Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

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skb
Posts: 50
Joined: Tue Mar 28, 2017 2:00 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby skb » Thu Apr 16, 2020 10:17 am

lakeswim wrote:hello SKB - thank you for updating us. like you said, it's so important to see that not all W&Ws continue to see clear results so i appreciate you checking in and letting us know and i am truly so sorry to hear this. i will have to research what VATS is as i am not familiar. i think about the chance of mets often so i don't take a clear test for granted - ever. that said, when I considered watch & wait, one of the statistics that stuck with me was what you just mentioned -- the chance of mets - even with surgery - is not zero.

are the lungs where it tends to met first - if it does? i understood it to be the liver or the lungs.

my best to you (and beccashocked),
lake swim





HI lake swim,
Based on statistics, the metastasis tends to occur to lungs if the initial cancer was in rectum. It tends to be in the liver if the initial cancer was in colon above the rectum. It has to do with how the blood vessels from various portions of the body are connected.

This is just based on research papers that I have read online and should not be taken as scientific or physician advice. I am not a medical professional.

Hope this helps.

skb
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no invasive adenocarcinoma
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge resection
9/19, 12/19, 4/20, 7/20- Clean CT, MRI, NED

lakeswim
Posts: 226
Joined: Sat Mar 31, 2018 9:37 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby lakeswim » Thu Apr 16, 2020 10:57 am

Thank you, SKB. I just spoke to my oncologist last week and he said the same.


[/quote]


HI lake swim,
Based on statistics, the metastasis tends to occur to lungs if the initial cancer was in rectum. It tends to be in the liver if the initial cancer was in colon above the rectum. It has to do with how the blood vessels from various portions of the body are connected.

This is just based on research papers that I have read online and should not be taken as scientific or physician advice. I am not a medical professional.

Hope this helps.

skb[/quote]
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
May 19 - flex Sig - looks good
Sept 19 - Chest/ab CT no change, MRI no change, flex Sig looks good
Jan 19 - flex sig - looks good
*grateful*

lakeswim
Posts: 226
Joined: Sat Mar 31, 2018 9:37 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby lakeswim » Thu Apr 16, 2020 11:17 am

Hello, Roadrunner.
I don't know the current research on how long to wait but I do recall seeing the curve I think you are referring to back when I was making my decision. So, I can only share my experience.

My local surgeon did an MRI @6-8 weeks after the end of radiation (did chemo before radiation). And a flex sig @8 weeks (can't remember exact days but know roughly when it was). There was some hazy question as to my MRI (tumor was gone but something about my uterine wall). As for my flex sig (which local surgeon felt was the most impt metric), the tumor was completely gone. My local tumor board didn't think I was a candidate for W&W but my local surgeon was willing to wait another 4 weeks to do another MRI - but recommended I go seek another opinion at MSK.

A month later (delayed a week by snowstorm), which was probably at 12 weeks or so after end of radiation, I had an MRI @MSK and a flex sig and their tumor board/surgeon felt I was a candidate. Both surgeons (here and there) felt flex sig was most impt. metric.

I know this doesn't help you with timing. What does your surgeon think about waiting additional time? They are most familiar with your case. I don't know where you are but I am a firm believer in second opinions - even if you like your surgeon. Why not get an appt with another W&W friendly facility/surgeon and get a second opinion. (I know this is difficult in the current virus situation. I know this because I may not be able to have my appts in May, which is scary! But perhaps they can at least do a telehealth if you forward them your notes/MRI.) This way you will have a few experts opinions to help make your decision.

Good luck and keep us posted.
Lakeswim

roadrunner wrote:Hey guys quick question: I just got MRI (a little over 12 weeks since CRT) results today that showed a “near cCR.” It sounded like the radiologist wasn’t exactly sure whether there was any remaining cancer or not. My surgeon, who is fantastic, wants to wait about 5 weeks then do a flex sig to decide on surgery or W&W through palpating/observation. Of course, I ran home (well, I was home since it was a video conference!) and started researching this situation. I found some interesting material suggesting that many (or most?) people in my situation will end up with a cCR if given enough time. One suggested 18-22 weeks from CRT is optimal to maximize the chance of cCR (I will be at 18 or so, so I’m wondering if I should push it back a bit?). The studies also back my surgeon up that MRI is not the best way to decide this, and that there are visual signs that are more conclusive. I’m very comfortable with and trust my surgeon, as I said, but want full information as I go forward. Does anyone have any experience or knowledge (or links) on near cCRs and W&W-friendly current approaches to same? Thanks for any info.
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
May 19 - flex Sig - looks good
Sept 19 - Chest/ab CT no change, MRI no change, flex Sig looks good
Jan 19 - flex sig - looks good
*grateful*

