Suggest Treatment For Stage-4 Colon Cancer Metastasis In The Lumbar Spine

Posted on Mon, 10 Jul 2017

Question: Sir, I had stage four colon cancer that had metastasized to the liver 22 lesions.After 18 chemo treatments (Folfox,Folfiri and Avastin) I has surgery and there was only one tumor 1/2 dead left and it was removed. What concerns me now which I just found out about is a one centimeter lesion in the L2 vertebrae. I saw it and it was a round circle contained in or on the vertebra well defined. What is confusing was cancer was detected on 5/31/2017 from a cat scan.Nothing on the spine.6/27 was the next cat scan nothing on the vertebrae. Then at MD XXXXXXX in November this Indeterminate lucent lesion in the L2 vertebra appear more conspicuous or apparently enlarged. It shows coarse trabecula within (image 196), and may be a hemangioma, however its conspicuity is concerning, and attention to this on follow-up imaging may be useful. No suspicious destructive bony lesion. Degenerative changes in the spine. Again seen thoracic kyphosis with compression deformity of mid thoracic vertebra. Then an Apric MRI as well as a cat scan does not mention this. Then while at XXXXXXX XXXXXXX five days after my liver surgery 5/23/2017 I see this L2 focal lucency measuring 1 cm, not present on 5/31/2016 exam and appearing on 2/4/2017, compatible with metastasis. No additional suspicious lesions present. 4. 1 cm lytic lesion within L2, unchanged over two prior exams, appearing on 2/4/2017 exam and not present on 6/21/2016 or 5/31/2016 exams, concerning for metastasis. No one at XXXXXXX mentioned this. My XXXXXXX oncologist yesterday brought this issue to my attention and ordered a spinal MRI for Monday. First since it was colon cancer anywhere it spread would be treated with the Folfox and Folfiri and the tumors would have responed. They said from November of 2016 to the end of May 2017 no change in size of the spinal lesion. How can it only show up on two of five cat scans and nothing on an MRI. My CEA has gone from 16 to 3. Can you give me your opinions of what i have written? Do you think this is benign? Thank you

Answered by Dr. Dr. Ivan Romich (24 hours later)

Brief Answer:
Hard to say

Detailed Answer:
Hi and welcome.
It would be easier for me if I see MRI images. You can simply upload them here to the reports section of this web page.

But considering your description, it is not easy to specify if this is malignant or not. We, as doctors, always try to rule out the worst, especially in oncology patients. So any new lesion in someone with known primary cancer, is considered to be malignant until other is proven. In you case, there is obviously vertebral lesion which was not present 1 years ago or it wasn't detected by radiologist if he didn't focus on spine. but you said that they compared these images later and there is the visible development of spinal lesion. this is a bad sign of course, especially if it has irregular borders and osteolytic features.

The good sign is that it didn't grow in this period which may be a sign of benign nature or good response to chemotherapy. this latter seems more probable to me which would mean that this is not benign.

However, it can be confirmed only by bone scintigraphy or biopsy or MRI scan in periods of 2-3 months which could detect growing of lesions.

Wish you good health.
Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee