CRC lung nodule..... chances can be Mets?

iron9nadin

I was diagnosed (40yo female) 3c rectal tumor July 2024, did chemo and radiation august 2024 through Feb 2025, LAR in April, iliostomy reversal this past June. My CEA in May 3.8, July: 38. Just had CT scans done yesterday and found a 1.4x1.5cm spot on lower left lung. (A spot was noted in June 2024 petCT 3mm lower left lung and wasn't a concern at the time.)

Chemo doc wants biopsy and petCT, surgery to remove and then 6mo of chemo. He sounds pretty confident its CRC Mets to lung. Seems to be rush rush rush. I don't want to be pushed around in fear urgency. So hard to trust the "system" when I know I'm a huge $$$ for cancer docs.

How urgent can these Mets things be? I have a trip home next week to see family that I haven't seen for all of my treatment thus far. Thanks for your input.

bibliophile

Sorry I was offline for the last two weeks and you probably already had to make a decision. Here is my experience. Now 48yo female. Diagnosed 2 years ago with Stage IIIC sigmoid colon cancer. Did 6 mos CAPEOX. Had 5mm lower left lung nodule at diagnosis along with two other 3mm nodules other places. Monitored during regular scans for same reason as you - nodules can be anything and aren't assumed to be a concern. Nov 2024 CT started showing signs of growth in LLL, but still under 1 cm; other nodules never changed - presumed benign. Doc let me go on vacation with my family to Hawaii over New Year's. Did a PET scan immediately after and showed low-level uptake. Did ctDNA and came back positive. CEA still normal. Signs seemed to point to possible malignancy. Recommended surgery instead of just biopsy because lower left lung is easily resectable and then if post-surgery biopsy showed malignancy, it is already gone. Had laparoscopic wedge resection for 9mm mass in March and recovered very quickly. Biopsy showed malignancy, but surgery had removed it with clean margins. I hope my experience helps you weigh your options and you can have an open conversation with your doc regarding urgency. If he wasn't concerned before, but is now and it has grown, that is information to consider. My doctors have been really great about helping me weigh the importance of family time vs treatment. I just took one cycle off of my current chemo regimen to go to family camp with my husband and kids (a 20-year tradition) and take a 25th anniversary trip to Montana with hubby and start again Tuesday. Hopefully your doctors are as open to conversations about pros and cons. I would love to hear an update from you if you care to share.

iron9nadin

https://csn.cancer.org/discussion/comment/1723979#Comment_1723979

Thanks so much for your input. I did end up canceling my trip for now. I found it more advantageous to set myself up for success by being home, getting scans done, good sleep and eating, prepare for post surgery. I live in the hawaiian Islands and will have to travel to Oahu for surgery. The family reunion and my siblings bday/summer BBQ fun would have been good memories; and I would not have allowed myself to enjoy it the same; I wouldn't eat the cake and probably would stay up late every night making memories and draining my immune system. Thankful that I know myself and recognize it. Thankful to push the trip forward a few months and maybe get back for fall colors, pumpkins and cool weather. We will have a grand time whenever it is.

We decided to go with a 2in1 biopsy and removal surgery. Less time on the table, all robotic and 3d CT ion, something hi-tech. My surgeon is top in the west. Stoked for the team, prompt care and thorough communications.

How was your recovery from the lung sugery?

Did you do chemo after lung surgery?

How are you doing now/feeling?

Thanks for keeping in touch, no pressure if it's too much. Aloha

bibliophile

Knowing yourself and how you will deal with things is also important to consider. Glad you found a plan you are happy with. Hoping your surgery gets the best results possible! When is it?

Sounds like I had a similar surgery to the one you are having and I would call my recovery from surgery very easy, but I know people who have had very different experiences. I am 48, and generally in very good health otherwise. I was in the hospital for two days to monitor the chest tube afterwards. The chest tube was painful at times, but was only in for about 24 hours and once it was removed I was only mildly uncomfortable - more sore muscles than anything. Tylenol once in the hospital while chest tube was still in, no pain meds after that. On restricted upper body movement for about 2 weeks, and after that I was fine. My surgeon said no flying for 3 months.

My oncologist did not recommend chemo after surgery for the following reasons: 1)I had no other suspicious areas at that time 2) the nodules had not disappeared on chemo before so my tumor review board did not think the benefits of chemo to possibly eradicate unseen cancer cells that were not causing any symptoms outweighed the side effects. I guess hindsight is 20/20. I totally agreed at the time.

I was feeling amazing after my surgery. I had zero symptoms before my surgery and once I recovered, I had zero symptoms again and was hoping everything was taken care of and I could move on with my life. Unfortunately, my 3-month CT/ctDNA/CEA checks showed previously undetectable (and therefore likely aggressive) spread to abdominal lymph nodes and my peritoneum with positive ctDNA and rapidly rising CEA. So my local oncologist started me on a treatment plan of FOLFIRINOX with consults to major cancer centers about the possibility of cytoreductive surgery. Both Cleveland and Mayo confirmed that chemo plan and I have settled on local chemo with Mayo directing my surgical evaluation. I have a baseline MRI the 18th and follow-up MRI and exploratory laparoscopic surgery at Mayo November 4th to try and determine extent of disease to see if I am a candidate for surgery. At some point they will probably add Avastin to my treatment plan as I am KRAS mutant and not eligible for any of the known immunotherapies, but we are waiting until after my son's wedding in a few months because I tend to get bad side effects to most things and don't want to risk missing the wedding. So to answer how I am feeling, the chemo is really rough for the first 2 days while I am on active infusions, but the farther out I get, the better I feel (I am on 2-week cycles). Just trying to enjoy every good day to its fullest and still get some exercise and eat healthy as much as possible.

