Since I’ve posted on this thread before, I thought I’d post an update, and I do have a question or two at the bottom for you W&Wers.
To summarize, I was diagnosed as Stage 3 RC with 2-3 local nodes likely positive (I was told 70%/30% likelihood that these were positive), I did 4 cycles of FOLFOX last fall as part of TNT. Jumped to chemorad due to side effects (huge DVT, wild liver enzymes, arrythmias, neutropenia, etc.) and excellent initial response (reduction of 70-80%). Did 60Gy rad with Xeloda, also did an extra 4 weeks of Xeloda. MRI in the spring showed a “near cCR” but was not conclusive. Flex sig showed little palpable tumor left, but not quite the flat white scar desired for W&W. A biopsy was performed and the results were negative. My surgeon thought the best course was TME surgery, but staged with a periopetative biopsy first after transanal excision (all part of one procedure). After consultation with my surgeon and oncologists, I underwent the 4 remaining cycles of FOLFOX (to complete TNT), and despite some weird bleeding issues and the familiar arrythmias, I completed those about 6-7 weeks ago. My oncologist advised that I “had a cCR” after a rectal exam, but that my surgeon’s assessment should guide next steps. Another flex sig was done, and nothing palpable was found, just a red area. My surgeon scheduled a transanal excision to investigate the remaining tissue, but this time without a likely TME procedure to follow in the same procedure.
So I’m now scheduled for a TAE. My question is: Do any of you have experience with this approach — excision then possible W&W? If so, are there any things I should be looking for/expecting, before, during, or after the procedure? For example, am I likely to get a clear choice after the tissue is tested, or might it be a matter of degrees of risk? Obviously, I’d love to avoid the big surgery but my main point is to live through this challenge. Any wisdom/experience is welcome. Thanks!
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.