prs
Posts: 172
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Thu Apr 16, 2020 5:27 pm

roadrunner wrote:Hey guys quick question: I just got MRI (a little over 12 weeks since CRT) results today that showed a “near cCR.” It sounded like the radiologist wasn’t exactly sure whether there was any remaining cancer or not. My surgeon, who is fantastic, wants to wait about 5 weeks then do a flex sig to decide on surgery or W&W through palpating/observation. Of course, I ran home (well, I was home since it was a video conference!) and started researching this situation. I found some interesting material suggesting that many (or most?) people in my situation will end up with a cCR if given enough time. One suggested 18-22 weeks from CRT is optimal to maximize the chance of cCR (I will be at 18 or so, so I’m wondering if I should push it back a bit?). The studies also back my surgeon up that MRI is not the best way to decide this, and that there are visual signs that are more conclusive. I’m very comfortable with and trust my surgeon, as I said, but want full information as I go forward. Does anyone have any experience or knowledge (or links) on near cCRs and W&W-friendly current approaches to same? Thanks for any info.


The procedure established by Dr Habr-Gama for determining a CCR is entirely visual. I understand there's a detailed list of things your Doctor has to check off during a flex sig before a CCR can be confirmed. I believe the MRI, while important, comes in a distant second after the personal determination by your Dr.

At the Kaiser facility where I get my treatment they have a special MRI procedure for rectal cancer patients, and a particular Doctor who has trained to interpret them. After a follow up flex sig and MRI about a year after I went on W&W I was called back in for another flex sig because the MRI report came back as possibly problematic. That was a bit of a scare, but it turned out the specialist Doctor who normally read those rectal MRIs had been on vacation, and another Dr had taken his place. Everything was fine!

roadrunner, unless things have changed in the last five years, calling a CCR is all in the skill and expertise of your surgeon. If he/she is saying wait another 5 weeks, I'd go with that. If you do go on W&W will chemo be the next step in your treatment? If so you might want to enquire about starting now rather than waiting.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

roadrunner
Posts: 55
Joined: Sun Jan 12, 2020 8:46 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby roadrunner » Fri Apr 17, 2020 11:06 am

Lakeswim and PRS: Thanks for the replies. My subsequent research has supported the view that the MRI is not definitive (some authorities don’t use it at all for determining cCR), and that the visual exam is. Mr surgeon wants to do that in about 5 weeks, so I’ll be at about 17-18 out of radiation. I did find a recent study by Habr-Gama (2019) that suggests 18-22 weeks (or even more) may be required to really see if it’s a cCR, so I may want to talk that over. You both have emphasized that this can be a judgment call, and mine sounds “close” right now, so I do understand the importance of getting as much input as possible. My surgeon is a prominent W&W advocate and has worked with Habr-Gama, and is a super positive and extremely impressive guy, so I’m comfortable there, though I’ll admit that it’s a little unnerving to have such big and way, way different consequences depend on what can be super-close judgment calls. So I’ll think about those issues some more.

One open question I still have — my medical
oncologists still want me to finish TNT FOLFOX teatment, which admittedly had a huge effect the first time, so I’m wondering if that’s worth trying now or later (because I’m obviously so close (at least)). It’s hard to pull that trigger right now, though, because I got neutropenia last time and my last known counts were borderline. The COVID issue is a big challenge there at present.
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
Switched to neoadjuvant chemorad in 11/19 (Xeloda and approx. IMRT, 60 Gy, 33 fractions)
Trying to achieve cCR.

Annie50
Posts: 95
Joined: Mon Jul 16, 2018 3:44 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Annie50 » Mon May 04, 2020 2:43 pm

Jogey wrote:Thank you Peter and absolutely I am hoping to get to that 2 year mark where the chances of local recurrence fall considerably.