I would love to hear how your surgery goes and am happy to chat any time, even by private message if you prefer. Best wishes!

iron9nadin

Thanks for the reply.

My surgery is on 8/18. Hope your scans on 18th go well as well. Great to hear how your recovery was.

I appreciate you sharing your story. My surgeon said similar, since it grew when I was doing chemo, it is probably resistant and I guess most stage 4 situations are. I'm guessing the chemo you did (FOLFIRINOX) is different from what you did previously. I did folfox before.

The wedding will be so wonderful. Do you do other special adjunctive treatments at this time? Or in-between treatments? My partner looking at gerson and I've been doing high dose vitamin C iv since last year.

I am active, healthy and otherwise well. I'm manifesting this is the end of this journey for me and I'll have years of clear road ahead. Hoping the same for you!

bibliophile

https://csn.cancer.org/discussion/comment/1724002#Comment_1724002

Sorry for the late reply. I have been sick this week (virus).

Yes, this chemo is different. I did CAPEOX (oral capecitabine instead of IV 5FU) the first time, so this adds irinotecan to the mix. Other than trying to eat really clean, mostly raw vegan (although that is much harder now that I am back on chemo), I am not doing an alternative treatments at the moment. I am researching the vitamin C, though, as there are some promising studies in other cancers. Do you mind if I ask what you think the effects of that have been for you? Do you get them through your oncology practice or an alternative provider? Does insurance cover it?

Thinking of you as you get ready for surgery! I hope everything goes really well! Keep us updated afterwards as you feel like it. Best wishes!

iron9nadin

https://csn.cancer.org/discussion/comment/1724102#Comment_1724102

Hi. Hope you're well. I'm doing great, considering I am 1 week post lung segmentectomy. Pain is pretty minor, I'm taking tylenol as needed. Chest tube was a very interesting thing, they said the removal was the smoothest pull they'd seen yet. No pain at all. I was walking 2 Miles a day in the hospital (1mi= 22laps). Definetly more pain from the tube than the incision sites. The walking really helped my recovery. I'm home now and taking this time of slower living to listen to my intuition. It's a work in progress that will help me in all my days to come.

Pathology came back, tumor was positive for my same CRC, as well as one of my lymph nodes they took. So, technically, I'm stage 4. I meet with my Oncologist on Wed, and I know he already wants me to do 6mo of chemo. Can you tell me about how the chemo you're on now feels?( no pressure, if they put me on the same, I'll be doing Hella research.) I wonder if that's what he'll set for me. I do want to make sure my new tumor DNA is put in the equation to see what's the best treatment for ME!

I set up a HDVC appt for Wed this week. I've been doing 50 grams of Vit C majority of the time. I have done 75g which is the max. It definetly does NOT feel like sunshine in an orange grove. I am very thirsty when I'm on the drip and after. If you feel any pain (pinch/burn) during, it's running in to fast or too high of an amt. I've done many in the last year, try for 1 a week during my chemo and radiation weeks. I felt it helped my immune system rebound faster from the treatments. I did schedule a nap in my calendar after. As you've researched you've seen all the benefits. My Oncology was against it, my radiation doc said, I don't know enough about it to say it's helping or not. I think that is the best answer from western trained medical folks. The VIT C was from a private center here and is pricey. Ive seen clinics on line on mainland US for $150. Its $250 for 50g and $315 for 75 g. I didn't see much benefit from the 75g dose competitively. The way I understand it, taking Vit C orally is an anti-oxidant, which is what the oncologists don't want you taking. They are giving you chemo and and antioxidant could negate their treatment efficacy. HdVC iv treatments are oxidating your system. When it is intravenous, it works similar to how peroxide works on the skin, creating oxygen. Oxygen kills cancer. I feel the benefit is greatest for boosting immune system and killing off roaming cancer cells that are wandering in the blood looking for a place to settle in. I'll be hitting the HDVC extra hard now, post surgery to aid.

I hope you got Scan results back by now from your MRI last week and things progress well for you.

bibliophile

Hi, iron9! So glad to hear that the surgery recovery is going really well. Sorry to hear that there was also a positive lymph node. Were they able to get clear margins on everything?

I am currently on Folfirinox (or a variant of it) which is Oxaliplatin, leucovorin, irinotecan, and 5-FU, all IV. In general, I feel much more "sick" than I did on the oxaliplatin + capecitabine I was on the first go-round. More nausea, and I get one of the nasty, rarer side effects from the irinotecan. Much more fatigue also. I felt like I didn't let CAPEOX keep me from doing the things I wanted: never missed church, never missed a high school sporting even for my kids. This time I am missing things because I am just too wiped out. That is a bummer. If that ends up being what they put you on and you have more specific questions, please ask. I would happy to share. I think the reasoning for such an aggressive regiment, though, is that I still progressed on CAPEOX, so they needed to up the ante.

Thanks for your experience with HDVC, that was informative. I will take that under advisement.

I assume that your oncologist will send out for all your genetic markers because there are some promising treatments for some of them. I just didn't match any of those.

I had my MRI on Monday, but the radiology report from my local radiologist wasn't very informative. Had it pushed to Mayo today so they could read it and am hoping to get some feedback from them soon. It didn't look worse than expected, though, so that is good.

Thanks for the update! Keep in touch!