Question for those who have had radiation for rectal cancer

[cathy123]

I am going to start chemo radistion in a week or so. I recently checked back with the surgeon who provided my second opinion and among other things he said that if I have treatment with him(which isn't the plan due to distance) I need to be tattooed under anesthesia before surgery starts so he will know where the tumor is if radiation completely shrinks it. This time he also said he has seen cancer return in these cases when all the cancerous areas are not removed

. I had asked my surgeon about this before send he said it isn't neccesary because he will be removing the entire rectum. So it sounds like just a difference in the doctors methods which is fine. But I just wanted to check whether tattooing is the standard and something I should ask my surgeon about again or not. If it is needed I have a short time to get it done before radiation starts. Any comments are appreciated.

[BrownBagger]

Hi Cathy. I have a very small tattoo--about the size of a small mole, that they put on me to be able to line up the radiation equipment. I wasn't under anesthesia or anything--it was quick and painless. And, as I told the rad tech, "we'll always have this tattoo to remind us of our relationship.

I had a complete response to radiation/chemo. My T3 tumor was gone. But the affected area still needed to come out, along with about a foot of colon in order to get at the lymph nodes.

Women have special requirements during radiation that they usually don't tell you about, I gather. Be sure to ask some of the women around here for some tips.

[John72]

Same experience as BB. Nothing to add except that I know they need the tattoos for the radiation techs to properly target the radiation.

[Bob_Weiss]

My experience was exactly the same as Brownbagger. The reasons given by the radiation nurse doing the tattoo was that the skin markings will help to guide the radiation to the tumor area in the rectum. The surgeon previously told me that the radiation treatments were desirable because 1)It should shrink the tumor which will make the surgery easier so that nerve or muscle damage is less likely; 2)The radiation reduces the likelihood of a local recurrence.

In your case where the rectum will be removed, the radiation seems to have no purpose. But I'm no oncologist.

[JaninOz]

Hi Cathy. I was tattooed inside when my colonscopy was done and the tumour was found. I imagine to do it now it would be similar to prep and colonoscopy sedation.

But like Brownbagger I had entire rectum above sphincter and sigmoid removed so there were good margins all round. Also a complete response from chemoradiation. And I have three teensy dots where they lined up equipment.

[Coppercent]

I am similar to everyone else. They removed my whole rectum along with the tumor. But I had radiation pre-surgery. Drink a lot of lemon juice to prevent burning on radiation at the end. Sounds crazy but it really works.

[cathy123]

Thanks all. The tattooing I was talking about was the internal tattooing similar to what JaninOz describes. My surgeon says it isn't needed, the other surgeon said it is really important, so just wanted to make sure it isn't something that I should demand to have done. But, it doesn't sound like it is done in all cases, so I think I will let it go.

I did just have the mini tattoos done during radiation prep. Looks like I will be starting next Wed. Mentally it will be good to get on with the treatment instead of dealing with all these questions about whether I am making the right decisions.

[KWT]

When I had the endoscopic ultrasound they made tattoo marks around the tumor. They said regardless of how much shrinkage occured they would still take out the same amount of tissue. I also only did the five day course of radiation they weren't really trying to shrink the tumor so much but wanted to kill the bad cells

[Mastan]

The one surgeon that suggested the internal tatoo is perhaps considering sparing some of the intestine if there was a significant response to chemo/rad. The most conservative approach is to remove the entire rectum and part of the colon in which case the tatoo is unneccesary. This is what I had done as well as a number of other respondents. I dont have any stats other than the people on this board and data from my Onc but when RC reappears it is usually in the lungs as evidenced by my and others signature lines on this forum. The surgeons are pretty good at ridding the local disease if they take the conservative approcach and remove the rectum and about a foot of colon. The journey will be challenging so take itone day at a time.

Mark

[weisssoccermom]

Cathy if I remember correctly, your tumor is fairly low, correct? In that case, unless you are planning on avoiding surgery all together, then the tattoo isn't necessary. Even though I only had an excision, there was no need for an internal tattoo. Let's suppose your tumor responds 100% from the chemoradiation.....it does leave a small 'scar' that is different from the surrounding tissue so even if you are only having something like an excision, your surgeon will know where the tumor was located. If you are having an LAR where most, if not all, of the rectum (plus some of the sigmoid) is removed, then honestly, there is no need for the internal tattoo. In addition, as a few other posters have said, it can be done during a few different procedures....such as the rectal ultrasound or a rectal only flex sig....none of which need anything more than an enema or two and certainly don't need anesthesia.

If you're not going with the surgeon who recommended this, I would just let it go.....particularly since you did address the question to the surgeon you are going with.

[sparklefox]

My experience is really similar to BrownBagger - just the external tattoos.

I did daily radiation(5 days/week) for 6 weeks. I have to say, that it wasn't really bad until the end, and actually the side effects were the worst *after* the series was over, for about two weeks. My tip: go low residue diet while on radiation and especially for a few weeks after.

Good luck!!

[Ontario Guy]

Like sparklefox, just external tattoos, 4 of them.

Also, like sparklefox, the effects of radiation got a lot worse toward the end. Then, about 10 days after my last zap, things got so bad I was hospitalized for pain management and spent several weeks attached to a drug pump. I got to know a couple of powerful narcotics very well.

The good news is that that was the worst part of treatment, and that two weeks after surgery I was off pain-killers for good, so no real harm done. The even better news (at least from my perspective) is that I'm still alive.

Good luck!

[lhawk0730]

My mom's tumor is about 8 - 10 cm into her rectum. She had an internal ultrasound and an internal tattoo at the same time. Her surgeon's reason was that he needs to make sure to remove all of the cancerous tissue, while preserving as much rectum, and therefore her anus, as well. She is doing 5 weeks of chemoradiation right now. Maybe time for a third opinion or asking both doctors to explain their differing approaches? If your rectum/anus are potentially salvageable, wouldn't that be ideal? But keep in mind, mom had to get her tattoo before radiation to make sure the margins were accurate.