Surgery Monday UPDATE

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Re: Surgery Monday

Postby Bat-Mom » Mon Mar 09, 2015 4:05 pm

Just saw this now. Hope everything went well. I remember I couldn't wait to get out. Also my diet. Was craving fresh fruit. Had someone smuggle pears in. Surgeon caught me and said to hold back on good food. Wanted me to eat processed bad food I think it's called low residue. Holding the pillow through pain and coughing helps too. I thought surgery would be a piece of cake but wow I don't bounce back like I used to.

My advice is give yourself all the time you need. Ge gentle to yourself and don't expect too much too soon. Some stuff will get better and some stuff may be the new normal.
54 y/o
10-2013 colonoscopy
11-2013 colon resect
12-2013 stage 3b results are in 4 of 11 LN
12-2013 - 5-2014 folfox
9-2014 cea 1.7 12-2014 CT clear cea 1.7 3-2015 cea 1.6
6-2015 new doc new lab. Cea now 3.9???

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O Stoma Mia
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Incisional and parastomal hernias

Postby O Stoma Mia » Mon Mar 09, 2015 5:56 pm

TheLadySkye wrote:... The nurses had a thin blanket they folded into a square, med taped that way, and drew a smiley face on. Every time I had to cough or sneeze, I was told to hold that as tight as was comfortable (in other words, not very tight!) against my abdomen. This helps limit movement during coughing/sneezing and helps with pain and the possibility of tearing the surgical site. Honestly, that silly thing was a lifesaver for me after surgery. Especially when I would get up to walk, coughing seemed inevitable for awhile....

TheLadySkye -

You have brought up a very important point that I think should be emphasized for all patients undergoing CRC surgery: it is the possibility of tearing of surgical site due to any unusual, vigorous activity that puts stress on the new incision(s). This condition is called an"incisional hernia" when it occurs at the site of the main LAR or APR incisions, and it is called a "parastomal hernia" when it occurs near the ileostoma incision site. These two conditions are to be avoided at all cost because they can cause considerable problems later on and can reduce the subsequent quality of life.

The good news is that incisional hernias and parastomal hernias can be avoided -- but only if the post-surgery patient takes extreme care not to allow unusual tension at the incision sites. This means, among other things:
  • Absolutely no lifting of any heavy objects in the post-surgery period.
  • No lifting yourself up or pulling yourself up out of bed in the post surgery period. (Call the nurses if you need assistance in getting up out of bed.) Do not try to use the hand rail or overhead bar to raise yourself up, or you risk the possibility of tearing the surgical site.
  • No coughing or sneezing allowed during the immediate post-surgical period. If this is unavoidable, then I think you should insure that you have some kind of abdominal support to hold the surgical incision site(s) firm. Devices like abdominal binders might be appropriate in this case, if approved by the doctor. If you develop uncontrollable coughing and sneezing, then you could damage the incision site, causing delayed healing and eventual incisional hernia.
This is just my own personal opinion, and the reason I am mentioning this here is that there seems to a constant reminder that we have to "walk, walk, walk" just after surgery, but there is rarely any mention that in order to get up to walk you have to first get out of bed, and the maneuvers that you use to get yourself out of bed could easily cause problems to your new incisions.
Last edited by O Stoma Mia on Tue Dec 15, 2015 9:54 am, edited 1 time in total.

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Re: Surgery Monday UPDATE

Postby cathy123 » Wed Mar 11, 2015 2:44 pm

Surgery apparently went well. It ended up taking about 7 or 8 hours, because they had to handsew the colon since there was not enough space to staple. They were able to do it laproscopically, which will hopefully help with recovery. I am feeling reasonably good while laying down, although there is lots of pain when I try to get in or out of bed. I took a short walk earlier and spent some time in the chair. My bag is working ok so the surgeon said I may be able to go home tomorrow. Not quite sure whether I am ready to deal with the bag or navigating stairs quite yet but it will be nice to get home.

Biopsy results should be ready in a week. Please keep the prayers coming that the biopsy doesn't show any surprises.

Diagnosed 10/14 low rectal cancer age 43
Clinical T2NXMX
Radiation/xeloda 12/14-1/15
LAR with temp Ileo 3/15
pT2N0M0, lymphatic invasion 0/37 nodes
4 xelox, 1 xeloda only
Reversal 9/15
Mom to 9&11 year olds

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Re: Surgery Monday UPDATE

Postby DarknessEmbraced » Wed Mar 11, 2015 3:41 pm

I'm glad that your surgery went well. I'm glad that it was done laproscopically. I had the open surgery. Yes, getting in out of bed is very painful. I spent time in the chair near my bed and then was able to walk around the ward. I ended up staying longer at the hospital because of pain issues, problems with my urinary catheter and nausea problems. Just pace yourself, take it slow and steady. I found stairs very difficult for a while after I came home from surgery. Of course our apartment is on the third floor with no elevator. I hope the biopsy doesn't show any surprises and I wish you luck with your recovery! Please keep us updated.
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)

Nik Colon

Re: Surgery Monday UPDATE

Postby Nik Colon » Wed Mar 11, 2015 3:53 pm

Glad things went well, hope they stay that way and you will heal soon! Keep us updated.

