Stage II and no chemo?

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silversprmom
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Joined: Mon Mar 10, 2014 4:37 pm

Stage II and no chemo?

Postby silversprmom » Mon Mar 10, 2014 6:11 pm

This is my first time posting, though I have often come just to read other posts. I was diagnosed in October 2012 at the age of 37 with Stage II CC (T3N0M0). After the resection, my oncologist recommended against chemo b/c I had only "low risk" pathology factors. He said that the increased benefit of chemo would be only 2%-3% in my case and that I could cut my risk of recurrence/metastasis through regular exercise and a daily mini-aspirin. That he recommended against chemo came as a surprise to me, as I had spent considerable time on the blogs and actually wanted the poison. I'd love to hear from others who chose not to do chemo for Stage II - do you regret it? I'd also love to hear from those who did chemo. Thank you!
Mom of 4, age 37, colon cancer -- 10/17/2012
Colon resection -- 10/26/2012
T3N0M0, 37 nodes neg -- 11/1/2012
Onco recommends NO CHEMO (Rx= exercise, 80 mg aspirin) -- 12/2012
CT scan -- 1/2013, NED
CT scan -- 7/1/2013, NED
CEA -- 1/7/2014 -- 0.7

sofarsogood
Posts: 36
Joined: Sun Nov 20, 2011 10:00 pm

Re: Stage II and no chemo?

Postby sofarsogood » Mon Mar 10, 2014 9:13 pm

I have the same situation. Dx'd in Sept. of '10 stage II with 49 nodes negative. My onc didn't recommend chemo either and we didn't really ask if she would have given it to me if we had decided to go that way. She has been keeping a pretty close eye on everything with the scans etc. and so far it's worked out good. It's a tough choice but we decided to put all our faith in the Dr.'s going in and have stuck with that decision. If it's any help, my Onc sent everything to MAYO and they agreed with everything we are doing.
Dx Sept. '10, age 49
Surgery Sept."10
Stage IIA
NED so far

orcasres
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Location: Orcas Island, WA

Re: Stage II and no chemo?

Postby orcasres » Mon Mar 10, 2014 9:26 pm

This is a very individual decision. I had some risk factors (lymphovascular invasion) and an unusual tumor type. My onc described the pros and cons in detail. I decided for chemo because I felt I had to be able to look myself in the eye if I had a recurrence and say I did all that I could do. It was a pretty unpleasant experience overall, but I do not regret it and will not regret it if the cancer comes back.

Lois
63 yo F
Colon resection Sept. 2010
pT3N0M0 Stage 2A
Medullary Tumor 6.5cm long
Lymphovascular invasion
Lynch negative
12 FOLFOX 11/2010 to 5/2011 8 w/Oxi
NED so far

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TheLadySkye
Posts: 269
Joined: Thu Oct 24, 2013 1:40 pm

Re: Stage II and no chemo?

Postby TheLadySkye » Mon Mar 10, 2014 9:48 pm

I am curious about what your low risk factors were.

I'm in a slightly different boat. I have small intestine cancer, not colon, though I guess since small intestine cancer is so rare, they are treated quite similarly.

Following surgical resection, my results looked like this:

- T4N0M0
- Clear surgical margins
- Clear lymph nodes. Only 7 were sampled. I don't know if that is because there are significantly fewer around the small intestine? It seems like a low number, but the surgeon feels quite confident that he got and sampled everything needed.
- Moderately differentiated cells
- No evidence of lymphatic or nerve or blood vessel invasion
- Showed itself via obstruction (not complete, but enough to cause issues) and subsequent CT and scoping.

Both my medical team at Roswell Park Cancer Institute and my second opinion at Memorial Sloan Kettering were on board with following up with adjuvent FOLFOX for 12 sessions even though my surgery appeared successful and my post-surgical scan showed NED. They cited some potentially high-risk factors including the T4 tumor and obstruction. They also cited my young age (I was 39 at diagnosis in August 2013) as a factor in wanting to treat this as aggressively as possible.

No lie, the chemotherapy sucks. There is no way to sugarcoat it. But I AM glad to be doing everything I can do to prevent recurrence. I HATE that so much of this out of my hands, and sometimes you and the doctors can do everything and recurrence can still occur. That is the scariest part of all of this for me.

My understanding is that chemo treatment for stage II is still pretty hotly contested in the medical community, but in my case, my doctors felt the benefits would outweigh the cons. Good luck in your decision.
TheLadySkye
Stage 2b (T4N0M0) small intestine (jejunum) 8/13
Small bowel resection 9/13
CT 10/13 - NED
FOLFOX chemotherapy 11/13 - 4/14
CT 6/14 - NED and my nemesis (the power port) out!
Clean colonoscopy and endoscopy 9/14
CT 12/14, 6/15 - NED!!!

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joybella
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Re: Stage II and no chemo?

