Rectal cancer (Stage 3A) diagnosed late June 2017

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NHMike
Posts: 672
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby NHMike » Wed Dec 06, 2017 4:47 pm

Aqx99 wrote:You may want to look into crusting to help heal the areas of irritation you have. There are some good videos on YouTube about it. Basically, you layer stoma powder and barrier wipes to form a crust over the raw area that protects it so it can heal, but still allows the adhesive to stick. It has worked well for me.


So you use the wipe as opposed to just the paste on the wipe to layer with? I have heard of layering before but it would seem like the wipe would take off the powder. A spray sounds like a better approach. I've been working on:

Dental Cleaning
Chest Port Surgery
ChemoTeach
Meeting with my regular oncologist (met with backup today because he's on vacation)
Infusion start date

And the dates for all of those are set. Tomorrow morning, I leave at 4:30 AM for Boston to meet with the Stoma Nurse and I'll have a list of things to ask her. My appointment is at 8 AM but the traffic is light between 4:30 and 5:30 and I'll just work remotely there until the appointment and then drive home. The next two weeks will be a whirlwind. I hadn't realized that there's so much to do leading up to Adjuvant Chemo. I started a topic on another board asking about people that didn't have issues with Oxaliplatin and there were only a few responses - but at least I'm getting a better idea of the range of side-effects.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

NHMike
Posts: 672
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby NHMike » Wed Dec 06, 2017 4:53 pm

MissMolly wrote:Mike:
Instead of individual packets of skin protectant, you can always use Cavilon Liquid Skin Protectant. It comes in a small 4 Oz. Spray bottle. Cavilon is hands-down The Best skin protectant and a trusted favorite of those with permanent ileostomies. Not all skin protectants are equal in quality. You can purchase Cavilon Liquid Skin Protectant from Amazon or from your Ostomy supply provider. It retails for $15.

Marathon Liquid Skin Protectant is the best for healing skin irritated or excoriated by exposure to urine or liquid ileaotomy output. It is an advanced wound care product. Available through Amazon and a few of the Ostomy supply companies (but not all).

I would encourage you to rethink your use of Ostomy paste as you describe. There is no advantage to the ring of Ostomy paste that you are applying. Ostomy paste is like grout. It is meant to fill dips, creases, and divots in the skin to make a level surface for applying a wafer. Ostomy paste is more similar to tooth paste than to a glue. The ring of paste that you are applying lessens the total area of skin contact with the hydrocolloid water and will add to the incidence of leaks. You will be best served with use of a barrier ring (Ekin Cohesive Adaptic Ring) and NO Ostomy paste.
Karen


I added the Cavilon to my Amazon cart. They have it for $12 right now. I don't know that I need the Marathon but I'll make a note of it.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

Aqx99
Posts: 275
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby Aqx99 » Wed Dec 06, 2017 5:04 pm

NHMike wrote:
Aqx99 wrote:You may want to look into crusting to help heal the areas of irritation you have. There are some good videos on YouTube about it. Basically, you layer stoma powder and barrier wipes to form a crust over the raw area that protects it so it can heal, but still allows the adhesive to stick. It has worked well for me.


So you use the wipe as opposed to just the paste on the wipe to layer with? I have heard of layering before but it would seem like the wipe would take off the powder. A spray sounds like a better approach. I've been working on:

Dental Cleaning
Chest Port Surgery
ChemoTeach
Meeting with my regular oncologist (met with backup today because he's on vacation)
Infusion start date

And the dates for all of those are set. Tomorrow morning, I leave at 4:30 AM for Boston to meet with the Stoma Nurse and I'll have a list of things to ask her. My appointment is at 8 AM but the traffic is light between 4:30 and 5:30 and I'll just work remotely there until the appointment and then drive home. The next two weeks will be a whirlwind. I hadn't realized that there's so much to do leading up to Adjuvant Chemo. I started a topic on another board asking about people that didn't have issues with Oxaliplatin and there were only a few responses - but at least I'm getting a better idea of the range of side-effects.


