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Thread: Direct Extension vs Metastatic Cancer

  1. #1
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    Direct Extension vs Metastatic Cancer

    I recently discovered that my colon cancer had gone into my lower spine. My oncologist stated this is could be a direct extension from my known cancer. They started 10 treatments of radiation. However, she also stated that there is a high likely this is metastatic and incurable disease currently. I plan on seeing MD Anderson in Houston for another opinion and other treatment options.

    Technically I guess I'm considered Stage IV since it's reappeared now in my spine. Her approach now that a CT and PET showed everything is clear is to wait. No more treatment options. However she's prepped me for KRAS testing just in case this is metastatic.

    To anyone that has had direct extension cancer: What treatment options did you undergo? Has anyone been to MD Anderson and discovered they offered different treatment options than what is being recommended by their local oncologist?
    1/15/09 - Colonscopy Biopsy (Stage IIIc Colon Cancer)
    1/26/09 - FOLFOX - 5-FU, leucovorin, oxaliplatin, avastin
    5/5/09 - Removal of Stage IIIC Colon Cancer Tumor & Permanent Ostomy. 13 lymph nodes removed 12 positive for cancer.
    8/6/09 - Started 6 weeks radiation w/5-FU pump
    9/21/09 - FOLFOX regimen - 5-FU, leucovorin & oxaliplatin.
    10/12/09 - FOLFIRI regimen - 5-FU, leucovorin & irinotecan.
    05/07/10 - Stage IV cancer in bones and lymph nodes.

    Age Diagnosed 34. Current Age: 35

  2. #2
    Super Moderator Top User sheila's Avatar
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    Moms never had that but from what I understand is it kindof grew another mass from the original that is connect like (an umbilical cord look) and it feeds from the original site. I would think they would treat it like the 1st one either shrink or operate. then with a chemo followup -I pray the find a tolorable regime for you to follow I would think something could still be tried-its gd that yu are trying other opinions and possible other options. dont give up were praying for you I hope someone can step forward with more info on their experience with this type.
    MOMS Journey
    April06- Emergencysurgery,exploratory,10units blood,largetumor and 10inches of colon removed,temp.colostomy.diagnosed stage IV colon.
    oxyplatin,5fu
    Oct06-radiation,surgery,several lymphs,cervix,1 ovary,fallopian,40% remaining colon,large tumor to adipose tissue,appendix,gallbladder removed.permant colostomy/iliostomy
    oxyplatin,transfusion.
    April 07-xeloda-overdose
    surgery-1/3liver,partial diaphra, removed clipped and questionable spots oblated.
    port-port rejection-port removed 1week.
    picc line,5fu,oxyplatin,camptosar.
    Oct-08-surgery-remaining ovary engulfed in tumor,partial bone scrape.
    transfusion central line TPN 1 month.
    oct-09-surgery tumor ,colon and jejuneum removed.
    xeloda reduced. severe dehydration,heart attack.
    april10-remission-avistan
    oct-10-erbitux,camptosar
    Jan-11-5fu
    mar-11 return to original site-oxyplatin,5fu
    Aug-11-erbitux,camptosar.
    dec-28-blood transfusion
    dec-30-back to chemo erbitux camtosar
    Jan-16 injections neulasta and aranesp
    feb16-transfusion
    feb 21-Tumor found stomach,liver, and liver "hot spots" inflamed lymph in rt ureter in kidney causing obstruction-surgery schedualed Mar 16.
    march 16/12-no more kidney obstruction not lymph ...dehydration is causing blockage, two litters blood for anemia, stomach liver tumor small-med,abalation, 1 hidden tumor deep in muscle mass on side flank(hid from scans) -gone!
    june/15/12-blood transfusion
    starting a regimine of celebrex
    aug/16/12-blood transfusion
    aug/30-12 discontinued celebrex -failure one kidney. needed to see urologist
    sept/10-12-good urologist report one kidney functioning well for now.
    oct/23/12-chemo pill Stivarga(regorafenib)
    Nov/22/12-blood transfusion
    dec/18/12-blood transfusion chemo pill dosage cut back to 1 pill.
    Feb/21/13 neulasta injection
    Feb/22/13-blood transfusion. still taking stivarga.
    mar/20/13-arenespt injection rehydration and magnesium IV
    mar/21/13-acute renal failure-kidney infection
    april/1/13.-recovery from 4 day coma infection cleared/4 units blood/ off stivarga/starting rehab therapy,
    swollen hand no apparent reason black spots in vision off and on. both cleared up.
    may/22/13-home oxycodone for pain shoulder neck arm
    june/1/13 pain subsided off oxy onto aleve
    june/09/13-pain back off aleve on vicodin
    june 10/13-cancer in back/neck- starting radiation for arm neck and shoulder pain.
    june24/13-last day of radiation-on steroids
    july1/13-swollen legs and feet-lasix off steroids still on vicodin and xanax
    july 23/13 vicodin cut in half blood transfusion.
    sept/6/13-off all pain meds since late aug
    scan results fracture in spine mid back
    sept/12/13-spine healing on its own,weaning off steroids, no visible tumors.
    nov/7/13-edema both legs and one arm on lasix since oct.
    nov/21/13- leg edema subsiding still alot in one arm- she is talking but keeps her eyes closed. achy but no major pain. nurse and aide to visit once a week schedualed. having trouble standing.
    nov/24/13-sadly but peacefully moms cancer journey is at an end, she will start her new spiritual journey together hand in hand with dad.

  3. #3
    Top User topazil's Avatar
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    California
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    I am going to have to do some research on "Direct extension" rather than metastatic cancer, I have always "assumed" (and we know what that does (grin) that if colon cancer moved to another site it was metastatic but then I don't even know what direct extension means yet

    Mine went from my colon to my lungs and liver, had already done so before I was even diagnosed or the colonoscopy or biopsy or surgery to take out the tumor from my colon was done the Oncologist said from the amount and size of the mets.

    Is this incurable? As of now yes stage 4 colon cancer metastasized to other areas is considered incurable and in some cases (mine) inoperable but that could be due to my now Oncologist being very anti surgery (won't even really talk about ablation surgery at this time, although when I decide it is time to bring "that talk" up with him again I will.

    It does not however mean that a cure won't be found in this year, next year, the year after that etc. Realistically I have set myself to now hoping to make it to my 52nd birthday (My 50th is this July) which is way past what they told me but I am being optimistic (but again my moods do change LOL) and positive that my chemo will keep me going for a few more years.

    I do have the KRAS mutation and there are two types, one is like a dormant kind and doesn't affect you really, I have the other kind where some forms of chemotherapy are out for me as the KRAS mutation makes those chemos not work for some reason.

    I hope to hear good things back from you regarding what you find about if it's direct extension versus metastasized, your treatment and how it goes and am praying your test for the KRAS comes back negative or the kind that really doesn't affect you.

    You sound in good spirits but I am wondering why your Onc. said no more treatment options?

    Also sorry but I can't help with the direct extension or M.D Anderson questions but hopefully someone will come along and be able to answer them.

    You are in my thoughts and prayers and (((((((((hugs)))))))))))
    Total hysterectomy July 23 2008, mass in colon.
    Colonoscopy Aug 2008
    Rigid Sigmoidoscopy with a laparoscopic-assisted partial colectemy with enbloc small bowel resection Sep 2008
    Diagnosed: Stage IV Colon Cancer mets to lungs and liver. (T3,N2,M1,G2) KRAS Mutation
    Started chemotherapy: 09/14/09 Folfox-6/Avastin then Camptosar/Avastin & last Folfox-6/Avastin
    On Hospice, started 11/12/10
    Last PET scan: Oct 12th
    Most recent CEA Level: 09/27/10: 696.7 up from 08/16/10: 284.8

  4. #4
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    Topazil,

    From what I understood when the doctor explained the difference between metastatic and direct extension cancer. Metastatic travels through the bloodstream to get to another location. Direct extension cancer is leftover cancer cells that had migrated outside of the primary tumor and spreads into the surrounding tissue. Sometimes the evasion is so far reaching that it affects and causes secondary tumors to nearby areas. Since my primary tumor was in my colon she stated it isn't a far stretch that it reached the lower spine. We are hopefully optimistic.

    She went on to state "if this spine lesion is related to direct extension from his known cancer, we may be able to significantly improve his survival". When I corner her what significantly improved meant she said it would be like having the same survival as where I was before Stage 3c.

