repeat rectal adenomas/LAR?

[mgAZ]

I am meeting w/GI today for results on my 3rd colonoscopy/polypectomy. I am 46 years old and adopted with no familial history.

* 1 year ago I had a 55mm pre-cancerous tubulovillous adenoma removed. (first and only). The Dr was more shocked than I was that it was not cancerous given it's incredible size. It was removed via polypectomy in sections approx 1 month post-finding it.
* 6 months ago at repeat colonoscopy, a new 13mm growth (again pre-cancerous tubulovillious) was removed at the same location. We assumed (hoped) that it was unseen/missed cells.
* Last week, I had a 3rd scope and 13mm growth at almost the exact location as the first two polyps. The GI gave us the indication in recovery last week that even if the polyp is pre-cancerous, I am dodging a bullet that will eventually come if I do not have surgery to resect the rectum. It is obviously aggressive in nature as it is 6 months between each scope.

Does any one have similar experiences with repeat (large and fast) polyps?

I'll get more information today, but from what I understand from the GI doc in recovery, the area to be resected is the most difficult location, about 10cm inside the anal opening which would cause "significant lifestyle changes.".....

1) can anyone shed light on this resection, recovery, lifestyle change?

2) Does anyone have experience with this difficult resection and referrals to the best colorectal surgeons in the US? I'll travel anywhere.

[Travelgirl]

So sorry your going through this.

I have read about certain types of polyps returning like that.

I had a client with a cancerous polyp in that same area. She went to NorthWestern Univeristy in Chicago. She ended up with a temporary colonopspy bag and then that was reversed. I recall her saying she spoke and met with several doctors before she was comfortable and northwestern was the only place that said she would not need a permanent bag.

I would also put a call into the Mayo Clinic. They have hospitals in Arizona, Florida and Minnesota. You need a hospital where the GI Dr and the Surgeon work hand in hand together.

I wish you the best..

[Daisymae]

I'm just cutting and pasting a reply I did to a similar post earlier in the week: Hi - I had a 9x6 cm tubulovillous adenoma that was 2 cm in. I had ULAR at MSKCC with an ace surgeon. It have a hand sewn coloanal anastamosis (or as my friends say, a custom recrum I had a temp loop ostomy which was reversed 3 months later. It was a rough go for a few months but now 4 years out - life is pretty normal. I go to the bathroom more frequently but it's not a QOL issue - I just pop in and out as needed. So no urgency - just that I go several times a day where it used to be 1 x a day. I eat everything, do triathlons, have even had another baby since then. Quality of life is impt to me and I really hated living with a bag but everyone is different. My mass was high grade dysplasia so not invasive Cancer - considered stage 0. I would make the same decision again but I had a good experience. My doctor did tell me not to google the surgery because I would freak out. Good luck to you

[Nik Colon]

From your name, you live in AZ? if so, I agree about the Mayo there.
http://health.usnews.com/best-hospitals ... gi-surgery

http://health.usnews.com/best-hospitals/rankings/cancer

http://health.usnews.com/doctors/locati ... l-surgeons

http://www.medscape.com/viewarticle/828249

[Buckeye]

I have had LAR surgery on 11/2015. I had Rectal cancer and my tumor was 8cm from my Anal verge. I had my surgery laparoscopically, which if you find a surgeon and hospital that specializes in that technique I would go that route instead of open.

As far as quality of life... I do basically what ever I want. I do go to the bathroom more frequently, but it gets better with every passing week. I mostly go after a meal then maybe 1 or 2 more times. I have never had incontinance . I have 2 cm of my rectum left and they took a foot of my colon and reattached everything. Gas is uncomfortable, because it feels like a bowl movement. You have to give it a minute to dissipate then let it out as it comes back.

I had my surgery at Christ hospital in Cincinnati. It is ranked In the top 50 hospitals in the US. They have a great colorectal surgery office and team of physicians.

[MaryannW]

I was stage 2a with a villous adenoma which was cancerous. Located 5.5cm in. After pelvic radiation and chemo was down staged to stage 1. I was hoping the adenoma was not cancerous but we just got to it too late. I've had mop up chemo and will have my reversal on 7 April. My opinion is don't wait until it turns cancerous as you will be able to avoid chemo and particularly radiation which is hard treatment. I now have radiation damage to my bladder and other pelvic tissue as a result. I'm hopeful my reversal will go well and surgeon has said about 6 months to reach a new normal. All the best.

[Mendezbo61]

My tumor was 11 cm from the anal verge Dr Julio Garcia Aguilar at Memorial Sloane Kettering in Manhattan perform a laparoscopic surgery with the Da Vinci robot no bag. Four days hospital stage. Took about 9 months for my bowels to adjust to the change. But no complications are all.