Dab the wipe on the powder, don't wipe.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
Diagnosed at age 39
2/21/17 Diagnosis
2/21/17 CEA 0.9 ng/mL (Siemens Chemiluminescent Method)
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR with temp loop ileostomy, ovaries and fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 - 12/18/17 CapeOx, 6 Cycles
7/24/17 Diagnosed with precursor ovarian cancer
9/6/17 CA 125 11.1 U/mL
11/27/17 CEA 2.6 ng/mL (Roche ECLIA Method)
12/5/17 CT showed NED
1/18ish Reversal

rockhound
Posts: 47
Joined: Fri Jul 14, 2017 5:00 pm

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby rockhound » Wed Dec 06, 2017 5:23 pm

Aqx99 wrote:
NHMike wrote:
Aqx99 wrote:You may want to look into crusting to help heal the areas of irritation you have. There are some good videos on YouTube about it. Basically, you layer stoma powder and barrier wipes to form a crust over the raw area that protects it so it can heal, but still allows the adhesive to stick. It has worked well for me.


So you use the wipe as opposed to just the paste on the wipe to layer with? I have heard of layering before but it would seem like the wipe would take off the powder. A spray sounds like a better approach. I've been working on:

Dental Cleaning
Chest Port Surgery
ChemoTeach
Meeting with my regular oncologist (met with backup today because he's on vacation)
Infusion start date

And the dates for all of those are set. Tomorrow morning, I leave at 4:30 AM for Boston to meet with the Stoma Nurse and I'll have a list of things to ask her. My appointment is at 8 AM but the traffic is light between 4:30 and 5:30 and I'll just work remotely there until the appointment and then drive home. The next two weeks will be a whirlwind. I hadn't realized that there's so much to do leading up to Adjuvant Chemo. I started a topic on another board asking about people that didn't have issues with Oxaliplatin and there were only a few responses - but at least I'm getting a better idea of the range of side-effects.


Dab the wipe on the powder, don't wipe.



The powder was key also- pour it on, get rid of excess (I just kind of brushed it off), then dab it with Cavilon wipe. I would do this 1-3 times (per ostomy nurse instructions) for coverage, all the while hoping that my stoma would not start expelling...gotta get quick with this!
42 yr old male
Diagnosed December 2016, age 41
Stage 1/IIA rectal cancer - T2/3N0M0 via MRI (MRI indicates stage 1; onc/surgeon = stage 2a)
Lynch syndrome, MSH6 mutation, MSI-H
2 to 3/2017 Xeloda + Radiation
5/10/17 - Robotic LAR with temp. loop illeostomy, 0/20 lymph nodes
6 to 7/2017 - Six cycles Folfox @ full strength
9/20/17 - Ileostomy takedown
10/17 - Clear CT

Aqx99
Posts: 275
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby Aqx99 » Wed Dec 06, 2017 5:25 pm

rockhound wrote:The powder was key also- pour it on, get rid of excess (I just kind of brushed it off), then dab it with Cavilon wipe. I would do this 1-3 times (per ostomy nurse instructions) for coverage, all the while hoping that my stoma would not start expelling...gotta get quick with this!


I put the powder on, then pat my belly to make it jiggle so the excess falls off. That way I don't accidentally brush off some that might have stuck otherwise.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
Diagnosed at age 39
2/21/17 Diagnosis
2/21/17 CEA 0.9 ng/mL (Siemens Chemiluminescent Method)
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR with temp loop ileostomy, ovaries and fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 - 12/18/17 CapeOx, 6 Cycles
7/24/17 Diagnosed with precursor ovarian cancer
9/6/17 CA 125 11.1 U/mL
11/27/17 CEA 2.6 ng/mL (Roche ECLIA Method)
12/5/17 CT showed NED
1/18ish Reversal

NHMike
Posts: 672
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby NHMike » Thu Dec 07, 2017 6:53 am

The CEA lab report showed up on my hospital portal this morning and the really low number was partially due to a different scale used by Dana Farber. Dana Farber's scale for normal is 0 to 2.5 and my local hospital is 0 to 3.8. So my 0.6 DFCI number rescaled to my local hospital is 0.9. So something that I'll have to keep in mind with results from different labs. 0.9 is still a lot better than the 1.7 after chemo/radiation.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

User avatar
susie0915
Posts: 536
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby susie0915 » Thu Dec 07, 2017 9:55 am

NHMike wrote:The CEA lab report showed up on my hospital portal this morning and the really low number was partially due to a different scale used by Dana Farber. Dana Farber's scale for normal is 0 to 2.5 and my local hospital is 0 to 3.8. So my 0.6 DFCI number rescaled to my local hospital is 0.9. So something that I'll have to keep in mind with results from different labs. 0.9 is still a lot better than the 1.7 after chemo/radiation.