Take Care,

Jogey

Hi Jogey

Is that right about 2 year mark and risk decreases substantially?
Love Annie xx

Annie50
Posts: 95
Joined: Mon Jul 16, 2018 3:44 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Annie50 » Mon May 04, 2020 2:44 pm

prs wrote:
roadrunner wrote:Hey guys quick question: I just got MRI (a little over 12 weeks since CRT) results today that showed a “near cCR.” It sounded like the radiologist wasn’t exactly sure whether there was any remaining cancer or not. My surgeon, who is fantastic, wants to wait about 5 weeks then do a flex sig to decide on surgery or W&W through palpating/observation. Of course, I ran home (well, I was home since it was a video conference!) and started researching this situation. I found some interesting material suggesting that many (or most?) people in my situation will end up with a cCR if given enough time. One suggested 18-22 weeks from CRT is optimal to maximize the chance of cCR (I will be at 18 or so, so I’m wondering if I should push it back a bit?). The studies also back my surgeon up that MRI is not the best way to decide this, and that there are visual signs that are more conclusive. I’m very comfortable with and trust my surgeon, as I said, but want full information as I go forward. Does anyone have any experience or knowledge (or links) on near cCRs and W&W-friendly current approaches to same? Thanks for any info.


The procedure established by Dr Habr-Gama for determining a CCR is entirely visual. I understand there's a detailed list of things your Doctor has to check off during a flex sig before a CCR can be confirmed. I believe the MRI, while important, comes in a distant second after the personal determination by your Dr.

At the Kaiser facility where I get my treatment they have a special MRI procedure for rectal cancer patients, and a particular Doctor who has trained to interpret them. After a follow up flex sig and MRI about a year after I went on W&W I was called back in for another flex sig because the MRI report came back as possibly problematic. That was a bit of a scare, but it turned out the specialist Doctor who normally read those rectal MRIs had been on vacation, and another Dr had taken his place. Everything was fine!

roadrunner, unless things have changed in the last five years, calling a CCR is all in the skill and expertise of your surgeon. If he/she is saying wait another 5 weeks, I'd go with that. If you do go on W&W will chemo be the next step in your treatment? If so you might want to enquire about starting now rather than waiting.


Hi peter. Just reading from Jogey that chances of recurrence drop substantially after 2 years? Is that right ? Xxxx hope you well? X Annie cxc

prs
Posts: 172
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Mon May 04, 2020 2:51 pm

Annie50 wrote:
prs wrote:
roadrunner wrote:Hey guys quick question: I just got MRI (a little over 12 weeks since CRT) results today that showed a “near cCR.” It sounded like the radiologist wasn’t exactly sure whether there was any remaining cancer or not. My surgeon, who is fantastic, wants to wait about 5 weeks then do a flex sig to decide on surgery or W&W through palpating/observation. Of course, I ran home (well, I was home since it was a video conference!) and started researching this situation. I found some interesting material suggesting that many (or most?) people in my situation will end up with a cCR if given enough time. One suggested 18-22 weeks from CRT is optimal to maximize the chance of cCR (I will be at 18 or so, so I’m wondering if I should push it back a bit?). The studies also back my surgeon up that MRI is not the best way to decide this, and that there are visual signs that are more conclusive. I’m very comfortable with and trust my surgeon, as I said, but want full information as I go forward. Does anyone have any experience or knowledge (or links) on near cCRs and W&W-friendly current approaches to same? Thanks for any info.


The procedure established by Dr Habr-Gama for determining a CCR is entirely visual. I understand there's a detailed list of things your Doctor has to check off during a flex sig before a CCR can be confirmed. I believe the MRI, while important, comes in a distant second after the personal determination by your Dr.

At the Kaiser facility where I get my treatment they have a special MRI procedure for rectal cancer patients, and a particular Doctor who has trained to interpret them. After a follow up flex sig and MRI about a year after I went on W&W I was called back in for another flex sig because the MRI report came back as possibly problematic. That was a bit of a scare, but it turned out the specialist Doctor who normally read those rectal MRIs had been on vacation, and another Dr had taken his place. Everything was fine!

roadrunner, unless things have changed in the last five years, calling a CCR is all in the skill and expertise of your surgeon. If he/she is saying wait another 5 weeks, I'd go with that. If you do go on W&W will chemo be the next step in your treatment? If so you might want to enquire about starting now rather than waiting.