Postby joybella » Mon Mar 10, 2014 10:09 pm

My Oncologist did not recommend any chemo following my surgery in September, 2013 and 20 negative lymph nodes. He did say if I wanted to do it, he would prescribe it, but he felt it was not necessary. I trusted his judgement because he has treated another family member with stage IV colon cancer (very successfully) and has a stellar reputation here in TN. I had my first follow up in February and I asked about a CT scan and he said all I would need was the colonoscopy a year from my surgery. I kind of worry about that as most people on here mention that they have follow up scans. My doc also said to walk and take a low dose aspirin for prevention .
I send my best wishes for your decision and for continued good health.
Joy
8-20-13 Colon Cancer II A
Distal Cecum/Appendix
5 cm
20 nodes-negative
9-20-13 Hemicolectomy
Joy

orcasres
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Joined: Mon Jul 01, 2013 10:23 pm
Location: Orcas Island, WA

Re: Stage II and no chemo?

Postby orcasres » Tue Mar 11, 2014 12:08 am

The standard of care for Stage II A here is a CT scan after the end of treatment and an annual scan for five years (assuming you stay NED). Two years of blood tests (metabolic panel, CEA, and CBC) every three months following end of treatment, then every six months for the rest of the five year period. Finally a colonoscopy at 1 year after diagnosis. If no polyps then the next colonoscopy comes three years after, and if clear, then every five years. I think this is fairly typical standard of care for Stage II.

Lois
63 yo F
Colon resection Sept. 2010
pT3N0M0 Stage 2A
Medullary Tumor 6.5cm long
Lymphovascular invasion
Lynch negative
12 FOLFOX 11/2010 to 5/2011 8 w/Oxi
NED so far

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

Re: Stage II and no chemo?

Postby weisssoccermom » Tue Mar 11, 2014 1:26 am

I would ask your onc a question before you make any decision. The 2-3% benefit that your onc mentions, with respect to the stage II patient, usually refers to the addition of oxi to either Xeloda or 5FU. Is that the 2-3% he/she is referring to? If so, there is the option of taking either the Xeloda or 5FU all by itself which does the majority of the work. Let me explain a little further. Too often, when dealing with the stage IIA patient, oncs tend to make the chemo scenario a 'black and white' discussion. It is either FOLFOX or XELOX or nothing.

FOLFOX = 5FU/leucovorin + oxaliplatin
XELOX = Xeloda + oxaliplatin

In simplistic terms, Xeloda is the oral form of 5FU

However, there is another alternative......just the Xeloda or 5FU/leucovorin by itself. Unfortunately, too many oncs don't look at this scenario, even though until 2004, this was the main protocol as oxi wasn't yet approved. So yes, I believe your onc is correct in saying that there is a 2-3% benefit....but that benefit refers to the addition of the oxi, not necessarily some chemo. You might want to ask your onc about doing either Xeloda or 5FU/leucovorin (personally, I'd pick the Xeloda...no port, no infusions, etc.) and see what he/she says.
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

Choijk
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Facebook Username: June choi lee
Location: Glendale, ca

Re: Stage II and no chemo?

Postby Choijk » Tue Mar 11, 2014 1:47 am

My mother also had no prognostic factors but the oncologist indicatd that if she wanted it, he would recommend Xeloda. We also obtained a second opinion who agreed with the recommendation .

Moms surgery was in June and now not nearly a year later, something on an MRI showed that her liver cyst now looks different. It's been diagnosed as a biliary adenoma which the oncologist surgeon said he won't know if it's malignant until he takes it out.

Her liver resection is set for May 1. Mom is terrified because she doesn't want to go through another surgery but surgery is scheduled and we can't live our lives being scared of, what if it is cancer. According to the surgical oncologist he doesn't think it's a liver met but a new primary. I trust his medical opinion as he seems to have a very good reputation as he is the chief of surgery at kaisers sunset location.

If she did chemo, would the result be different ? We will never know. It is a very difficult decision. May you stay Ned forever.

Mom also exercises, but always has. Also takes baby aspirin at the recommendations of her oncologist and vitamin d1000g also At doctors recommendation. Cea every 3 months, yearly ct scans and colonoscopies .

Many blessings to you, June
Daughter to 73 yr mom at dx 5/16/13
6/5/13 rt hemi
T3n0mx (no prognostic factors)
No txmt, observation only
2/14- MRI: potential new primary. Biliary adenoma
5/1/14 liver resection (7th sector) and gallbladder also taken out

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Cherie
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Location: New Zealand

Re: Stage II and no chemo?

Postby Cherie » Tue Mar 11, 2014 1:59 am

Dont' do it! If you had any idea how bad chemo can be for some then 2-3% is not worth it. I have finished chemo and need morphine everyday to walk, I can't use my hands to open anything and I need 12hours sleep. I have less problems from the cancer!!! Count yourself lucky and go exercise. :D
36Yo F
2000 UC
2013 Stage 4 CC 15/126 LN spread to the omentum
June Collectomy all visible cancer removed
July Folfox + Avastin
2/14 clean scan
8/14 Ileo-anal pouch surgery still NED
1/15 Emergency illeostomy spread to peritoneum and small bowel

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

Re: Stage II and no chemo?