    I was equally confused what she meant by no more treatment options if metastatic and is one of the primary reasons I seek advice from MD Anderson. In the back of mind I always thought there was surgical treatments, RFA, cyrotherapy, radiation, etc. Though none of them is a guaranteed "cure" you might be that 1 in 10 that survives. She has already prepared me with the possibility of chemo to extend life but as far as any other options mentioned above she stated you won't find any surgeon willing to perform surgery for stage IV cancer. To me it sounded like she was basically turning her back on me with that statement.
    1/15/09 - Colonscopy Biopsy (Stage IIIc Colon Cancer)
    1/26/09 - FOLFOX - 5-FU, leucovorin, oxaliplatin, avastin
    5/5/09 - Removal of Stage IIIC Colon Cancer Tumor & Permanent Ostomy. 13 lymph nodes removed 12 positive for cancer.
    8/6/09 - Started 6 weeks radiation w/5-FU pump
    9/21/09 - FOLFOX regimen - 5-FU, leucovorin & oxaliplatin.
    10/12/09 - FOLFIRI regimen - 5-FU, leucovorin & irinotecan.
    05/07/10 - Stage IV cancer in bones and lymph nodes.

    Age Diagnosed 34. Current Age: 35

  5. #5
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    It is worth getting a second opinion to know our options. I would like to share my story if it's okay with you. When my dad was diagnosed with stage 4 colon cancer in July 2009 with mets to lung (two small spots), the oncologist told us that this was incurable, but he can offer chemo to prolong life. We were told that based on my dad's age (5 and being a very healthy person besides having cancer, his average lifespan could be around another 3 years. We were devastated and when the surgeon told us there was a possibility of the cancer and metastasis being operable and what he considered "curable," we took that chance. The November 2009 surgery was unsuccessful. Once they opened him up they said they had a better look and didn't think it was operable. He had a very tough time getting the incision to heal and we couldn't start chemo to prolong life because they won't do chemo if you have open wounds or infections. We never were able to start chemo. He ended up with multiple large obstructions throughout his small intestine and he ended up passing away March of this year.

    My friend's dad went through a similar experience as my dad. Apparently, if the surgery is unsuccessful in removing the cancer, once they close you up there is a very high chance it will spread even faster. The cancer cells get disturbed during the surgery and migrates to various organs. Looking back, we were so devasted with the prognosis of possibly 3 years to live that we took the chance on surgery without knowing that things would be shortened. We thought that if surgery didn't work out we could do chemo and still have 3 years.

  6. #6
    Super Moderator Top User sheila's Avatar
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    Thats crazy-moms 76 years old with an initial diagnoses of stage IV colon cancer and here she is still here 41/2 years later and all her doctors are still trying every angle possible. Now with surgery it probably depends on where the mass /tumor is located. but usually there are things they will try .
    MOMS Journey
    April06- Emergencysurgery,exploratory,10units blood,largetumor and 10inches of colon removed,temp.colostomy.diagnosed stage IV colon.
    oxyplatin,5fu
    Oct06-radiation,surgery,several lymphs,cervix,1 ovary,fallopian,40% remaining colon,large tumor to adipose tissue,appendix,gallbladder removed.permant colostomy/iliostomy
    oxyplatin,transfusion.
    April 07-xeloda-overdose
    surgery-1/3liver,partial diaphra, removed clipped and questionable spots oblated.
    port-port rejection-port removed 1week.
    picc line,5fu,oxyplatin,camptosar.
    Oct-08-surgery-remaining ovary engulfed in tumor,partial bone scrape.
    transfusion central line TPN 1 month.
    oct-09-surgery tumor ,colon and jejuneum removed.
    xeloda reduced. severe dehydration,heart attack.
    april10-remission-avistan
    oct-10-erbitux,camptosar
    Jan-11-5fu
    mar-11 return to original site-oxyplatin,5fu
    Aug-11-erbitux,camptosar.
    dec-28-blood transfusion
    dec-30-back to chemo erbitux camtosar
    Jan-16 injections neulasta and aranesp
    feb16-transfusion
    feb 21-Tumor found stomach,liver, and liver "hot spots" inflamed lymph in rt ureter in kidney causing obstruction-surgery schedualed Mar 16.
    march 16/12-no more kidney obstruction not lymph ...dehydration is causing blockage, two litters blood for anemia, stomach liver tumor small-med,abalation, 1 hidden tumor deep in muscle mass on side flank(hid from scans) -gone!
    june/15/12-blood transfusion
    starting a regimine of celebrex
    aug/16/12-blood transfusion
    aug/30-12 discontinued celebrex -failure one kidney. needed to see urologist
    sept/10-12-good urologist report one kidney functioning well for now.
    oct/23/12-chemo pill Stivarga(regorafenib)
    Nov/22/12-blood transfusion
    dec/18/12-blood transfusion chemo pill dosage cut back to 1 pill.
    Feb/21/13 neulasta injection
    Feb/22/13-blood transfusion. still taking stivarga.
    mar/20/13-arenespt injection rehydration and magnesium IV
    mar/21/13-acute renal failure-kidney infection
    april/1/13.-recovery from 4 day coma infection cleared/4 units blood/ off stivarga/starting rehab therapy,
    swollen hand no apparent reason black spots in vision off and on. both cleared up.
    may/22/13-home oxycodone for pain shoulder neck arm
    june/1/13 pain subsided off oxy onto aleve
    june/09/13-pain back off aleve on vicodin
    june 10/13-cancer in back/neck- starting radiation for arm neck and shoulder pain.
    june24/13-last day of radiation-on steroids
    july1/13-swollen legs and feet-lasix off steroids still on vicodin and xanax
    july 23/13 vicodin cut in half blood transfusion.
    sept/6/13-off all pain meds since late aug
    scan results fracture in spine mid back
    sept/12/13-spine healing on its own,weaning off steroids, no visible tumors.
    nov/7/13-edema both legs and one arm on lasix since oct.
    nov/21/13- leg edema subsiding still alot in one arm- she is talking but keeps her eyes closed. achy but no major pain. nurse and aide to visit once a week schedualed. having trouble standing.
    nov/24/13-sadly but peacefully moms cancer journey is at an end, she will start her new spiritual journey together hand in hand with dad.

  7. #7
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    Mar 2008
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    Houston, Texas
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    I think that is what I have. My original tumor was in my colon, but it spread to the peritoneal tissue next to it.

    They thought it had spread to my liver and my adrenal gland, but now they are not sure about that, as my last CT scan showed those clear. I'll know more on my next scan in May.

    My CEA has always been normal. I was under the impression that CEA shows the cancer is in the blood, but I am not positive about that.

    I read that the main tumor can make colony tumors, but it keeps them microscopic because it doesn't want to compete with them. When the main tumor is removed, they are free to grow, and start showing up. I think this is why my doctor told me if the cancer was going to show up, it would most likely do so in the first 18 months after the tumor was removed.
    10/01/07 - Removal of Colon Cancer Tumor & Temporary Colostomy
    11-07-07 to 04-09-08 FOLFOX and Avastin. 04-28-08 Colostomy Reversal
    June 2009 3 Tumors in the Peritoneal tissue- FOLFIRI and ERBITUX.
    11-25-09 Tumors inactive(Oct). Finish FOLFIRI, continue ERBITUX
    Jan 2010-May 2010 FOLFIRI and ERBITUX.
    June 2010 Cancer in Liver. Nov 2010 - Oxyplatinum, Avastin and IROX
    Age Diagnosed 40. Current Age:44