Hi peter. Just reading from Jogey that chances of recurrence drop substantially after 2 years? Is that right ? Xxxx hope you well? X Annie cxc

Yes, I was told the chances of a recurrence decrease as time passes, and that they decrease significantly once you pass the two year mark. I had to go in for quarterly MRIs and flex sig follow up exams for the first two years. Once I hit the two year mark my follow ups decreased to every six months.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

Annie50
Posts: 95
Joined: Mon Jul 16, 2018 3:44 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Annie50 » Mon May 04, 2020 3:26 pm

Hi Peter, thanks so much for your prompt reply .. roll on June then as that’s my 2 years .. is that for local and distant? Xxx

prs
Posts: 172
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Mon May 04, 2020 6:31 pm

Annie50 wrote:Hi Peter, thanks so much for your prompt reply .. roll on June then as that’s my 2 years .. is that for local and distant? Xxx

Annie, looking back at my treatment history, I had whole body CT and PET scans periodically during the first two years. After that it's been six monthly rectal MRIs and annual colonoscopies only. From this I have to assume the risk of distant metastasis is pretty much gone after two years.

We'll be breaking out the champagne for you in June, and that's not very far away at all. :D
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

User avatar
CRguy
Posts: 10235
Joined: Sun Feb 10, 2008 6:00 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby CRguy » Tue May 05, 2020 4:32 pm

Annie50,
Not to throw water on the party here ......
STILL crack the champagne !!!!
BUTT... maybe refer to this post of mine earlier in this same topic
viewtopic.php?f=1&t=53498&start=45#p452519

Don't know what surveillance you may have planned ???

I would strongly suggest you do have SOME eyes on your situation moving forward
BTDT = lung met resected just under 3 years post resection with full monitoring still in place

Cheers and best wishes all

STAYIN' Covid SAFE
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
13 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

nifty624
Posts: 22
Joined: Sun Mar 03, 2019 12:34 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby nifty624 » Sat May 23, 2020 1:02 pm

Hi All,

It's been a while since I posted - a busy time even before the pandemic. I hope everyone is well and doing OK with the phsyical distancing, etc.

So far, I have been doing well although like everyone else, the covid-19 situation has complicated my follow up testing. I was meant to see my oncologist and have a CT-scan plus a flex-sig in late March and early April. Those appointments were all canceled (some by them and some by me) to be rescheduled. I am now scheduled to have labs drawn on July 6 and have my CT-scan that day, too. Then there will be a teleconference appointment with the oncologist on July 9. I haven't made contact with the surgeon's office yet regarding when to reschedule the flex-sig and I believe I am actually supposed to have had a colonoscopy in March, as well.

My tests in August (flex-sig/ labs), in October (Ct-scan/labs) and November (flex-sig/labs) were all clear and in October my oncologist said she was comfortable with a 6 month gap before coming to see her again (hence, the early April appointment). The surgeon was likewise pleased with my results in November and said to shoot for March for the next flex-sig, though probably just do the colonoscopy at that time.

After the chemo port was removed in August, I had been spending my time out of state with family to recover from the treatment side effects, but returning for those appointments in early October and late November. I came back home for good in January and in late February I called the surgeon's office to schedule the colonoscopy. They had to get back to me, but never did and I meant to follow up but put it off due to a great deal of family change going on (good changes, but lots of work and stressful). Next thing the pandemic shutdowns began and I realized it was just as well as I would have been rescheduling anyway.

I'm feeling well and I'm taking the attitude that there's not much I can do about it right now, so I will try to use this time to declutter and organize my apartment and hopefully get my affairs into really simplified order.

I can't remember if I gave an update on how I did after the local excision surgery followed by the adjuvent chemotherapy. It was pretty rough for me, but I am now almost fully recovered, regained my weight (plus a couple of pounds) and did not have any lasting neuropathy, thank goodness.
F57yo DX T2 carcinoma 11/6/18
CT scan 11/09/18 MRI 11/15/18 T3N1M0
nCRT Xeloda/Radiation X28 12/10/18 - 01/22/19
Hospitalized 01/02/19 w/acute ileitis (radiation enteritis)
01/02/19 CT scan: tumor "significantly reduced"
6 week MRI 03/06/19 nearly complete CR
Flex SIg scope/biopsy 03/08/19; no evidence of malignancy
Local Excision TAMIS 04/05/19
Pathology: NED
Chest port installed 04/29/19
(FOLFOX) begins 05/01/19.
10/02/19 MRI -> NED
11/15/19 flex sig -> NED

mozart13
Posts: 154
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Thu May 28, 2020 2:30 pm

hi prs and every body else.

I see a lot's of good discussion is going on.