Postby PainInTheAss » Tue Mar 11, 2014 3:32 am

From what I understand, Standard care for stage IIa with no risk factors is becoming to not do chemo. Stage IIb is treated differently. The recurrence rate for stage IIa is so low that even adding 5FU/Xeloda alone isn't going to make much of a statistical difference. Risk factors can be things like poor differentiation, vascular invasion or anything your doctor thinks is a risk factor.

If your Doctor isn't recommending chemo, you may want to get a second or third opinion. If it all comes back the same then you can rest assured you've made the right decision listening to your doctors.

No one on this message board has the exact same cancer or pathology as you, so you can't compare what is the right treatment for you simply by stage.
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

Nixma
Posts: 88
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Location: CNY

Re: Stage II and no chemo?

Postby Nixma » Tue Mar 11, 2014 6:28 am

Last summer, in July they found a large tumor in my colon. It was removed, along with 46 lymph nodes that came back clean. Chemo was not recommended to me at that point because I was "stage 2". Now, 8 months later, my CEA went up, my PET lit up, and now I am going to start chemo for the mets to the lymph nodes near my pancreas and waiting on pathology on nodes next to my ovaries. I wish I did the chemo last summer, I had a feeling back then that my cancer would recur. I should have gotten a second opinion. Hindsight is 20 20 they say. I would get another opinion.


Nixma
42 F when diagnosed July 13
July 2013 Large tumor removed vie R hemi colectomy
no chemo
January 14 CEA doubles
Pet Lites up
Now Lymph nodes near pancreas cancerous
Stage 4 mcrc
Folfox 3/18/14
Hysterectomy 7/15/14
Resume Folfox 8/27/14

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PGLGreg
Posts: 1427
Joined: Sat Nov 04, 2006 12:38 am
Location: Waimanalo, HI

Re: Stage II and no chemo?

Postby PGLGreg » Tue Mar 11, 2014 7:29 am

PainInTheAss wrote:The recurrence rate for stage IIa is so low that even adding 5FU/Xeloda alone isn't going to make much of a statistical difference.

Yes, from reading a number of similar previous discussions here, that's what I gather. However, the conclusion that one shouldn't do chemo isn't obvious. A small statistical difference is a difference.
I also don't understand the relevance of taking baby aspirin or doing exercise. Those may be good things, but I think they would be good regardless of whether you do chemo, and, so far as I know, chemo would still have some small benefit.
(I took 5FU+leucovorin during radiation with no apparent ill effect except a touch of nausea at the time.)
Greg
stage 2a rectal cancer 11/05 at age 63
LAR 12/05 with adjuvant radiation+5FU,leucovorin 1-2/06
NED for 12 years, cured

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

Re: Stage II and no chemo?

Postby Deb m » Tue Mar 11, 2014 9:30 am

My husband was a stage ll also. Because he was a t4 they wanted him to do chemo. He did 12 hits of folfox (oxi omittted from the last two treatments due to side effects). Overall he did well. If we had to do it all over again, we would do the same thing. If the chemo gets to be to much for you, you can always stop it.

Also, our oncologist told us that he considered a t4 and t3 both as high risk features. I would get a second opinion.

It's not an easy decision to make, but I wish you the best possible out come either way.

Deb m

JAZZToo
Posts: 509
Joined: Sun Oct 01, 2006 10:46 am
Location: New York City

Re: Stage II and no chemo?

Postby JAZZToo » Tue Mar 11, 2014 9:54 am

Having colon cancer at age 37 is young. Is there a history of colon or endometrial or ovarian cancer in your family? Was your tumor tested for microsatellite instability? A test result of microsatellite high could indicate a genetic mutational cause of the cancer and require further testing to see if Lynch Syndrome might be involved. With Lynch Syndrome, chemo for stage II or IIIA is not recommended because it has little effect and a Lynch tumor is less likely to spread than a random one. In any case, you do need follow-up with CAT scans of the chest/abd/pelvis and monitoring of your CEA on a regular basis to pick up any signs of recurrence or spread outside of the colon to liver, lungs or lymph nodes.

Leslie
Lynch Syndrome
1995 Endometrial Cancer age 49
2003 Colon Cancer age 57

drdrh
Posts: 66
Joined: Wed Oct 31, 2012 5:16 pm
Facebook Username: doreene.hyatt

Re: Stage II and no chemo?

Postby drdrh » Tue Mar 11, 2014 11:32 am

Originally I was told no chemo, but with my age (45), presence in the nerves and proximity to the rectum, the oncology board (a group of Drs from around the state) decided I should do chemo. I didn't question (in fact, I wanted to make sure that I had nothing to regret later) and I finished the 12. Not a picnic, but nothing as bad as I expected. The bad came later, the post-chemo side effects. Peripheral neuropathy (not too bad, just annoying tingling) and seriously painful arthritis. I still wouldn't do anything different.....

drdrh
45yr old swf - rectosigmoid stage IIA
10/26/12 Colonoscopy, CBC, CMP normal, CEA 4.2
10/29 Biopsy positive, CT Scan no evidence of spread
11/13 Resection of tumor and 19 nodes - all negative
11/17 Emergency surgery (leak)
1/8/13 port placed
1/9/13 Folfox


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