EMVI question. Post Op: Colon tumour removed however pathologyresults showed EMVI in one of the 5 veins

Hi SE26 

My understanding is that the UK has not yet got standards in place for invasions as it is relatively recently being measured and still not done everywhere. There is some medical journal data about invasions from other countries.

The fact that your husband has no spead to nearby lymph nodes nor other organs is very positive.

My histology covered 3 invasion tests in addition to standard margins and local lymph nodes tests. All of my invasion tests showed extramural invasion, so that means cancer in lymphatic, venous and perineural.

Chemo was a definite for me as I had cancer on local lymph nodes and nerves that needed blasting.

Chemo can have lots of pros and cons so I'd suggest your husband considers what makes up a quality of life to him, such as work, physical activity, mental wellbeing, etc so that he can review with oncologist whether the gains balance the risks. It may be helpful for him to ask what monitoring his hospital offer too.

Thank you so much for reply.  And sharing your experience which has given me extra clarity on our current situation.  I am very grateful and wonder how you are doing given chemo is a definate option for you.  I'm not sure if you have started, in the middle of or finished chemo however sincerely hope all you are coping with it all and receiving positive outcomes.  It's all very raw and new for us.  8 weeks ago we were in Spain; bought a house and planning a future and suddenly, the rug was pulled from under our feet.  Just like that.  But yes, that's how it is for most you just never think it's actually going to me me sort of thing.  But here we are.   I feel like we are in this grey area regarding chemo.  Albeit the appointment with oncologist will surely make it less o a grey area.  The conversation focus pre operation with Consultatant was focused on if spread into lymph nodes; if so chemo if not no chemo and that was the result we were waiting for. Leaked into lymph nodes or not?  There was no mention of this EMVI (which we heard for first time today); so it has come as quite a shock to figure out.  It's all very confusing.  Our son on hearing this news put it quite simply; he asked but Dad do you or do you not have cancer?  And we were stumped.  We don't know.  We know tumour removed completely.  We know no spread to other organs.  No leakage to lypmh nodes.  And out of 10 target EMVI/IMVI only one positive.  But what that means in reality no real idea. I feel I'd just like to establish first and fore most if my husband has cancer.  As would he.  We are on the same page with this question.  And right now, neither him nor I know the answer to that.  So we feel a bit stupid at this point not knowing this very important question.  I'm sure the oncologist will confirm.  However that will be another 2 weeks or therefore I'm going to call our consultant (surgeon) tomorrow and try find out.  I can't bear another day of not actually knowing.  We just need to know this fundamental basic question.  Is it obvious from this result that yes he does have cancer or not.  Honestly we have no idea and google has not provided any cohesive answer.  I think it's important to know in order to make a decision going forward.  I can't stand this blurry situation and confirmation either way will help us make the right decision going forward; chemo or no to chemo depending on the risks % of chemo and the risks of no chemo.  We both resonate very much with all you say in your last paragraph.  Completely.  It just comes down to the benefit of chemo compared to the % of not having chemo. Is it worth a 3% benefit considering the trauma of chemo has on the body.  If it was 20% or 30,40,50% benefit it's a no brainer, but what I can see, and could be wrong, it appears we are talking around 3% benefit to undergo chemo.   Sorry for long email reply; and thank you for taking the time to get back to me.  I'm aware what a long read it already is!  I just don't know yet how to cut to the chase of trying to discuss this.  I'm sure I'll get better at this as time goes on.  Many thanks, so appreciative of all you said.  You appear very balanced and rational; unlike me atm; sincerely hope all is going well with your treatment path.  

Hi SE26 

The first few weeks of diagnosis and awaiting treatment plan discussions can be the most unsettling time.

If, while you await his oncology appointment, you and you husband can fill your time with positive distractions, this will leave you each in the best state should any further treatment be required.

You can click on people's usernames, as our profiles have an about me section. It's helpful to use this to post key elements of our journeys, as and when we feel like sharing it. The forum's search engine can also help you find related profiles or discussion in specific areas or across the site.

Hi SE26 You’ve had a great reply from Crumpets and I just wanted to make you aware that there is an Ask a Nurse page too?

community.macmillan.org.uk/.../ask_a_nurse

Thank you. Agree about the waiting time feels like a twighlight zone.  Appreciate that we have access to specialists and it soon becomes apparent how busy these specialists are, which is sort of depressing news also.  To quote one specialist nurse "we are swamped" . Throughout we have tried to take one step at a time, not over think, over discuss or google.  But the elephant is always in the room.  There's no getting away from it.  There's nothing else for it but to keep going.  Thank you for your time and thoughts on this.  Appreciate very much.

I had a right hemi colectomy at the end of September 23 with the same result as your husband. T3 N0 V1(extramural) R0. As a result when I met the oncologist he left the decision about chemo entirely to me. He explained I had 80% chance of survival without chemo and 83% to 84% with chemo. He explained the possible side effects and I decided that as I was 77 at the time I would decide against it. Had it given me an extra 20% I wouldn’t have hesitated . When I gave him my decision he said he would have come to the same conclusion. I am having my first year scan on Friday and a colonoscopy in a couple of weeks. Needless to say my anxiety levels are sky high but so far so good. I wish your husband all the very best and would say just go with whatever you feel is right for you. Not easy!!

Hi SE26,

This must be a very difficult time for you both, I do understand how up you must be feeling right now. My husband had surgery to remove a rectal tumour in July and when he was told of the post op pathology results some weeks later, it was a shock to hear that there was ‘evidence of vascular invasion’ and he was then being referred to Oncology.

At the oncology appointment, we were told that pathology had found some extra mural vascular invasion (EMVI) -  and we later learned afterwards that there was also extra mural lymphatic invasion (EMLI) although the16 lymph nodes that were removed during surgery were thankfully clear. Hubby’s colorectal nurse who was present at the appointment added that the surgeon had got the tumour out with a very good margin (which also came back clear) and told us that they had seen no evidence of cancer remaining with the naked eye. 

Hubby was told that the adjuvant chemo was being offered in order to prevent the cancer coming back and to make sure any tiny cancer cells that may be lurking around in his body could be dealt with. Statistically speaking, the oncologist said chemo adds roughly 5% extra onto the chances of the cancer not coming back, sometimes less. However, he also explained about the psychological benefit of undergoing chemotherapy for some patients. At the end of the day, it comes down to an individual choice and decision. My hubby had already decided he was going to take chemo if it were offered to him, just to throw everything at the cancer and give himself the best possible chance of survival. He’s only 56, we have two grown up children aged 22 and 28 and he feels he has so much more to do in his life. He still has some other questions for the oncologist and will direct these to him in due course. Despite having made a list of questions prior to the actual appointment, it was only once we returned home and had a chance to digest all the information, that it generated more questions. It can be hard to take so much in but it’s better if you can be there as an extra set of ears, with a notebook to write down the relevant points. Then if your hubby forgets something, you might remember and vice versa.

The chemotherapy will last for 8 cycles lasting 6 months and hubby is now over a week in to cycle 1. Despite feeling tired and his appetite being slightly reduced, he’s glad that it is underway. It’s his fightback as he puts it. We just take it a day at a time.

Wishing you and your husband all the very best.

Take care,

Roses x