  8. #8
    Super Moderator Top User sheila's Avatar
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    Jul 2008
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    bethel park pa
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    I agree with REB as to how the cancer grows. but alot of the metastic cells with chemo or radiation etc are weakened and alot are wiped out. When metasticised to lymph nodes ar to the blood stream that is the most difficult.-NOT that it cant be done its just alot harder. We could before gaurantee something would show up every 4-6 mo after chemo but moms is one of the most agressive and not all fall under that catagory-I cant tell you how many times mom decided no more treatments then as time grew closer she changed her mind and decided to keep fighting. and because of that we have had some really nice memmorable family time
    but as of right now they see none visable with the scan 2 days ago. that is encouraging her to keep going. And what REB was saying about growing and going through the colon walls-thats what happened to mom-she just waited too long. Had she of caught this earlier it may not have been this case. Do this not only for your family but for yourself especially Your heritage should be able to give you strength. Dont give up on your dignity. hang ion there I will be praying for you as well as REB)
    MOMS Journey
    April06- Emergencysurgery,exploratory,10units blood,largetumor and 10inches of colon removed,temp.colostomy.diagnosed stage IV colon.
    oxyplatin,5fu
    Oct06-radiation,surgery,several lymphs,cervix,1 ovary,fallopian,40% remaining colon,large tumor to adipose tissue,appendix,gallbladder removed.permant colostomy/iliostomy
    oxyplatin,transfusion.
    April 07-xeloda-overdose
    surgery-1/3liver,partial diaphra, removed clipped and questionable spots oblated.
    port-port rejection-port removed 1week.
    picc line,5fu,oxyplatin,camptosar.
    Oct-08-surgery-remaining ovary engulfed in tumor,partial bone scrape.
    transfusion central line TPN 1 month.
    oct-09-surgery tumor ,colon and jejuneum removed.
    xeloda reduced. severe dehydration,heart attack.
    april10-remission-avistan
    oct-10-erbitux,camptosar
    Jan-11-5fu
    mar-11 return to original site-oxyplatin,5fu
    Aug-11-erbitux,camptosar.
    dec-28-blood transfusion
    dec-30-back to chemo erbitux camtosar
    Jan-16 injections neulasta and aranesp
    feb16-transfusion
    feb 21-Tumor found stomach,liver, and liver "hot spots" inflamed lymph in rt ureter in kidney causing obstruction-surgery schedualed Mar 16.
    march 16/12-no more kidney obstruction not lymph ...dehydration is causing blockage, two litters blood for anemia, stomach liver tumor small-med,abalation, 1 hidden tumor deep in muscle mass on side flank(hid from scans) -gone!
    june/15/12-blood transfusion
    starting a regimine of celebrex
    aug/16/12-blood transfusion
    aug/30-12 discontinued celebrex -failure one kidney. needed to see urologist
    sept/10-12-good urologist report one kidney functioning well for now.
    oct/23/12-chemo pill Stivarga(regorafenib)
    Nov/22/12-blood transfusion
    dec/18/12-blood transfusion chemo pill dosage cut back to 1 pill.
    Feb/21/13 neulasta injection
    Feb/22/13-blood transfusion. still taking stivarga.
    mar/20/13-arenespt injection rehydration and magnesium IV
    mar/21/13-acute renal failure-kidney infection
    april/1/13.-recovery from 4 day coma infection cleared/4 units blood/ off stivarga/starting rehab therapy,
    swollen hand no apparent reason black spots in vision off and on. both cleared up.
    may/22/13-home oxycodone for pain shoulder neck arm
    june/1/13 pain subsided off oxy onto aleve
    june/09/13-pain back off aleve on vicodin
    june 10/13-cancer in back/neck- starting radiation for arm neck and shoulder pain.
    june24/13-last day of radiation-on steroids
    july1/13-swollen legs and feet-lasix off steroids still on vicodin and xanax
    july 23/13 vicodin cut in half blood transfusion.
    sept/6/13-off all pain meds since late aug
    scan results fracture in spine mid back
    sept/12/13-spine healing on its own,weaning off steroids, no visible tumors.
    nov/7/13-edema both legs and one arm on lasix since oct.
    nov/21/13- leg edema subsiding still alot in one arm- she is talking but keeps her eyes closed. achy but no major pain. nurse and aide to visit once a week schedualed. having trouble standing.
    nov/24/13-sadly but peacefully moms cancer journey is at an end, she will start her new spiritual journey together hand in hand with dad.

  9. #9
    New User
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    Direct Extension & metastatic

    Hello - it is difficult to wade through all the 'terms and jargon' but my husband was diagnosed with metastatic colorectal cancer that was found due to his neck being stiff. He had been having physical therapy and when it did not work an xray found a tumor on his C2-C5. He is 51 and fit and never had surgry or a hospital stay in his life. He had pressure on his spine causing some paralysis so they surgically removed part of the tumor and then radiated what was left to relieve pressure.
    Consequently it was found that the primary is colorectal cancer and it is in his liver, both lungs, spine and thyroid as well as thorughout his small and large intestine. ALthough we have been told it is inoperable due to the distant mets we had 3 rounds of chemo (Folfiri and one with Avastin) and then he suffered a perforation of his small intestine - he is currently still recovering from perforation and luckily did not require surgery however spent 17 days in the hospital with IV's of antibiotics and food.
    We have no idea how much time he has - we have never asked but we know without chemo it is reduced. I wish you all the best and am so sorry we are all on this forum but I hope this helps.
    Husband DX 12/09
    Spinal Surgury Laminectomy 12/09
    Chemo Folfiri 3 rounds 1 round Avastin stopped on 3/19
    perforated small int. - currently recovering.

 
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