My lab shows 0-5 as normal. Mine is usually <.5 but has gotten as high as 1.1 during chemo. My oncologist says chemo can cause CEA to rise a little.
58 yr old mother of 3 Dx @ 55
5/15 DX T3N0MO/ 2A
6/15 5 wks of chemo/rad
7/15 sigmoidoscopy/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. 3 1/2 weeks in hospital,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod onc thinks scar tissue
monitored for autoimmune disorder/interstitial lung disease
7/17 no change lung nodule
10/17 Clear CT
11/17 CEA<.5

mpbser
Posts: 311
Joined: Wed Apr 19, 2017 11:52 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby mpbser » Thu Dec 07, 2017 10:15 am

Thanks for telling us what Dana Farber's range is for normal. I have read so many different ranges, but I would trust Dana Farber's info,
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm width T1 N0
CEA: 1.4 Pre-op; 2.1 2 days Post-op
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal expression of MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53

NHMike
Posts: 672
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby NHMike » Thu Dec 07, 2017 10:54 am

The visit to the Stoma Nurse went well this morning. The original appointment was for 10 days after discharge but it was moved out three weeks due to a conflict or something. I think that I would have been a lot better off if the original appointment date were kept. I think that the rationale would be that I've have a Visiting Nurse work with me including a visiting stoma nurse but I went back to work so quickly that there wasn't time for the latter (Visiting Nurses are basically cancelled when you return to work).

The Stoma nurse showed my the approach with the powder and the Cavilon spray and demonstrated the crusting mentioned in this thread yesterday or the day before. She also gave me a Convatec convex wafer this time and demonstrated that it's moldable even though it's not one of their "moldable" products. She also used the barrier paste (she asked me first) and she gave me a belt that works with Convatec products. I was looking at belts and wraps before and I wondered how they solved the problem of compression on the flange blocking flow and the belts do this by attaching to the outside of the flange using the hooks on the flange (I had wondered what those were for). So that approach would greatly improve bouncing around while running. It would be interesting to see how the wraps solve the problem. I think that using regular compression gear (I have Nike Pro Combat shirts and CW-X compression shorts and tights) might not work as well.

She had a list of samples that she would order for me and gave me the reference numbers for the things that we used today.

On Cavilon Spray vs wipes: insurance typically pays for wipes but not the spray. I'm inclined to order the spray as it looks to me like the convenience and comfort of the spray outweigh the cost to me. If anyone has an argument for the wipes, then I'm all ears.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

rockhound
Posts: 47
Joined: Fri Jul 14, 2017 5:00 pm

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby rockhound » Thu Dec 07, 2017 11:53 am

NHMike wrote:The visit to the Stoma Nurse went well this morning. The original appointment was for 10 days after discharge but it was moved out three weeks due to a conflict or something. I think that I would have been a lot better off if the original appointment date were kept. I think that the rationale would be that I've have a Visiting Nurse work with me including a visiting stoma nurse but I went back to work so quickly that there wasn't time for the latter (Visiting Nurses are basically cancelled when you return to work).

The Stoma nurse showed my the approach with the powder and the Cavilon spray and demonstrated the crusting mentioned in this thread yesterday or the day before. She also gave me a Convatec convex wafer this time and demonstrated that it's moldable even though it's not one of their "moldable" products. She also used the barrier paste (she asked me first) and she gave me a belt that works with Convatec products. I was looking at belts and wraps before and I wondered how they solved the problem of compression on the flange blocking flow and the belts do this by attaching to the outside of the flange using the hooks on the flange (I had wondered what those were for). So that approach would greatly improve bouncing around while running. It would be interesting to see how the wraps solve the problem. I think that using regular compression gear (I have Nike Pro Combat shirts and CW-X compression shorts and tights) might not work as well.

