver Mets.
DH age 47
DX 10/22 stage 4
2 tumors in sigmoid colon 2 Mets liver
adenocarcinoma
MSI-H, TMB-H 38, KRAS G13V, ERBB2 neg, BRCA2, Lynch Syndrome
Grade 1 well differentiated
12/1/22 Yervoy and Opdivo CEA 5.4
12/19/22 Yervoy & Opdivo CEA 4.6
01/12/22 Yervoy & Opdivo CEA 3.9
2/13/23 Yervoy& Opdivo CEA 3.4
3/7/23 ct scans no change
3/9/23 Opdivo CEA 3.4
4/4/23 Opdivo CEA 2.3
6/1/23 Opdivo CEA 2.6

User avatar
Jacques
Posts: 678
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: Tumor calcification?

Postby Jacques » Tue May 23, 2023 2:39 am

nmorgen wrote:..
They also did a ct w/out contrast, and I just saw the results in the portal. It says that the liver tumors show internal calcification. I haven’t seen that from any of the other ct scans. Does anyone have any idea what that means?

Here are several articles from the Radiopaedia web site that may be of interest to your husband. In one of the Radiopaedia articles it mentions a possible correlation between calcified liver mets and primary tumors with a "mucinous" histology. Does your husband have the pathology report from the initial colonoscopy biopsy, and if so, does it mention "mucinous" anywhere in the report?

Calcified liver metastases

https://radiopaedia.org/cases/calcified-liver-metastases?lang=us

Colorectal cancer liver mets

https://radiopaedia.org/articles/colorectal-cancer-1?lang=us

Lynch syndrome

https://radiopaedia.org/articles/hereditary-non-polyposis-colorectal-cancer-1?lang=us

=====
Calcified Metastases - Mucinous Adenocarcinomas

https://www.youtube.com/watch?v=y-Fz4uLePSw

Mucinous colorectal adenocarcinoma: clinical pathology and treatment options

https://pubmed.ncbi.nlm.nih.gov/30922401/
Last edited by Jacques on Wed May 24, 2023 2:15 am, edited 2 times in total.

nmorgen
Posts: 82
Joined: Sat Nov 05, 2022 10:31 am

Re: Tumor calcification?

Postby nmorgen » Tue May 23, 2023 2:45 pm

Thank you Jacques,

I will read through all of the articles you posted. I’m sure they will be informative. I’ll have to go and look at the original pathology.
DH age 47
DX 10/22 stage 4
2 tumors in sigmoid colon 2 Mets liver
adenocarcinoma
MSI-H, TMB-H 38, KRAS G13V, ERBB2 neg, BRCA2, Lynch Syndrome
Grade 1 well differentiated
12/1/22 Yervoy and Opdivo CEA 5.4
12/19/22 Yervoy & Opdivo CEA 4.6
01/12/22 Yervoy & Opdivo CEA 3.9
2/13/23 Yervoy& Opdivo CEA 3.4
3/7/23 ct scans no change
3/9/23 Opdivo CEA 3.4
4/4/23 Opdivo CEA 2.3
6/1/23 Opdivo CEA 2.6


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