Latest update from brother: Thoughts on maintenance approach?

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Morning Roy, I was looking forward to hearing from you. Just wondering what your thoughts are about the oncologist just monitoring his lung via blood work rather than a biopsy. Also, would signaterra test be recommended at this juncture? I think it was you that mentioned that a while back. My brother is content at this time to follow what his doctor recommends but I prefer to be a little more proactive. He may or may not take my advice but knowledge is power to me. Of couse, we still need to wait to see what his colorectal doctor says so I may be jumping the gun but still wanted to post these results.

Hi - I would suggest you try to get answers to the following questions, 1) does the doctor believe there is evidence of cancer currently in the lung 2) how was the lung scanned was it a CT or MRI. An MRI might be better to differentiate scar from active cancer 3) You mentioned blood work is going to be done 3 months from now what tests are going to be done to determine act of cancer.

Signatera is covered by Medicare but it's typically used only to detect new cancer or recurrence of cancer. To do this test you would have needed to procure a sample of the original colorectal tumor as the test is made to react to those cancer cells. Ask the oncologist about whether Signatera or another test called Guardant Reveal

Continuing.... Would be applicable to detect whether there is active cancer, And which test would be good for detecting residual or recurrent cancer.

@roywalton Interesting thank you. I had Avastin with Folfiri for my stage 4 dx for appendix cancer (now NED). I also have a small area on my lungs which is monitored as part of my 4 monthly CEA blood tests and PET-CT scan. I understand from my oncologist that they prefer not to do a lung biopsy because of the risks involved in the surgery, unless it becomes necessary to take on those risks. Any thoughts?

42-62% of indeterminate nodules detected by are found to be benign after biopsy. Furthermore, 15% of transthoracic needle biopsies result in complications. So often oncologists take a wait and see approach. If the nodules are small there's a good chance that they cannot be sampled and so that you will get a false negative result because good tissue was tested

True.
After diagnosed with stage 3C colon cancer and having my colon and 108 lymph nodes removed (some malignant), scans found numerous things including 6 spots on the lungs. They monitored them via regular CT scans - they were too small to biopsy - thus the "wait and see" approach. Those spots didn't change over the following 3.5 years. Mayo is now monitoring everything via regular CEA tests.