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Stage 3c with no nodes

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Stage 3c with no nodes

Postby srwl21901 » Sat Jun 01, 2013 11:51 pm

Just wondering if anyone is stage 3c with all clear nodes. I have ask my doctor who said its because there was tiny cancer in the margin around the very small tumor when removed. I don't understand 3a and 3b if 3c is with node involvement and also without. Any views on this would be appreciated.
Stage 3
Rectal cancer
DX 2/20/13
LAR 3/27/13
Xeloda (canceled)
Oxaliplatin
Port placed on May 8, 2013
Folfox6
srwl21901
 
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Re: Stage 3c with no nodes

Postby disco nap » Sun Jun 02, 2013 7:01 am

Staging has gotten so complex since I was dx'd. It used to be 4 or more lymph nodes was stage IIIC.

Here's a link - if you look at the three bullets for stage IIIC do any of them apply?

http://www.cancer.gov/cancertopics/pdq/ ... ient/page2
DX July 2 '10 CC Stage IIIC, 11/18 nodes+
Right Hemi July 6 '10
Folfox: Aug 17'10 - Feb 17'11
Mar 13 '12: Lynch Syndrome MLH1
"Declared well" and been well ever since.
Update: CT scan April 2014: clean. MRI July 2014: Clean.
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Re: Stage 3c with no nodes

Postby pog451 » Sun Jun 02, 2013 8:05 am

Make sure you arent mixing up the "T" (1,2,3,4) status of your tumor with the total "staging" of your diagnosis (I,II, III, IV and A,B,C as appropriate), which includes "T" along with node involvement "N" and metastasis status "M".

The definition of "Stage III" is that nodes are involved (N>0) so no nodes is by definition Stage II, although the tumour itself may be T3.

You can find good definitions of all this in the stickies at the top of the forum.
09.11 Dx @ 46, uT3uN1M0 G2
11.11 radio+Xeloda
01.12 LAR
03.12 Xeloda
09.12 Liver mets, 2 LN
09.12 Folfox+Avastin
02.13 Resection
04.13 Folfox & Avastin
11.13 Local recurrence
02-07.14 FOLFIRINOX
08.14 Re-rediation
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Re: Stage 3c with no nodes

Postby weisssoccermom » Sun Jun 02, 2013 8:51 am

I was also going to say the same thing as pog. My guess is you're getting the T staging confused with the overall staging. Another reason why something seems amiss is that with rectal cancer, almost all stage II and above get chemoradiation (most in the neoadjuvant setting) and you don't indicate that you have had any.
I would sit down with my onc and get everything spelled out for me. IF you are indeed, a stage 3C, then I would want to know WHY the onc isn't rxing some radiation. Local recurrence with rectal cancer is much higher without radiation. Even if you are a stage II (that and stage I are the only stages without nodal involvment), then again I would wonder WHY no radiation. If, by some chance you are a stage I, then I would wonder WHY the chemo...particularly with the oxi.
Ask some questions, know your specifics and make sure you get answers that make sense. Ask the doc for your TNM staging.
The 'T' stands for the tumor depth, N is for nodal involvement and M is for distant metasteses. That is how your overall staging is determined.
Jaynee
Dx 2006 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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Re: Stage 3c with no nodes

Postby Bussman » Sun Jun 02, 2013 9:03 am

pog451 wrote: The definition of "Stage III" is that nodes are involved (N>0) so no nodes is by definition Stage II, although the tumour itself may be T3.


This is not the case. You can in fact be stage 3 without any positive nodes. If microscopic tumor deposits are found in the fat around the colon, this would be an N staging of N1c, and either stage 3a or 3b. (however 3c requires positive nodes.)
See my signature as an example. The staging guidelines for this changed around 2010. Not many people around here seem to have this staging.

Here's a source that explains the details, pay attention the mentions of "N1c":

http://www.cancer.net/cancer-types/colo ... ustrations

Get a copy of your pathology report and it will give the details.

