Biopsies

Fergus2007

Before people get diagnosed with the various stages of colon cancer where biopsies done on other (possibly effected) organs?

Let's say a colon tumor is detected an a biopsy has determined that it is cancerous; if the CT scan shows other "shadows" or "spots" on the liver and lungs shouldn't a biopsy be done to rule out other things that cause shadows and spots?!?
... or would a blood test to check for elevated liver enzymes be enough for a doctor (even though elevated liver enzymes COULD be other things ... )?!?

nudgie

I was Dx with Stage II (NO/MO) colon cancer in July 06 by emergency surgery. They took 7" of my colon and biopsied the tumor which actually staged it.

From other posts, yes, the only way to "determine" the stage of a tumor is to take a piece of it and evaluate it. They can do this to the lungs, liver, etc.

CT Scans will show tumors, but PET Scans can actually show living tumors, smaller ones than CT Scans.

KathiM

While it is true, the only accurate staging is a surgical (biopsy) staging, many people today are being diagnosed/treated without any surgical involvement. It depends on the location, and the tests already mentioned...CT, PET, MRI, blood levels....Staging is a way of telling whether the cancer has spread (also, sadly, a way for the insurance companies to red line you...sigh...)

Some places are hard to reach. But the treating community has become VERY good at finding the beast!

Hugs, Kathi

Fergus2007

nudgie said:

I was Dx with Stage II (NO/MO) colon cancer in July 06 by emergency surgery. They took 7" of my colon and biopsied the tumor which actually staged it.

From other posts, yes, the only way to "determine" the stage of a tumor is to take a piece of it and evaluate it. They can do this to the lungs, liver, etc.

CT Scans will show tumors, but PET Scans can actually show living tumors, smaller ones than CT Scans.

So by analising the colon tumor - spread can be determined to other organs without doing a biopsy on those?!

Fergus2007

KathiM said:

While it is true, the only accurate staging is a surgical (biopsy) staging, many people today are being diagnosed/treated without any surgical involvement. It depends on the location, and the tests already mentioned...CT, PET, MRI, blood levels....Staging is a way of telling whether the cancer has spread (also, sadly, a way for the insurance companies to red line you...sigh...)

Some places are hard to reach. But the treating community has become VERY good at finding the beast!

Hugs, Kathi

So by analising the colon tumor - spread can be determined to other organs without doing a biopsy on those?!

shmurciakova

Hey Fergus,
Let's see if I can explain it any better. A CT scan would be done to show if there are any lesions in the liver, lungs, etc. The liver and lungs are the normal places or should I say the expected places for colon cancer to travel. They analyze the colon tumor. If it is adenocarcinoma of the colon it is expected that it would metastasize to the liver and/or lungs first after leaving the colon via lymph nodes. See what I mean? So, if you or whomever has spots show up on a CT scan it is likely they are mets from the colon cancer tumor. I had a met to my liver show up a while after my original diagnosis. They had a strong feeling it was colon cancer 1)because of my history and 2) because my CEA which is a blood tumor marker was elevated to 40. 3) I had elevated liver enzymes. There was no need to do anything other than remove that part of my liver. It was then sent to the lab for biopsy and indeed was a CC met. While I was on the table they also did an ultrasound of my liver. That way they could see if there were any other mets too small to be seen on the scans. I did have one benign cyst on my liver too which they left alone.
As for the lungs, once again it depends on the patients history. If they have had CC and something shows up on the lungs, more than likely it is mets, esp. if they have elevated CEA...They will then perform a PET scan. The nodules have to be around 1cm before a PET scan will work though. In a PET scan they inject radioactive glucose into the blood stream. Cancer cells readily take up this sugar which then "lights up". They place the PET scan over the CT scan (like a layer) and then can tell if what they saw on the CT was indeed cancer. They can also do a needle biopsy on lung mets.... they are then sent off to biopsy. However, I think the normal route on a Stage IV patient is still an open surgery in which the "nodules" are removed and then sent off for biopsy.
(that is what I had).

Those are the only tests that I know of. I hope that helped, that is generally how it works.
Susan H.

shmurciakova

Fergus2007 said:

So by analising the colon tumor - spread can be determined to other organs without doing a biopsy on those?!

No, but they can tell if the colon tumor has gotten into the lymph nodes. They remove adjacent lymph nodes and biopsy them. They then do a CT scan to see if there is cancer in the distant organs, followed usually by a PET scan, then surgery if necessary or possible. It is possible to have cancer that has spread to lymph nodes but not distant organs. This is Stage III.

Fergus2007

shmurciakova said:

Hey Fergus,
Let's see if I can explain it any better. A CT scan would be done to show if there are any lesions in the liver, lungs, etc. The liver and lungs are the normal places or should I say the expected places for colon cancer to travel. They analyze the colon tumor. If it is adenocarcinoma of the colon it is expected that it would metastasize to the liver and/or lungs first after leaving the colon via lymph nodes. See what I mean? So, if you or whomever has spots show up on a CT scan it is likely they are mets from the colon cancer tumor. I had a met to my liver show up a while after my original diagnosis. They had a strong feeling it was colon cancer 1)because of my history and 2) because my CEA which is a blood tumor marker was elevated to 40. 3) I had elevated liver enzymes. There was no need to do anything other than remove that part of my liver. It was then sent to the lab for biopsy and indeed was a CC met. While I was on the table they also did an ultrasound of my liver. That way they could see if there were any other mets too small to be seen on the scans. I did have one benign cyst on my liver too which they left alone.
As for the lungs, once again it depends on the patients history. If they have had CC and something shows up on the lungs, more than likely it is mets, esp. if they have elevated CEA...They will then perform a PET scan. The nodules have to be around 1cm before a PET scan will work though. In a PET scan they inject radioactive glucose into the blood stream. Cancer cells readily take up this sugar which then "lights up". They place the PET scan over the CT scan (like a layer) and then can tell if what they saw on the CT was indeed cancer. They can also do a needle biopsy on lung mets.... they are then sent off to biopsy. However, I think the normal route on a Stage IV patient is still an open surgery in which the "nodules" are removed and then sent off for biopsy.
(that is what I had).

Those are the only tests that I know of. I hope that helped, that is generally how it works.
Susan H.

The reason I'm asking is:
My father was diagnose with colon cancer 3 months ago.
It's a small tumor that never caused any problems but they did see "spots on the liver" and "shadows on the lung".
There are two lymph nodes around the liver they are "concerned about".
A biopsy has never been done on the lung OR liver ... but a pet scan might have been done.

He has been given VERY aggressive chemo treatment and after only two rounds ended up at the Intensive Care Unit with blood poisoning.
Despite all of that the doctor informs us that he "responded well to the treatment" - the colon tumor shrunk enough to send the Stent though the colon ... and the doctor has been talking about removing the rest of the tumor via surgery.
We are just wondering WHY the colon tumor that was never that big to begin with was not removed before ... and if perhaps the treatment was entirely too strong - and in fact the wrong treatment if it has not been 100% established that the other spots and shadows ARE cancer and not calcium deposits or fungal infections (such as CWD bacteria that does cause blood poisoning ...).

shmurciakova

Fergus2007 said:

The reason I'm asking is:
My father was diagnose with colon cancer 3 months ago.
It's a small tumor that never caused any problems but they did see "spots on the liver" and "shadows on the lung".
There are two lymph nodes around the liver they are "concerned about".
A biopsy has never been done on the lung OR liver ... but a pet scan might have been done.

He has been given VERY aggressive chemo treatment and after only two rounds ended up at the Intensive Care Unit with blood poisoning.
Despite all of that the doctor informs us that he "responded well to the treatment" - the colon tumor shrunk enough to send the Stent though the colon ... and the doctor has been talking about removing the rest of the tumor via surgery.
We are just wondering WHY the colon tumor that was never that big to begin with was not removed before ... and if perhaps the treatment was entirely too strong - and in fact the wrong treatment if it has not been 100% established that the other spots and shadows ARE cancer and not calcium deposits or fungal infections (such as CWD bacteria that does cause blood poisoning ...).

Geez, I couldn't tell you why they didn't remove the tumor right away. It seems to me they needed to shrink it first. They probably also wanted to attack the "spots on the liver" and "shadows on the lung". When is your dad scheduled for another scan? He needs to go ahead and have the original tumor removed, so that seems right. What about his CEA? What is that number?
There is no way to tell if the spots on your fathers lungs are cancer or not, unless they are 1cm in size or greater. They would not light up on a PET scan if they were smaller and area also very difficult to remove when they are smaller than that as well. I doubt if they would operate on him if there are multiple spots or if they are located in certain locations (like the lung lining). There are only certain circumstances in which surgery is an option. That being said, it doesn't matter the size of your fathers tumor. Some people have a relatively small, singe polyp that spreads all over the place (like me). Other people have large tumors blocking the bowel, that end up being stage II. So, it really varies from one patient to the next. I suggest you write down all of your questions so when you talk to the doctor next time you won't forget any of them.
Also, you might consider taking Dad to a major cancer center for a second opinion if you are not already being treated at one.
Best wishes,
Susan H.

hopefulone

If they are relatively confident that spot is cancerous in liver they sometimes do not do a biopsy because there is a chance of seeding... My husband did have a biopsy done and it did indicate cancer as the PET also showed. God Bless
Diane