She had a list of samples that she would order for me and gave me the reference numbers for the things that we used today.

On Cavilon Spray vs wipes: insurance typically pays for wipes but not the spray. I'm inclined to order the spray as it looks to me like the convenience and comfort of the spray outweigh the cost to me. If anyone has an argument for the wipes, then I'm all ears.


The belt was really great running, except mine would sometimes pop off the hooks; would have to stop and reattach under the compression wrap. So perhaps tighten the belt up well! I never used the Cavilon spray so can't comment vs. the wipes, but the wipes were pretty easy to use. Glad to hear that the appointment was helpful.
42 yr old male
Diagnosed December 2016, age 41
Stage 1/IIA rectal cancer - T2/3N0M0 via MRI (MRI indicates stage 1; onc/surgeon = stage 2a)
Lynch syndrome, MSH6 mutation, MSI-H
2 to 3/2017 Xeloda + Radiation
5/10/17 - Robotic LAR with temp. loop illeostomy, 0/20 lymph nodes
6 to 7/2017 - Six cycles Folfox @ full strength
9/20/17 - Ileostomy takedown
10/17 - Clear CT

NHMike
Posts: 672
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby NHMike » Thu Dec 07, 2017 11:57 am

rockhound wrote:
The belt was really great running, except mine would sometimes pop off the hooks; would have to stop and reattach under the compression wrap. So perhaps tighten the belt up well! I never used the Cavilon spray so can't comment vs. the wipes, but the wipes were pretty easy to use. Glad to hear that the appointment was helpful.


She is requesting a Colopast Mio Convex for me and a belt and their belt has two attachments per side and they go under instead of over so there might be a more secure fit with those.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

MissMolly
Posts: 441
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby MissMolly » Thu Dec 07, 2017 12:39 pm

Mike:
It sounds like you had a great session with the ostomy nurse, with a good exchange of conversation regarding pouching ideas and learning.

I adore the Coloplast Mio. I am a dedicated Coloplast consumer. The Mio wafer has elastic polymers, which makes it highly pliable and flexible. For someone as active as you are, the Mio will likely be a good fit.

I dislike barrier wipes as individual packets and much prefer the Cavilon spray. The spray is a no fuss approach. Easy-pessy to apply. The individual packets are an exercise in frustration - opening the resistant packet, unfolding the tiny wipe, the wipe often having insufficient moisture/product. Thumbs down to barrier wipes.

Continued best wishes,
Karen
Devoted daughter to my father, diagnosed with stage 2 colon cancer Nov-2014.
Dear friend to Bella Piazza, former CC member.
I have a permanent ileostomy and offer advice on living with an ostomy.
I have been on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression and recurrent infection x 4 years. I transitioned to Hospice Sept-2016, but it was not yet my time. I am back on Palliative Care and live a simple life due to frail health.

rockhound
Posts: 47
Joined: Fri Jul 14, 2017 5:00 pm

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby rockhound » Thu Dec 07, 2017 3:29 pm

NHMike wrote:
rockhound wrote:
The belt was really great running, except mine would sometimes pop off the hooks; would have to stop and reattach under the compression wrap. So perhaps tighten the belt up well! I never used the Cavilon spray so can't comment vs. the wipes, but the wipes were pretty easy to use. Glad to hear that the appointment was helpful.


She is requesting a Colopast Mio Convex for me and a belt and their belt has two attachments per side and they go under instead of over so there might be a more secure fit with those.


Coloplast mio Convex is what I used for ~90% of my time with the ileo; the belt is for sure more secure. Just tighten it up if you go running and also don't be surprised if it every once in a while, pops off anyway. No big deal!