Best of luck with your treatment and good health.

Bussman
1/21/11 dx CC @ 53
2/09/11 rt colon resect
0/18 LN; 4 tumor dep.
stage IIIB T4a N1c M0
3/11- 8/11 - 12 FOLFOX tx
6/11, 12/11 PET/CT scans- clean
1/12 follow-up scope - clean
6/12, 12/12,6/13 PET/CT scans- clean
NED
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Re: Stage 3c with no nodes

Postby SkiFletch » Sun Jun 02, 2013 9:41 am

•Cancer has spread through the serosa (outermost layer) of the colon wall and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes.


One can be IIIC with no lymphatic spread. If the tumor has penetrated the outer wall of the colon and had a couple cells attach to nearby organs/tissue, that's IIIC. It is indeed very confusing. The "good" news for IIIC cases like yours is that the cancer shows a propensity for growing "out" but doe not seem to how a propensity for expanding via the blood or lymphatic sytem. Tumor like thi are more likely to have local or abdominal recurrence as opposed to liver/lung/lymph recurrence. Doesn't mean it WILL recur that way, or CANT recur another way, just an idea of where the probability/odds are
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D

"Can any one of you by worrying add a single hour to your life."
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Re: Stage 3c with no nodes

Postby srwl21901 » Sun Jun 02, 2013 12:09 pm

Thank you all. I think I do recall them saying n1c. I didn't have radiation before surgery. The surgeon believed she would be able to remove 100% of the tumor which she said was about the size of a raisen. When the path report came back it showed the tiny speck within the margins. My surgeon didn't want to do radiation after surgery because she said it would also damage my new reconnect. I am about to have my 3rd round of folfox on the 5th. I have been reading a lot on the forum and noticed that almost everyone who was 3c had node involvement. I had 14 nodes removed all of which were negative. Thanks again.
Stage 3
Rectal cancer
DX 2/20/13
LAR 3/27/13
Xeloda (canceled)
Oxaliplatin
Port placed on May 8, 2013
Folfox6
srwl21901
 
Posts: 123
Joined: Tue Mar 12, 2013 12:29 pm

Re: Stage 3c with no nodes

Postby pog451 » Sun Jun 02, 2013 1:55 pm

With liver mets the finer points of Stage III get irrelevant, I have to admit, and I didnt know that "N1c" thingy - Always something new to learn.

The previous question about radiation remains a good one, though.
09.11 Dx @ 46, uT3uN1M0 G2
11.11 radio+Xeloda
01.12 LAR
03.12 Xeloda
09.12 Liver mets, 2 LN
09.12 Folfox+Avastin
02.13 Resection
04.13 Folfox & Avastin
11.13 Local recurrence
02-07.14 FOLFIRINOX
08.14 Re-rediation
pog451
 
Posts: 776
Joined: Thu Oct 13, 2011 6:11 am

Re: Stage 3c with no nodes

Postby weisssoccermom » Sun Jun 02, 2013 4:42 pm

Well, this thread confuses me. From the link previously posted:

Stage IIIC:The cancer of the colon, regardless of how deep it has grown, has spread to four or more lymph nodes, but not to other distant parts of the body (T4a, N2a, M0; T3 or T4a, N2b, M0; or T4b, N1 or N2, M0


From the American Cancer Society:
Stage IIIC

One of the following applies.

T4a, N2a, M0: The cancer has grown through the wall of the colon or rectum (including the visceral peritoneum) but has not reached nearby organs (T4a). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites.

T3-T4a, N2b, M0: The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral peritoneum (T4a) but has not reached nearby organs. It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to distant sites.

