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Monitoring for reoccurrence
Hello Warriors, new member here, and apologize in advance for the length of this question.
Seven year EC survivor here, diagnosed late Stage 3B, T3N2M0 adenocarcinoma with signet ring cell morphology. Originally considered inoperable due to tumor completely encasing the celiac artery. I had been diagnosed years before with Barrett’s Esophagus and had endoscopic biopsies done on a regular basis (including a clean biopsy 3 months prior to discovery of adenocarcinoma). The problem with my tumor was it grew on the outside of the esophagus and stomach, and was never detected by Endo biopsies of the Barrett’s. Long story short, after 7 months of EOX chemo regimen, followed by 28 radiation treatments along with constant 5FU chemo pump, tumor shrank and had majority of both esophagus and stomach removed along with tumor and all affected lymph nodes. Thanks for bearing with me. My question is now, since I no longer have the upper sphincter in my stomach, acid is a constant issue, and I have been diagnosed again with Barrett’s. My oncologist still does bloodwork every 6 months and my GI doctor does annual endoscopy with biopsies on my confirmed long-segment metaplasia. Since my cancer was never found in previous biopsies of my Barrett’s, I’m inclined to think any reoccurrence won’t be detected as well. Besides CT, PET and MRI scans, which has it’s limitations on detecting signet ring cell, are there any other early detection techniques available? In studying signet ring cell, it is particularly difficult to detect (until later stages) and has a particularly higher frequency of reoccurrence. Many thanks, and again sincere apologies for bring long-winded!
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Congratulations on your 7 year survival mark. Given the description of your case history, that is quite remarkable
It seems as if your GI and oncology are providing you with appropriate follow up and maintenance care. As you are aware, EC be it adeno or squamous cell is rarely fully curable but with appropriate therapies one may experience a good sustained clinical response and the disease may become indolent. Yet, it's still present in the body and may be undetectable with various imaging techniques. WIth time it will recur, often due to molecular/genetic changes of the tumor cells metabolic profiles which confers them with resistance to the effects of prior chemotherapies.
You did not mention in your query as to weather you medical team had ordered any molecular testing for ctDNA which is useful for detecting residual disease burden. There a number of these test/assays that are available for various cancers.
The Signatera test, offered by Natera is the one most widely utilized for EC. I assume you've had numerous previous biopsies that have been examined by immunohistochemistry and molecular genetic analysis. Natera requires tissue that can be extracted from one of your biopsy tissue blocks in order to construct a personalized screening library to assay and quantify levels of ctDNA in your blood samples. It's a fairly sensitive assay with reasonable specificity and prognostic significance. The turn around time for completion of your initial test/assay and reporting of results is usually 4 wks
Subsequent follow-up test results may be obtained in shorter time frames as they can utilize your personal oncogenetic screening library that they created utilizing the initial biopsy material submitted for your first test.
If your doctors haven't already done so, I suggest you discuss ctDNA testing with them. The results may be informative as to the efficacy of your current maintenance therapies, or may identify new actionable targets for treatment with other chemotherapies.
JD
I don't know anything about signet ring cells, but plan to learn more. I recently had 3rd endoscopy along with biopsies and now have Barrett's esophagus after have had radiation and chemo to get rid of tumor in lower esophagus several years ago. I'll be interested to hear how you progress?
Don
I'm a retired clinical pathology & lab medicine doc. Signet ring cells are associated with and diagnostic of a particularly aggressive form of esophageal adenocarcinoma that may be tre1atment resistant. The term Signet ring refers to the appearance of the fixed & stained epithelial/mesenchymal cells esophageal adenocarcinoma when viewed under the microscope. The signet ring cells produce excessive amounts of muting protein which accumulates in the cells cytoplasm and deforms the normally roundish shape of the nucleus to an thinner elongated shape that is pushed to the periphery of the cell giving it the appearance of a signet or pinkie ring.
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Hug
1 ReactionThank you for explaining all this. Do you know why it’s difficult to spot in early stages, and if there are any definitive testing available to spot early onset, before it reaches a stage 2 and 3 level?
It's a matter of cell numbers detected in the analysis of the biopsy. Often in early phases of the disease signet cells are not a majority of the dysplastic cells that may appear in the biopsies. It's also dependent upon obtaining biopsy samples from areas of the tumor or nodes that may be enriched for signet cells.
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