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Re: Surgery Monday UPDATE

Postby Moon » Wed Mar 11, 2015 4:13 pm

Good news, wish you a quick recovery.
nov. 2011 RC Stage 3
dec. 2011 lap. rectumresection, temp. ileo.
jan.-june 2012 FLOX
aug. 2012 ileo. rev.
jan, sept 2013 surg. for livermet
june 2014 local recurrence + PC, FOFIRI/Avastin june-dec. break
june 2015 surg. for colon blockage

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Re: Surgery Monday UPDATE

Postby Stanfordmom » Wed Mar 11, 2015 4:29 pm

Congrats!! I will pray for your speedy recovery.

DX 4/2/2014 at 44, stage 4, mets liver and ovaries
Mom to 2 boys
Three surgeries, HAI pump and lots of chemo

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Re: Surgery Monday UPDATE

Postby HannaandJuliansMom » Wed Mar 11, 2015 5:11 pm

So good to hear that it went well Cathy! It's fantastic that they managed without opening you up. Wishing you a good recovery and sending you positive thoughts on healing and the pathology results.
47 y/o female
two kids (12 and 4)
11/2014 Rectal Ca St. 2a
Chemoradiation (28 days) finished on Jan 30, 2015
LAR 3/27/15

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Re: Surgery Monday UPDATE

Postby Rasputin » Wed Mar 11, 2015 6:24 pm

Cathy, so good to hear! Thanks for taking the effort to post.
Dec 07 50 y/o 'scope dx CRC
Jan 08 surgery took 7" colon 7" in. T1N0M0 NED
09-13 'scopes NED
Nov 14 CT thumb sized mass near surgery outside colon
Dec 14 PET, biopsy dx malignant, no mets
Jan/Feb 15 25X Xeloda, radiation
4/9 LAR, perm. ostomy, cancer remaining?
5/22 start 8X XELOX

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Location: NJ

Re: Surgery Monday UPDATE

Postby midlifemom » Wed Mar 11, 2015 9:03 pm

Cathy, glad to hear your good news. Don't go home too soon. Be sure you're ready, to avoid a hernia or readmission.
Stage 3 cc - dx Jan '14 age 53, cea 2.9
t2n2m0, KRAS mutant, MSS
Folfox Feb - Aug '14
Nov '14 cea 27.7 -2 liver masses
Dec '14 left lobectomy and HAI
Jan '15 FUDR and FOLFIRI
Aug '15 fudr done, liver clear, add avastin for lungs. Cea 4.3
Feb '16 CEA rising
May '16 2 wk break then drop Iri for 6 weeks.
Jul '16 cancer grew, constricted main bile duct. Stent inserted. On break till jaundice clears. CEA climbing. Doing reduced Folfox. Allergic to Oxali.
Sep'16 chemo failed. Trial or hospice?

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Re: Surgery Monday UPDATE

Postby lpas » Wed Mar 11, 2015 9:38 pm

Great news--thanks for filling us in! Will be anxious to hear about the results of your pathology report.
11/14 Dx sigmoid CC @ 45yo
12/14 Colectomy + hysterectomy
Stage IIIB, T3N1bM0, 2/20 nodes, MSS, G2, KRAS(A146T), TP53, SMAD4, ERBB2, CEA 1.0
2/15-7/15 XELOX & celecoxib
2/19 clean scope
11/19 clean CT
Ongoing celecoxib, cimetidine & other targeted supplements
Mom to a 5 & 8yo

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O Stoma Mia
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Pathology report templates

Postby O Stoma Mia » Fri Mar 13, 2015 5:40 am

cathy123 wrote:...Biopsy results should be ready in a week. Please keep the prayers coming that the biopsy doesn't show any surprises.

Cathy -

To understand the upcoming pathology report on your biopsy, you could spend some time now reading up on standard path report templates for colon cancer. There will be a lot of new technical terms to learn, and it will be important to try to understand what your report is saying, because that report will likely form the basis of your final staging and will help determine what your first-line treatment regimen and your overall prognosis will be.

Path report -- what information is typically included?