I could see how the spray would work easier than the wipes. With the wipes, it was always a race against the clock to dab enough before they dried (and if I needed to open another, etc.) vs. my stoma getting active.
42 yr old male
Diagnosed December 2016, age 41
Stage 1/IIA rectal cancer - T2/3N0M0 via MRI (MRI indicates stage 1; onc/surgeon = stage 2a)
Lynch syndrome, MSH6 mutation, MSI-H
2 to 3/2017 Xeloda + Radiation
5/10/17 - Robotic LAR with temp. loop illeostomy, 0/20 lymph nodes
6 to 7/2017 - Six cycles Folfox @ full strength
9/20/17 - Ileostomy takedown
10/17 - Clear CT

NHMike
Posts: 672
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby NHMike » Fri Dec 08, 2017 2:25 pm

Learning Curve: The Surgeon as a Prognostic Factor in Colorectal Cancer Surgery

http://eknygos.lsmuni.lt/springer/404/86-104.pdf

Thirteen consultants, none of whom had a special interest in colorectal surgery, operated on 645 patients with colorectal cancer. Outcome differed tremendously between the individual surgeons. The rate of curative resection varied from 40% to 76%, postoperative mortality from 0% to 20%, local recurrence from 0% to 21%, anastomotic leakage from 0% to 25%, and survival at 10 years from 20% to 63%. These important differences in outcome were not entirely explained by differences in patient population (case-mix, e.g., more advanced tumor stage). The existence of a significant
inter-surgeon variability was hereby proven. The individual surgeon was later identified as an independent prognostic factor for the frequency of locoregional recurrence and survival in rectal cancer patients by applying multiple logistic regression analysis adjusting for case mix differences (Hermanek et al. 1995). A great number of publications followed, investigating the prognostic role of the surgeon as well as of surgeon- and hospital-related factors (e.g., board certification, subspecialty training, annual caseload, teaching status). Most tumor-related, patient-related, and treatment-related predictors of outcome cannot be altered. The majority of surgeon- and hospital-related factors, however, can be influenced positively. Herein lies great promise, since an enhancement of surgeon and hospital related factors will lead to a significant improvement in the patient’s outcome.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

User avatar
O Stoma Mia
Posts: 915
Joined: Sat Jun 22, 2013 6:29 am

Re: Rectal cancer (Stage 3A) diagnosed late June 2017

Postby O Stoma Mia » Fri Dec 08, 2017 2:51 pm

NHMike wrote:Learning Curve: The Surgeon as a Prognostic Factor in Colorectal Cancer Surgery (2005)

http://eknygos.lsmuni.lt/springer/404/86-104.pdf

Thirteen consultants, none of whom had a special interest in colorectal surgery, operated on 645 patients with colorectal cancer. Outcome differed tremendously between the individual surgeons. The rate of curative resection varied from 40% to 76%, postoperative mortality from 0% to 20%, local recurrence from 0% to 21%, anastomotic leakage from 0% to 25%, and survival at 10 years from 20% to 63%. These important differences in outcome were not entirely explained by differences in patient population (case-mix, e.g., more advanced tumor stage). The existence of a significant
inter-surgeon variability was hereby proven. The individual surgeon was later identified as an independent prognostic factor for the frequency of locoregional recurrence and survival in rectal cancer patients by applying multiple logistic regression analysis adjusting for case mix differences (Hermanek et al. 1995). A great number of publications followed, investigating the prognostic role of the surgeon as well as of surgeon- and hospital-related factors (e.g., board certification, subspecialty training, annual caseload, teaching status). Most tumor-related, patient-related, and treatment-related predictors of outcome cannot be altered. The majority of surgeon- and hospital-related factors, however, can be influenced positively. Herein lies great promise, since an enhancement of surgeon and hospital related factors will lead to a significant improvement in the patient’s outcome.


Thanks for posting this. This is a very important finding, especially for the case of rectal cancer surgeons.
.
Useful Links:

How to Create a Signature
https://coloncancersupport.colonclub.co ... 97#p421597

How to Find a Board-Certified Surgeon
viewtopic.php?f=1&t=52349&p=410280#p410280

How to interpret a Pathology Report
viewtopic.php?f=1&t=51436&p=399172#p399172

Understanding TNM Staging
http://www.cancer.net/cancer-types/colo ... cer/stages


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