What diagnostic test should be done

tests needed
I believe that it is standard procedure to do a CT scan of both the chest and abdomen after a diagnosis of CRC in order to rule out metastasis to liver and lungs, and other less likely sites. CEA is of course standard also but less significant than the CT scans because CEA is not a reliable indicator of the presence or absence of disease in everyone.

dianetavegia said:

Trust your oncologist!
A CT scan will do just fine. I happened to have a CT of my lungs because I was suggested for a Mayo Clinic trial but my tumor was a KRAS mutant and that knocked me out of that trial.

Colon cancer usually mets to the liver first. Colorectal cancer usually mets to the lungs.

The CEA was done with the other blood work, most assuredly. You need to either trust this doctor or find one you DO trust or you're going to be miserable for the next 5 years. )

some suggestions
Hopefully they did a baseline CEA before surgery. This should help them to know whether cea will be a good indicator for you or not.

I also think that a PET/CT is very important. I looks at both the stucture of the organs and metastasis and also metabolic activity(pet portion)for increased activity. This should help to confirm that there is no metastasis.

I imagine at Stage III you will be getting chemo. They should do KRAS testing on your tumor so they know what type you are and what chemo drugs can be effective for you.

It is good of you to stay on top of things and make sure your docs are covering all the bases. We really have to be our own advocates today.

Wishing you luck in this journey.

Smiles,
Dawn

no CT scan or PET and they
no CT scan or PET and they are saying stage 3? Is the stage 3 just a visual the surgeon did with the resection? I had the CT scan before surgery and the PET before chemo started. Either the CT or PET is important to stage the cancer.

thready said:

Scans and Staging
They did not do any scans before surgery. (Someday I will be brave enough to mention why, but for now I am kind of upset with the surgeon.) Staging was done because the tumor went through the bowel and there was 1 lymph node involved. I will have CT of Chest ABD and Pelvis on October 13th. No CEA was done but that will be done before treatment starts on October 28th. I do have a scheduled second opinion with a Dr at UT southwestern, just to hear what he has to say, I probably will stay with my current oncologist. I really feel it was the surgeon who should have asked for the tests while I waited to have surgery, but I can't go back so I am hopeful that the scans will be clear and we can get on with the Chemo (folfox)

Thready
Hi there

I'm with you here in the metroplex.

I got my 2nd opinion at UTSW also - it's a small world isn't it?

Who is your oncologist - if you don't mind me asking?

I switched my care down to UTSW as I'm seeing Dr. Verma there.

I'm also getting my lung surgery down at UTSW next week on the 15th at Zale Lipschy bldg.

I was at the Arlington Cancer Center for the first 5 years, but things started going sideways and I made the move to UTSW and so far so good.

You may find you want to switch as well - it's a teaching hospital and they have the latest and greatest down there and are up to date and have the time to study the issues there that the private clinics do not - and the private clinics are in the "business" of cancer.

There's a reason you are getting a 2nd opinion (just like me) - so go with your gut instinct and don't be afraid to switch - it's scary but could be just the move you need.

Always great talking to another Texas - let me know if I can help at all.

-Craig

thready said:

UTSW, and local oncologist
Hi Craig,
It is great hearing from a "local" person, and one that has navigated the Texas healthcare stuff. It is great to hear that there can be a change if things don't work out, we have a good insurance plan that does not limit us but I really was not sure if we started in one place and it did not work out if we could change. Thank you so much for writing. My oncologist is Heidi Jordan and she is with Texas Oncology in Grapevine. She was recommended to me by my primary care doctor.

I like Dr. Jordan, but I am sort of conserned that we are leaving stones unturned. That is why we are going to UTSW. I know the treatment for IIIB is not going to change but we have had to suggest and almost insist to get a CT of the Chest along with the Ct of Abd and pelvis. (that is a guess on staging because I have not had any scans so far. My surgeon did not want us to do any ct scans prior to surgery, he said his visual and hands were better then a CT scan, I should have run away at that point and found someone else.) I will have the CTs on Wednesday the 13th so hopefully we will get good news then.

It is not Dr Jordan's fault that we did not have the scans first because we were told to have the surgery first and that the surgeon could tell if there was involvement elsewhere. At that point I did quickly run to my primary Dr whom I have a great amount of respect for and she said the surgery was inevitable but I should also make my appointment with Dr. Jordan, the way it worked out the surgery can before the appointment with Dr Jordan.

