When to repeat biopsy after chemoradiation tx? - 1269085

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marianne
When to repeat biopsy after chemoradiation tx? - 1269085

I completed chemo at the end of January 2015 and radiation in the next few days (3 day difference due to 2 holidays and one sick day). My medical oncologist ordered a CT scan with contrast to be done 6 weeks after cessation of treatment, and a follow-up of same in 3 more months. We did not discuss additional biopsy.

Meeting with Liver surgeon and colon-rectal doctor later, they both brought up another biopsy.

What is the standard timeline to have a biopsy done of the 25% remaining CT scan findings of mass in anal canal to distinguish scar tissue from tumor--keeping in mind radiation is thought to be continuing to work post-tx?

Marianne

DX 11/25/2014 by biopsy SCC of the Anal Canal
PET/CT scan 12/2014 Stage 4 SCC of the Anal Canal with mets to Liver (originally 1 20mm spot on left lobe; now 2 spots--3 mm and 5 mm in either lobe seen wih 3/9/15 CT scan with contrast)
TX 12/22/2014 - 2/2/2015 Chemoradiation - Nigro protocol
75% overall improvement

catdander
Marianne,

Marianne,

Biopsy is done primarily to dx cancer and more recently to find new or changing mutations. It's not possible to tell how much of a nodule is cancer and how much is inflammation or necrotic tissue through biopsy. It's kind of like looking into a window of a house and saying for sure there's one person home when you can only see one room and not into other rooms.

Radiation continues to work weeks after treatment and inflammation is common with radiation even months after radiation. Because of these factors it's very difficult to know what's going on within a few months on radiation. The primary way to follow after radiation is CT scans around 3 months after. Anything before can very easily be something besides cancer.

I'm sorry but it's once again a wait and see proposition. It's definitely a mind game to trick your head out of thinking about what ifs and I wish I had more to offer.

Keeping you in my thoughts,
Janine

marianne
More story here for Janine

More story here for Janine and others-

I did have a CT scan with contrast 3 months after tx stopped (3/9/2015).

The local surgeon who is following the possible liver mets suggested a biopsy when I next see the colon-rectal doc (last Friday)--who said we would have to wait 6 months post tx for a biopsy. He wants to do a sigmoidoscopy with ultrasound in May to see if there is growth. (My view is this is unnecessary--could be wrong. I'd as soon wait for the next CT scan three weeks later. But, open to it serving a real purpose.)

Is it that we can distinguish tumor from scar tissue in next CT scan (in June) by changes in size of findings? Scar tissue doesn't grow?

The doctors are the ones who suggested the biopsy. If there is still uncertainty after the June CT scan and any findings are well above the sphincter muscles, I'm going to request the colon-rectal doc go in and take it all out with any remaining inguinal lymph involvement.

Thanks, Janine, for your response.

Marianne

marianne
I had left a voicemail for

I had left a voicemail for the radiation oncologist's opinion on the biopsy and next steps to be taken. He just called to confirm the following: sigmoidoscopy in May with biopsy only if anything suspicious is found, CT scan in June.

Both my case management nurse oncologist at Cigna and outreach person at www.analcancerfoundation.org recommended:

http://www.tri-kobe.org/nccn/guideline/colorectal/english/anal.pdf

I feel better knowing that the sigmoidoscopy will not be a waste of my time--up at 5 am to do an enema and at the hospital by 7 am for an 8 am appointment--and then doing it all again for an August biopsy!

They do re-biopsy for progressive disease--which I hope won't be needed.

Thanks again,

Marianne