For new people, Radiation peak is about 16,17 weeks from the start of the Radiation :

http://www.iwwd.org/wp-content/uploads/ ... 015-NF.pdf

8 round's of chemo is good to have, as this brings recurrence near 0 :

https://www.ncbi.nlm.nih.gov/pmc/articl ... po=27.5000

wish well to all !
55 year at the time of diagnosis, male
Diagnosed with T1,T2 N0 M0 rectal cancer
Total neoadjuvant therapy or TNT (chemoradiation followed by systemic chemotherapy)
Negative since Feb. '17
No surgery
Watch&Wait approach 8)
I don’t come much to the forum , so if this is not updated it means I remain negative!
Wish good luck to all!

Jolene
Posts: 156
Joined: Wed Jan 23, 2019 10:17 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Jolene » Tue Jun 02, 2020 1:31 pm

Hello everyone - just checking into this thread to say hi as I have mostly been busy and only have enough time to lurk around! Nice to see some familiar names popping up to update their situation and some new names joining the WW-ers!

My quarterly scans and test have been pushed back a number of times due to the pandemic lock down. Finally got round to getting it done just today - PET/MRI + CT. Fingers crossed. I should have the results over the next few days which will mark 1.5 years of WW since my radiation ended.

As time passes, the docs said the concern is now watching out for metastasis rather than local occurrence. He also mentioned that the crucial period is the first 3 years instead of 2 as mentioned in some earlier posts.

I have been busy with "cancer rehabilitation" over the last 6 months, a service which I'm very fortunate to benefit from with a non-profit cancer organization in my country. I developed tendonitis in my wrist which is likely due to the change in my hormones because of early menopause and it created a lot of agony in my everyday life so I had to keep seeing a hand surgeon and occupational therapist. I also developed agonizing muscle aching in my hip which I believed is a side effect of the radiation done 1.5 years ago and I have been seeing a physiotherapist for that. I have also developed terrible insomnia due to the menopausal situation and had to be advised by the cancer rehab doctor on several fronts to manage it. I was also introduced to a dietician to help manage my perspective of eating well and for recovering. Continuous emotional counseling was also provided as part of their service.

I am so very grateful to this team of rehab healthcare team as non of the medical doctors could or would officially acknowledge and assist in all the side effects I'm suffering from as I can tell that it's not really their expertise domain. Medical doctors aim is to keep the patient physically alive and looking into the side effects of the patients isn't really on their priority list.

Cancer rehabilitation is still a fairly new concept where I am from and I'm surprised that it has not been introduced nation-wide. I only chanced upon them due to my own pro-active research of any help that I could get !! I doubt most of the medical doctors are even aware.
Dx @ 39 F, married
Nov 18 - Dx of a mid-rectal tumour at T3N1M0 (2cm) 7cm from AV
Dec 18 - CRT, 28 sessions + Capecitabine at 3000mg daily
Jan - Mar - Wait and watch in place
Mar 19 - MRI, PET, sig flex and biopsy ordered to determine being a WW candidate.
Apr 19 - CCR. Surgery on hold. 6 cycles of Xelox.
Aug 19 - Completed 6 cycles of Xelox.
Oct 19 - Flex sig, biopsy, PET/MRI - clear
Jan 20 - Colonscopy, biopsy, MRI - clear
Jun 20 - Flex sig, biopsy, PET/MRI, CT - clear
Jan 21 - Tests scheduled

Hopepray
Posts: 17
Joined: Fri Feb 14, 2020 9:48 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Hopepray » Tue Jun 16, 2020 3:46 am

Awesome news Jolene! Happy for you.



In a dilemma myself after onc surgeon says get surgery on the safer side. As biopsy during flex sig following a neoadjuvant or preop chemoradiotherapy(1500mg cap per day plus 50.4 gy in 28 days) said negative for disease, even an mri and pet ct done four months apart agree.
However I am a bit unsure now as to what approach to take. The docs both medical and surgical say we would say get surgery but the decision lies with you.
Caregiver to mom
54 y, dx 2/20, T3N1B Upper Rectal CA,14 cms from AV
2.5 x 1.3 cm, base 1.5cm
CEA: 2.8 2/10/20;; 2.3 4/20;;1.3 6/20
CT and MRI show the tumour + Ground Glass Nodule Lung + Hemangioma Liver.
Grade 1 Tumor
EMVI absent
Genetics not done
28x/Cap/ CRT 28/Mar/20
MRI- 4/20- no mass seen, lymph node in peri-rectal space.
Pet/CT 6/20 no nodes or rectal mass, no Glass nodule in lung. Hemangioma.
Flex Sig w/ biopsy 6/20 : no mass, scar, biopsy -ve
LAR, no ileo 7/1/20
CapOX 3x begin 9/5/20


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