T2N0Mx

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mvdesh
Posts: 4
Joined: Mon Nov 04, 2013 8:53 am

T2N0Mx

Postby mvdesh » Mon Nov 04, 2013 9:36 am

My father (65.5 yrs) has been diagnosed with synchronous polyps in a routine colonoscopy. Surgeon found one large Polyp in the Sigmoid and two small in ascending and transverse colon. The histopathology of samples taken during colonoscopy suggested that sigmoid polyp was malignant and transverse colon polyp was benign. He further went for polypetomy to remove two small polyps and Anterior resection to remove sigmoid adinocarcinoma. The histopathological results of the mass classifies it as: T2N0Mx. All 11/11 lymph nodes were found to be reactive and CT of abdomen (prior to surgery) shows all other organs as free of any signs of malignancy. Proximal and distal margins of anastomosis are uninvolved. Microscopic tumor extension into the muscularis propria. Serosa is free of tumor infiltration. Histological measurement of tumor to nearest margin is 5 mm. Perinural invasion is not identified. Lympho-vascular invasion is not identified. Ulcerative lesion measures 3.4x2.8x0.8 cm and the nearest resected end was 4.2 cm away. The other resected end was 10.2 cm away.

The medical oncologist suggested only monitoring and recommended no chemo. Is it ok? or shall we go for second opinion?

Thanks in advance,
Mandar
Last edited by mvdesh on Mon Nov 04, 2013 11:24 am, edited 1 time in total.

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: T2N0Mx

Postby weisssoccermom » Mon Nov 04, 2013 10:35 am

Good morning and welcome. Based on what you have written, your father would be considered a stage I and chemo is generally not recommended for that stage. I would be surprised if, even with a second opinion, you would find an oncologist that would recommend chemo. In addition, keep in mind that the insurance company could very possibly deny chemo as well. Remember that chemo does have side effects and, although minimal, some risks. Weighting the risk of chemo vs the risk of recurrence.....chemo probably loses. Cancer treatments are based upon statistics and the stats for a stage I indicate that the cancer is 'unlikely' to recur. Obviously that doesn't say it can't or won't, just that the chances are high that it won't. The pathology report seems to be very thorough.....looking at all the potential negative prognostic factors and ruling them out.

Your father was lucky that his case was caught at such an early stage and that no further treatment, save for followups, is recommended. You could certainly get a second opinion, but I would be very surprised if you found another onc that recommended chemo and if you did, I would really want to know why. One question I do have though....you indicated that the CT scan was of the abdomen.....do you know if the chest and pelvis was done as well? That would be, IMO, something you would want to verify. The two most common places for colorectal cancer to metastasize to are the lungs and liver so just make certain that the CT included the chest/abdomen and pelvis.

Good luck.
Jaynee
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

mvdesh
Posts: 4
Joined: Mon Nov 04, 2013 8:53 am

Re: T2N0Mx

Postby mvdesh » Mon Nov 04, 2013 11:19 am

Thank you very much for your reply. The CT contrast was of chest, Liver and abdomen but was done just before surgery. I am posting the complete CT report here:
1. Visualised lung bases appear normal. No pleural effusion seen.
2. Liver: Normal in size and shows homogenous enhancement. No focal lesion seen. Intrahepatic portal vein, hepatic veins, IVC appear normal. No IHBRD seen.
3. Gall Bladder: Well distended. Wall thickness is normal. No mass lesions. Hyperdense foci within. ?Calculus.
CBD - Not dilated.
5. Pancreas: Normal in size and contrast enhancement. MPD not dilated. No focal lesions. No calcification/atrophy sen. Peripancreatic fat planes well maintained.
6. Spleen: Normal in size and contrast enhancement. No focal lesions. No collaterals at hilum.
MPV, SMV, SV appear normal. Splenoportal axis is patent.
7. Kidneys: Normal in size and position. Normal contrast enhancement seen. No hydronephrosis. No calculi. No focal lesions. Ureters are not dilated.
Bilateral adrenal glands appear normal.
Retroperitoneal vessels appear normal.
8. Bowels: Wall thickening in sigmoid colon.
Wall thickness: 11-13 mm.
Pericolic fat stranding with few pericolic nodes (6-7 mm)
9. Urinary bladder: Well distended. Wall thickness is normal. No local lesions.
No free fluid see in peritoneal/pelvic cavity

Impression Wall thickening in sigmoid colon. To rule out carcinoma.

-----------------

Speciman HPE post surgery showed 11 out of 11 resected lymph nodes show reactive changes.


-----------

Please let me know if I should type the whole of histopathology report of the lesion.


Thanks for your answer as I am so relived that we had a very narrow shave.

Best regards,
Mandar

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: T2N0Mx

Postby weisssoccermom » Mon Nov 04, 2013 11:52 am

We are not doctors here and can't give you medical advice but it seems as though, from everything you've posted, that the doctors have done a thorough job and are following the 'standard of care' protocol which is what you would want them to do.

Obviously with cancer there are absolutely no guarantees and yes, it can be scary to think that even one cancer cell is somewhere in the body just lurking. However, as I said earlier, cancer is based on statistics and with a diagnosis of a stage I with no negative prognostic factors (they would be such things as, say, an adenocarcinoma with mucinous characteristics, a poorly differentiated tumor or something like lymph or vascular invasion.....none of which it appears that your father had.

Yes, he is quite lucky that all of this was found quite early. The best thing your dad can do (and, btw, now YOU and your siblings as well) is to be diligent with follow ups, especially the colonoscopy and just be aware of what your body is 'telling' you. As I'm sure you've figured out, colorectal cancer, especially in the early stages, is oftentimes diagnosed with little to no symptoms but as it progresses, symptoms might be there but seem very mild or even just annoying. Know your body, know what is 'normal' and don't be afraid to speak up with your doctor if you think something is amiss. If you can't get a doctor to listen to you (perhaps because they deem you too 'young' ) then find another doctor if necessary.

If your father feels that a second opinion is warranted, then by all means get one. It certainly can't hurt and may just be the best 'medicine' that your dad needs right now.
Jaynee
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

mvdesh
Posts: 4
Joined: Mon Nov 04, 2013 8:53 am

Re: T2N0Mx

Postby mvdesh » Mon Nov 04, 2013 12:04 pm

Thanks a lot, Jaynee!
It is so nice of you to go through these posts quite patiently.
We will be careful and lookup for the "calls" and also follow it up with routine colonoscopy as advised by a doctor. Will post here if I get further doubt. I love this forum and highly appreciate the support that is extended.

Mandar

mvdesh
Posts: 4
Joined: Mon Nov 04, 2013 8:53 am

Re: T2N0Mx

Postby mvdesh » Fri Apr 21, 2017 12:45 pm

Hi fellows,

A bad news...My father had recovered well from the surgery and post op care. Subsequent followups showed no recurrence of the tutor. However, the followup colonoscopy today revealed another (new) lesion in the ascending colon that is "Large broad base polyp with friability in the ascending colon". The original anastomosis site is normal. The sample is sent for biopsy and hopefully we will know in next 2-3 days. Can someone help us to know about chances of this being malignant and also for options we may have?

Thank you in advance.

Mandar

Deb m
Posts: 558
Joined: Tue Jan 14, 2014 10:08 am

Re: T2N0Mx

Postby Deb m » Wed Apr 26, 2017 12:02 pm

bump

PainInTheAss
Posts: 673
Joined: Tue Jul 02, 2013 3:08 am

Re: T2N0Mx

Postby PainInTheAss » Wed Apr 26, 2017 7:56 pm

Did you get the biopsy results yet? If they are still calling it a polyp rather than a tumor, it still sounds like stage I even if it is malignant. Tney called me right away once my results came back positive, and I was in the office the next day discussing options.
47yo single mom of 4 (24, 21, 18, 16) at Dx
6/13 - RC T4b IIIc 5LNs on PET CEA 5.4
8/13 - Finish chemorad
10/13 - APR/hyst+ovaries/perm colostomy 2/12 nodes+
6/14 - Finish Xelox 6 rds
1/15 - CT clear CEA 0.2
10/15 - CT/MRI clear CEA 0.7
4/16 - CT clear
10/16 - CT/MRI clear CEA 0.6
5/17 - PET clear? Follow up MRI to verify inflammation

justin case
Posts: 4269
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: T2N0Mx

Postby justin case » Fri May 05, 2017 5:48 pm

mvdesh wrote:Hi fellows,

A bad news...My father had recovered well from the surgery and post op care. Subsequent followups showed no recurrence of the tutor. However, the followup colonoscopy today revealed another (new) lesion in the ascending colon that is "Large broad base polyp with friability in the ascending colon". The original anastomosis site is normal. The sample is sent for biopsy and hopefully we will know in next 2-3 days. Can someone help us to know about chances of this being malignant and also for options we may have?

Thank you in advance.

Mandar

Most gastroenterologists know if there is a problem, before sending a sample to the lab. (At least mine does) . My wife had a polyp, on her last exam, and when my GI recognized my voice, after the scan, he told me promptly, it's probably just a polyp. As folks get older, polyps do tend to appear, but many are benign .
Justin
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012


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