Please help - Rectal Cancer with Possible Lung Metastasis

Ok. I like you already as you exude take charge, all hands on deck, let’s knock this out!

Where do you live? And am I correct that all you know at this point is where the nodules are and how big they are. Is that correct? Has there been any mention of a biopsy to determine more about type of tumor it is?

This is an awesome community. Is it your first time here?

My personal instinct - and none of us are docs so can’t really give advice that constitutes medical advice - is whether you have trust and confidence in your current oncologist that you might ask him/her next week whether you need an oncologist specializing in pulmonary events- and if so can he recommend? And could he recommend a cardio/thoracic surgeon. It just seems to me that might be the most expedient path.

It can get complex trying to juggle an expanded team of surgeons,
oncologists, making sure they coordinate effectively, etc. I’m not saying it can’t be done well - but it would really need to happen at a Hopkins or Mayo level of multidisciplinary care.

We have incredible people and awesome mentors on this site. Give them a bit and you will have people
gathering to support you and answer what they can.

Hello @varg4258, I'm glad you came to us. You want a plan, and to take action! That's great but take a deep breath too. Be prepared for the diagnosis process to take a bit of time. It's often a game of 'hurry up and wait'. Your oncology team may be able to give you an idea if this is a new cancer (lung cancer), or possibly that your previous cancer has spread to the lung. As Pam noted, a biopsy can be most helpful in determining what is driving the cancer. Knowing what's driving the cancer is key to determining what types of treatments may be most effective, and key in determining the best oncologist specialty for you (thoracic/lung vs digestive). If your cancer is related to the rectal cancer that you were facing earlier this year, then treatments may be very different than a lung cancer treatment.
If you are able to access a heath care system that focuses on research and education, they will likely have oncologists that specialize in different types of cancer. There are many good cancer centers around the US. Here is a link to those approved by the National Cancer Institute that may be helpful:
https://www.cancer.gov/research/infrastructure/cancer-centers/find

Many thanks Lisa.
@varg4258 , Lisa is an awesome Mentor with a lot of facts and resources in her toolbox.

Live near the DC area but willing to travel anywhere for treatment. I am aware of the nodule size mentioned on the CT scan at this time and Radiology/Oncology meeting scheduled for early next week. There is a high probability the nodules will be cancerous based on my last month Signatera test results being positive. Nodules were discovered this month so it grew in the last 3 months. CEA score is still within normal range and has not changed after surgery. Took two Chemo drugs and not looking for more surgery.
How do you choose the best doctor for the various treatments? Hospital staff doesn't recommended any specific doctors either.

1) Look for medical institutions with "Tumor Board" where a group of various specialists (pulmonologists, surgeons, medical and radiation oncologists) discuss your case and make recommendations for best treatment options. Mayo Clinic does this.
2) Remember specialists have subspecialties - check out their backgrounds!!!!
3) Us News & World Report every year ranks best hospitals overall in the country and also shows their ranking by various diseases. Google it, free to read. You can choose from that which one is more convenient to you.
4) Get your records ready! Places like Mayo Clinic want it all including scans. Set up account with institution to facilitate transfer of medical records, follow up with phone call

Sorry you are going through this. Have you been diagnosed with lung cancer. Was confused by rectal surgery. As for hospitals, look for those with a “comprehensive cancer center”. Mayo Clinic, MSK in NYC, Cleveland Clinic, Dana Farber in Boston and others.
Best of luck to you during this scary time. People in this group will be supportive and helpful.

@varg4258, bringing this discussion back to you and your concern about metastatic colorectal cancer that has spread to the lung. Reviewing your initial discussion in the Colorectal Cancer support group here:
- Signatera results: Does the increase mean cancer is back? https://connect.mayoclinic.org/discussion/signatera-results/

I see that your original diagnosis was rectal cancer. The results of your recent CT scan shows that your cancer team is watching lung nodules that may indicate the rectal cancer has returned and spread to your lungs. First your team will determine if the lung nodules are
a) rectal cancer metastisis
or
b) non-cancerous lung nodules
or
c) new cancer, i.e., lung cancer

Rectal cancer that spreads to the lung (lung metastasis) is treated differently than cancer that originates in the lung. There are options to treat rectal cancer that spreads to the lung like surgery —usually with minimally invasive techniques—and sometimes in combination with chemotherapy.

You will be in good hands with a comprehensive cancer center that works as a team. If you would like to consider a second opinion at Mayo Clinic, here's where to submit a request http://mayocl.in/1mtmR63

Have you started a list of questions for your appointment this week? How are you doing?

I have had the same.
First, sigmoid colon cancer diagnosis and surgery.
All the while, we were also looking at a suspicious lung nodule in the very bottom of the right lobe.
Impossible to biopsy because of soft tissue.
Well, 7 weeks after colon resection, we were doing lung resection surgery. The nodule was cancerous.
All margins were clear with no lymph node involvement.

Both of my surgeries at Community Health Network- MD Anderson, Indianapolis, went great!
This all started 18 months ago, with Dr Sanjay Thekkeurumbil ( colon & rectal ) and Dr. Ashish Pulikal ( lung; Thoracic surgeon ).
If I had to do it all over again, I would not change anything concerning my health care choices!
Both of my doctors felt good about having removed all the cancers in both organs. I passed on the mention of chemo and elected to instead have ct scans and blood tests every 4 and 5 months respectively.
So far, so good!!!
Best wishes to you and your journey forward!
Paul

paul28-Great Information and appreciate you taking the time to respond with doctor details. I was looking at MD Anderson NY for a second opinion. I would not take the Xeloda & Oxiplatin if i had to do it over again and since the cancer came back in another organ.

Current hospital gave me 3 options- Focused radiation, surgery or Ablation therapy.
Not sure which option to choose from radiation or surgery?

Are you having any lung issues after the surgery? healing time?

I had lobectomy six mos ago for a small tumor ( 1.5”) on the periphery of the left lower lobe. It was malignant and so the surgeon did a lobectomy. Later pathology revealed clean margins and nodes. That was six months ago and I still have rib and diaphragm pain with deep breaths. Starting an off label anti inflammatory med tomorrow for that. Granted it’s an unusual surgical outcome. But not that unusual. Personally - and it is the only perspective I have - I would ask a lot of questions about ablation with a ”please convince me” plea.