And here's a typical path report template:

    Path Report Template

    Table 2
    Surgically resected specimens of colorectal cancer – Checklist

    Tumor site:
    Ascending colon
    Hepatic flexure
    Transverse colon
    Splenic flexure
    Descending colon
    Sigmoid colon
    Rectosigmoid junction

    Tumor size
    Maximum tumor diameter: cm

    Histologic type
    Mucinous adenocarcinoma
    Signet-ring cell carcinoma
    Small cell carcinoma
    Squamous cell carcinoma
    Adenosquamous carcinoma
    Medullary carcinoma
    Undifferentiated carcinoma
    Other (specify):

    Grade of differentiation
    Low grade (well or moderately differentiated)
    High grade (poorly differentiated or undifferentiated)
    High grade component (%):

    Depth of tumor invasion
    No evidence of primary tumor
    Tumor invades submucosa (pT1)
    Tumor invades muscularis propria (pT2)
    Tumor invades through the muscularis propria into the subserosal adipose
    tissue or the nonperitonealized pericolic or perirectal soft tissues (pT3)
    Tumor penetrates to the surface of the visceral peritoneum (serosa)
    Tumor directly invades other organs or structures
    (specify:) (pT4b)
    Tumor penetrates to the surface of the visceral peritoneum (serosa) and
    directly invades other organs or structures
    (specify: ) (pT4b)

    Margins of resection
    Proximal/distal margin
    Cannot be assessed
    Invasive carcinoma present
    Invasive carcinoma absent
    Distance of invasive carcinoma from closest margin:
    Circumferential (radial) margin
    Not applicable
    Cannot be assessed
    Invasive carcinoma present
    Invasive carcinoma absent
    Distance of invasive carcinoma from non-peritonealised margin:

    Regional lymph nodes
    Number examined:
    Number involved:

    Tumor deposits
    Not identified
    Present (number: )

    Response to neoadjuvant therapy
    Not applicable (no prior treatment)
    Complete regression
    Minimal residual tumor
    No marked regression

    Extramural venous invasion
    Not identified

    Pathologic staging (pTNM)
    TNM descriptors
    (required only if applicable)
    m (multiple primary tumors)
    r (recurrent)
    y (posttreatment)

    Primary tumor (pT)
    pTX: Cannot be assessed
    pT0: No evidence of primary tumor
    pTis: Carcinoma in situ, intraepithelial or invasion of lamina propria
    pT1: Tumor invades submucosa
    pT2: Tumor invades muscularis propria
    pT3: Tumor invades through the muscularis propria into pericolorectal
    pT4a: Tumor penetrates the visceral peritoneum
    pT4b: Tumor directly invades other organs or structures

    Regional lymph nodes (pN)
    pNX: Cannot be assessed
    pN0: No regional lymph node metastasis
    pN1a: Metastasis in 1 regional lymph node
    pN1b: Metastasis in 2 to 3 regional lymph nodes
    pN1c: Tumor deposit(s) in the subserosa, or nonperitonealized pericolic
    or perirectal tissues without regional lymph node metastasis
    pN2a: Metastasis in 4 to 6 regional lymph nodes
    pN2b: Metastasis in 7 or more regional lymph nodes

    Distant metastasis (pM)

    Not applicable
    pM1: Distant metastasis
    Specify site(s):
    pM1a: Metastasis to single organ or site (e.g., liver, lung, ovary,
    nonregional lymph node)
    pM1b: Metastasis to more than one organ/site or to the peritoneum

    Additional pathologic findings

    None identified
    Diverticular disease, ulcerative colitis, Crohn’s disease, familial
    adenomatous polyposis, other forms of polyposis, synchronous
    carcinoma(s) (complete a separate form for each cancer), etc.
    Polyps present (specify type and number):


    Recommendations for the Reporting of Surgically Resected Specimens of Colorectal Carcinoma

In addition, in your case (neo-adjuvant chemo/radiation), your report might get into a discussion of level of response (to chemo/radiation). I think the relevant terminology here is:

    cCR --The definition of a cCR (complete clinical response) is: (1) substantial downsizing with no residual tumor or residual fibrosis (2) no suspicious lymph nodes on MRI; (3) no residual tumor at endoscopy or only a small residual erythematous ulcer or scar (4) negative biopsies from the scar, ulcer, or former tumor location; and(5)nopalpable tumor,when initially palpable with digital rectal examination.

    pCR --The definition of a pCR (pathological complete response) is: the complete absence of intact tumour cells in the resected specimen, where pathologic examination of the surgical specimen reveals no viable tumor cells
Last edited by O Stoma Mia on Wed May 24, 2017 11:27 am, edited 1 time in total.

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Re: Surgery Monday UPDATE

Postby cathy123 » Fri Mar 13, 2015 2:21 pm

Thank you OSM. That will be very helpful when I get biopsy results. The surgical fellow who released me said he wasn't sure if they will call or just wait til my apot in two weeks. I will probably call them next week sometime. After I got out of surgery I only saw my surgeon one time for about 5 minutes. Is that normal?

I got home last night and have pretty much been lazing around in bed. I am going to try to gather energy to get downstairs in a bit. Pain isn't bad at all until I try to move around - then I get a little lightheaded and my stomach hurts. Getting used to this bag is going to take a bit - the home nurse came today and will be coming a few times a week for the next two weeks. Hopefully I will figure it out by then.

Diagnosed 10/14 low rectal cancer age 43
Clinical T2NXMX
Radiation/xeloda 12/14-1/15
LAR with temp Ileo 3/15
pT2N0M0, lymphatic invasion 0/37 nodes
4 xelox, 1 xeloda only
Reversal 9/15
Mom to 9&11 year olds

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