T4b, N1-N2, M0: The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby tissues or organs (T4b). It has spread to at least one nearby lymph node or into areas of fat near the lymph nodes (N1 or N2). It has not spread to distant sites


Something is awry with your staging. IF your pathology indeed did show N1c, then you cannot be a stage IIIC. I would get your onc to clarify this for you. As for radiation, I would get a second opinion on the 'no radiation'. While yes, radiation after reconnection can prove to be more difficult, the odds of a local recurrence (which btw are extremely difficult to handle....you do NOT want a recurrence in the pelvic area) are significantly increased without radiation. If it were me, I'd be wanting another opinion about the radiation. JMO.
Dx 2006 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness
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Re: Stage 3c with no nodes

Postby SkiFletch » Sun Jun 02, 2013 8:29 pm

Folks, at the risk of sounding like an a hole, the staging clearly says

...or into areas of fat NEAR the lymph nodes (N1 or N2)


If you have a tumor that has penetrated the CIRCUMFERENTIAL margin (the OP doesn't state which margin), then you can still be stage IIIC

I agree with Jaynee that radiation should be done, but it can be done after systemic adjuvant therapy if the goal is to allow full healing of the anastomoses first
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D

"Can any one of you by worrying add a single hour to your life."
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Re: Stage 3c with no nodes

Postby srwl21901 » Sun Jun 02, 2013 8:34 pm

Thanks so much. All good points to ponder. I will again follow up with onc this week.
Stage 3
Rectal cancer
DX 2/20/13
LAR 3/27/13
Xeloda (canceled)
Oxaliplatin
Port placed on May 8, 2013
Folfox6
srwl21901
 
Posts: 123
Joined: Tue Mar 12, 2013 12:29 pm

Re: Stage 3c with no nodes

Postby weisssoccermom » Sun Jun 02, 2013 8:39 pm

Fletch,
I'm confused and not truly trying to be difficult. IF someone is a N1c....I get what you wrote (btw....where is that quote from) but....both the ACS and the link that was posted before (which say the same thing) do NOT list an N1c in the stage IIIC classification. So, how can someone with an N1c (which I assume is what you are talking about in your quote) be a stage IIIC?
Jaynee
Dx 2006 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness
weisssoccermom
 
Posts: 4968
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Stage 3c with no nodes

Postby Bussman » Sun Jun 02, 2013 9:23 pm

What Fletch is talking about is a T4b t stage, tumor directly extends / infiltrates to adjacent structure/ organ. N1c are discontinuous tumor deposits in the surrounding fat, not a direct extension of the tumor, satellites so to speak, that may be the remnants of LN destroyed by cancer.

This single page clearly explains the current staging, including that T4b without any positive LN is stage 2. N1c can be 3a or 3b only.

http://www.cancerstaging.org/staging/po ... n12x15.pdf

Bussman

Edited with correct link
1/21/11 dx CC @ 53
2/09/11 rt colon resect
0/18 LN; 4 tumor dep.
stage IIIB T4a N1c M0
3/11- 8/11 - 12 FOLFOX tx
6/11, 12/11 PET/CT scans- clean
1/12 follow-up scope - clean
6/12, 12/12,6/13 PET/CT scans- clean
NED
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Re: Stage 3c with no nodes

Postby SkiFletch » Mon Jun 03, 2013 7:56 am

The OP never mentions being N1C...

Edit: The passages I was quoting come from the ACS' description of staging.
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D

"Can any one of you by worrying add a single hour to your life."
SkiFletch
 
Posts: 6354
Joined: Mon Dec 07, 2009 3:39 pm
Location: Buffalo, NY

Re: Stage 3c with no nodes

Postby weisssoccermom » Mon Jun 03, 2013 10:14 am

Fletch...sorry I should have been more clear. You are quite right that the original post doesn't mention it but the poster later does indicate remembering the docs mentioning the N1c designation.
Either way...something doesn't make sense and getting the pathology report AND a clear designation (with explanation) from the onc appears to be warranted. At least for me, I would want to know what my exact staging was. However, based on talks I've had with my surgeon in the past 5 years, not everyone feels the same way.
Dx 2006 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness
weisssoccermom
 
Posts: 4968
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

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