Solitary lymph node metastasis : what treatment is available?

OnTheRoad said:

I am in a very similar situation right now

I am in a very similar situation at this moment. 2 lymph nodes with around the same size of yours appeared in a control CT I do from time to time. My CT was done last week.

The comments from my oncologist were:

- The "normal" size of a lymph node is around 1cm. Your (and mine) lymph nodes are not much larger than that, which means it could not be cancer, but an infection

- He requested a PET scan to be done 3 weeks from now. This means I will do the PET 4 weeks after the CT that perceived the enlarged lymph nodes. He says if the lymph nodes are currently enlarged due to an infection or other cause not related to the cancer they should have a smaller size when the PET is done. If they light up and are still about the same size (or larger) he will consider them as mets and then we will plan how to get rid of them.

 

I am having biopsy today of the lymph node

OnTheRoad said:

I am in a very similar situation right now

I am in a very similar situation at this moment. 2 lymph nodes with around the same size of yours appeared in a control CT I do from time to time. My CT was done last week.

The comments from my oncologist were:

- The "normal" size of a lymph node is around 1cm. Your (and mine) lymph nodes are not much larger than that, which means it could not be cancer, but an infection

- He requested a PET scan to be done 3 weeks from now. This means I will do the PET 4 weeks after the CT that perceived the enlarged lymph nodes. He says if the lymph nodes are currently enlarged due to an infection or other cause not related to the cancer they should have a smaller size when the PET is done. If they light up and are still about the same size (or larger) he will consider them as mets and then we will plan how to get rid of them.

 

Thank you OnTheRoad for sharing your story. It helps me understand how other physicians are treating this

Hi Wadsdan, the biopsy returned bad results. Positive for metastatic adenocarcinoma. I cried a bit with my wife. Still processing. Worrying. I dont know what treatment if there is available

OnTheRoad said:

I am in a very similar situation right now

I am in a very similar situation at this moment. 2 lymph nodes with around the same size of yours appeared in a control CT I do from time to time. My CT was done last week.

The comments from my oncologist were:

- The "normal" size of a lymph node is around 1cm. Your (and mine) lymph nodes are not much larger than that, which means it could not be cancer, but an infection

- He requested a PET scan to be done 3 weeks from now. This means I will do the PET 4 weeks after the CT that perceived the enlarged lymph nodes. He says if the lymph nodes are currently enlarged due to an infection or other cause not related to the cancer they should have a smaller size when the PET is done. If they light up and are still about the same size (or larger) he will consider them as mets and then we will plan how to get rid of them.

 

I met with my oncologist yesterday and he asked about my openness to strong chemo (FOLFOXIRI) for about three months and follow up with maintenance chemo. I responded that I am open to everything.

He believes that the chemo can kill cancer cells in the lymph node and will provide systemic therapy. He was not an advocate for surgery. He said that removing the lymph node is an extensive surgery with potential complications, you might feel better if you remove it but it does not guarantee that cancer does not come back. If we go for surgery, he would like me to do surgery first , recover from it and then do the chemo. He also talked about potentially adding few doses of radiation to the area but was not sure of someone would be willing to do that for me.
I am being referred to a surgeon to see what options I have. And also a radiologist.

I would like the treatment to start as soon as possible but the oncologist says I have time and I should meet with surgeon and come up with treatment plan. Overall I am uneasy and anxious

SnapDragon2 said:

He is right.  It's

He is right.  It's complicated and a gamble for sure.

Have you had the ctDNA testing and CTC?

No, I have not. The oncologist (whom I respect immensely) said I am sending messages to him through the intenet too frequently before he even gets a chance to think. I have heard of CtDNA but forgot to include it in the list of questions when I met him. Dont know CTC. 

My oncologist says that cancer is in lymph node which means it could go anywhere from there and is probably circulating in blood stream. He says it is pointless to cut out one lymph node because you dont know where else  it might have gone . It might have gone to nearby lymph nodes, faraway lymph nodes or organs. Surgery will only get out one lymph node and he wonders whether it is worth the complications especially given that it does not guarantee that the cancer wont come back. He is advocating for strong chemo to get rid of as much cancer cells in the body as possible. If there is surgery and  chemo, he would do chemo only after the surgery and recovery from it. If we do the chemo first, he is concerned that the surgeon wont be able to locate the lymph node ( which is already too small, 1.2 cmx1.6cm )  would shrink further and become hard-to-locate. I am concerned that doing the surgery first, further delays chemo allowing cancer cells to circulate and spread . 

Real Tar Heel said:

I am maybe not the best

I am maybe not the best example but on the last recurrence, given the choice to do chemo or surgery I chose surgery only. I was in remission a little longer than I was when I was on adjuvant chemo. The best part about that time was not having chemo. When we are counting the days, I place some importance on being able to experience those days. I don't know about lymph involvement from any personal experience but if they are worried about being able to see what they need to cut out I think that is pretty important.

I don't know why he's bringing in he word "guarantee" because none of us have that, especially those who have spread to distant organs, no matter which path we take. If he means there is a greater likelihood of success with one way or the other, maybe listen to his advice.

There are a lot of "ifs," but if you do chemo first and they can't find what they need to cut you've lost an option. If you do surgery first, you have chemo left to try. With most treatment standard of care, you have option B and C left as well.

Thank you for your perspective Real Tar heel. Chemo needs to happen regardless of whether the surgery happens or not.