Postby Guest » Thu Mar 08, 2007 10:30 am
With regard to the different treatment regimens - Here is how I understand it:
First of all, Rectal cancer requires treatment with radiation. The TME has also become "standard" of care for ther reasons you stated in your post. It has to do with all the lymph nodes, nerves, fat, and blood supply to the pelvis. All that "stuff" is compacted in down in the pelvis and the chances are higher for recurrence around the original tumor site for rectal cancer, so they radiate. It is the timing of radiation that is under debate.
Chemo regemins are rapidly evolving and there is some debate as to what is the "best" combination of drugs for a particular stage. This is why there are so many clinical trials going for colorectal cancer.
Standard chemotherapy treatment has, for many years, involved 5FU for both colon and rectal cancer. How it is given is what differs, and often depends on your oncologist's personal opinion. Studies have show that 24/7 5 FU delivered by pump is preferred over the "bolus" or single IV infusion method. Especially when given in conjunction with radiation. Now, relatively new to the scene is xeloda which is a pill form of 5FU that works like the 24/7 delivery of 5FU because it is in your system on a continuous basis. Some doctors feel it has an advantage over the infusion 5FU because it does not require an IV or port. Others feel it needs to be around longer before they will get on the band wagon and prescribe it.
Depending on the stage of the cancer, other drugs are added to the 5FU. (ie, if it is stage IV you are going to see 5FU along with some other drugs such as Avastin (bevicizumab), campostar, irinotecan, where as you won't see if with stageII or III). Most of the time 5FU is given with leukovorin, which is an agent that helps the 5FU work better. Xeloda is not given with leukovorin, since it is converted by the body into 5FU.
There is also a lot of debate in the oncology community about timing of radiaion. Before surgery chemo and radiaiton is preferred now. It is supposed to "down stage" the tumor. However, in my husband's circumstance, they did not expect him to have positive lymph nodes and it was a bit of a "surprise" when they came back that way, so by all indications on his preoperative staging CT, endorectal ultrasound, CEA, etc, it looked like he was stage II and no preop radiation would be needed. Hence, he is doing post op (ie after surgery) radiation for 5 weeks. His doctor preferred to use xeloda rather than the 24/7 infusion of 5FU. Like I said, a lot of it depends on your doctor. Sometimes, I guess we have to have "blind faith" in those who take care of us.
However, if you don't have an open communication with your health care provider, NEVER hesitate to find someone else you feel comfortable with. Also, question them. Make THEM explain all this to you and aske them to explain (in plain english) why they think one method of treatme is preferable over another.
Also, there are always those circumstances that are out of the ordinary. We are humans, and no two are exactly the same, so why do we expect that the treatment would be the same for every single person? Also, people's cancer can act very differently from person to person. Just read the posts here, you will see that some have very unique stories that don't fit any one mold.
Bottom line, if you have questions about why your doctor chose a particular treatment regemin, have him/her explain to you why.
Hope this was helpful. - wdt