The people at Dr Jordan's office keep telling us we need to trust Dr Jordan, and I believe that is probably true, but how does one trust much when they have been hit with a diagnosis of cancer. I was healthy, working and active until I was turned into a semi colon.

You know this, but Zale Lipsche is a great place! We have known people who have had surgeries there and have done very well. I wish you the best next week, keep in touch. Do me a favor, keep those feet and toes moving and make sure you breathe deeply. My family kept nagging me while I was in the hospital to do these things and I did not have a hint of blood clots or pneumonia!

We, my family and I, will be praying for you. (I know sometimes I feel like I am alone and when people say they will pray I kind of wonder if that is true, but I want you to know that we are of the "Christian persuasion" very normal type people though, anyway when I tell you we are praying for you that is exactly what we will be doing!)

By the way I have a real name, I am Jan and I am married to a wonderful very supportive guy named Dan. Also I am not normally this chatty, and I usually only lecture my kids,so usually my messages are not this long. But I do like to hear from people!

Look forward to hearing from you,
Jan

Jan
Hi, Jan

Glad to hear back from you...you can talk as long to me as you want to or need to...I've been fighting cancer, now into my 6th year of this stuff. I'm a stage IV now, as I've had 2 recurrences since the original diagnosis during this time.

I know how you feel about building a relationship with your oncologist - I just left mine after 5 years and I've had mixed feelings about it, because I really like the guy...the clinic started to come apart and they began demanding the CO-PAYS up front, which is 25% for me. And we ordered test after test and I kept scheduling monthly payments - in the end we could not really get a firm answer, so I decided to go to UTSW for a 2nd opinion too.

What I find very interesting is that there were no scans of any type run for you prior to the surgery...that's almost hard to believe that they did nothing there...they used my CTs and PETs as a guideline to use and for the surgeon(s) to follow. I had a bowel resection (LAR) followed by almost a liver resection, but instead we did RFA and then followed up with CyberKnife to get the tumor locally.

And then we found it in the lung and UTSW has verified and they agreed with me not following what the other cancer center was doing. So, it made me feel better. So my new onc (Verma) and my thoracic surgeon are handling me now and I'm going to stay here awhile and see how my care progresses. It would be pretty hard for me to walk back to the old place now, given everything.

As I said before, these private clinics are in the "business of cancer." They are a for-profit organization...UTSW is a teaching facility and their staffs are paid on salary not on how much chemo or surgeries that they do, so it seems better.

I've heard of Texas Oncology and it sounds like you like your onc - but here's the thing, meet with your 2nd opinion onc at UTSW and see what he/she says about how your plan of treatment has gone and what UTSW thinks is the best thing to do. This will help you in your decision on whether to stay or go.

My old clinic was in town where I lived as I'm sure yours is in Grapevine, so it was conveient to go there and get treatments and see the onc and such...but as my cancer progressed, I began to think that this is life & death and I was at / am at a critical juncture in the battle...so I made a huge leap of faith.

Not sure who your onc will be - you can tell me...mine at UTSW is Dr. Verma and he is very very good - very thorough and very knowledgeable and he takes the time to study cancer - I think this makes the difference between UTSW and a private facility.

I'm following your story now and please keep me updated. I appreciate your prayers for me on the 15th, just 9 little days away - they are going to do the DaVinci surgical system on me - robot surgery as it's so affectionately called. I'm NUMERO UNO for my surgeon and by operating on me, he will get his "certification" and therefore will be able to do the DaVinci on other lung patients that follow me.

I've tried to use my cancer for the benefit of mankind, so this fits in - although I'm a little nervous, but am sure it will be fine...just the unknown is always unnerving until you do it.

Well, Jan, in case you did not notice, I DO talk alot and my posts are some of the largest on the Board, as many people will tell you.

If you want you can go back 3 o4 pages or more on the posts and you will see some of the ones I opened, they usually say something like Sundance Update followed by the topic - once you read them, you will understand more about me.

I too will pray for you and really want to know how it goes at UTSW...and if you decide to stay at TX Onc, then I want to know how things go with you.

You are not alone in this and I am glad there is someone local to me too....makes us feel connected and not all by ourselves down here

It was a pleasure to meet you - and just getting to talk and try to help people helps me take my mind off this surgery coming up - I'm worried but with all of the support on this board, I can't do anything but make it through - people will be waiting to hear how it went with DaVinci!

Take care
-Craig