[weisssoccermom]

MaryAnnW
I don't know who told you that you were downstaged after radiation and surgery but almost exclusively, no you are not downstaged. The chemoradiation did its job and your tumor shrunk. That doesn't mean, though, that you were downstaged. It simply means that pathologically, your tumor shrunk. If you look at your pathology report, you will see a 'yp' in front of the TNM staging (or at least you should). The 'y' means that you have had neoadjuvant treatment of some kind (could be radiation or chemo) and the 'p' simply means that it is a pathological designation. Had you truly been a stage I, it is unlikely that you wpuld have had adjuvant chemo...in your case Xeloda.
It is difficult to ascertain a patient's stage after neoadjuvant treatment simply because the treatment likely would have changed the size of the tumor and/or the number of positive lymph nodes. Your 'T" stage may have changed, but your overall staging did not.

[MaryannW]

I'm aware of the process. Downstaged is a term my surgeon used and regardless of how I got there, there was no macroscopic invasion of bowel muscle and only isolated spots of tumor left. I reckoned that was cause for celebration and the workability of the neo adjuvant therapy, albeit very harsh on my system. Oh and I was borderline for neo adjuvant too, some debate over staging pre surgery as MRI as you would know is approx 85% accuracy.

I just wanted to add also that there are a number of research articles titled Downstaging after neo adjuvant radiation etc. it is a term used in this sense. Obviously as I had neo adjuvant treatment prior to surgery, I was then downstaged post surgery as a result of neo adjuvant treatment. Downstaging is correct usage in this sense.

[Nik Colon]

Wanted to reply to a couple things. First, unless they are SURE of stage (like 4/mets) the only way to know is surgery PRIOR to tx as tx can change it. Second, they do NOT restage except on occasion like surgery where they find they are wrong. So from what I read, I'm confused.

[MaryannW]

My case was a bit ambiguous as I was told borderline 2a. Had a good result from radiation chemo and 'downstaged' due to neo adjuvant treatment. Do the semantics of the word 'Downstaging' matter. No. I'm just glad to be here and finishing treatment.

[weisssoccermom]

I think Nik and I are saying the same thing. Regardless of what your doctor may have said (and honestly, he is incorrect), you are being treated as a stage IIA.
In my case, all the initial testing were, like yours, borderline between a stage IIA and a stage I. It was difficult to determine whether or not my tumor was a T3 (making my overall stage an automatic IIA) or a very very late "T2" which would have made me a stage I. In my case, the ultrasounds, etc. could not determine exactly and, likely like your case, I was staged and TREATED as though I was a stage IIA. Almost exclusively, a stage I does NOT receive chemoradiation as the benefits at that stage do not outweigh the risks. Months later when I sought out a different surgeon, in her opinion, my initial testing would have been a stage I (late late stage I but stage I nevertheless) but nothing was ever changed. My treatment plan, like yours, followed the protocol for a stage IIA. Testing after chemoradiation showed no tumor....pathology confirmed this....but you are restaged. If that had been the case, I would have been 'restaged' as not having cancer and we all know that I did. I understand that the semantics may seem insignificant but once a patient has had any type of neoadjuvant therapy, it is next to impossible to determine what stage a patient truly is/was just because the 'yp' pathology results show a positive result. That's why the 'y' is before all pathology results....to allow the doctors to recognize that these surgical pathology results are seen AFTER neoadjuvant treatment and therefore aren't necessarily reliable.

[MaryannW]

Ok I was ''y' ed to stage 1 post surgery. I think my original post said I was downstaged following radiation and chemo which is a correct use of the phrase in a sentence rather than to strictly follow medical terminology. I have now wasted precious time on semantics and explanations of processes I'm already familiar with given I've gone through treatment and thank god out the other side with still a reversal to go. I have other questions on this board about daily dose of aspirin and reversal questions which are unanswered. It's a shame this is the main response I've got on this post and no responses on the others. Given my experience with this post I won't be coming here anymore. Thanks for the lectures. You've more than demonstrated your knowledge.

[Nik Colon]

Ok I was ''y' ed to stage 1 post surgery. I think my original post said I was downstaged following radiation and chemo which is a correct use of the phrase in a sentence rather than to strictly follow medical terminology. I have now wasted precious time on semantics and explanations of processes I'm already familiar with given I've gone through treatment and thank god out the other side with still a reversal to go. I have other questions on this board about daily dose of aspirin and reversal questions which are unanswered. It's a shame this is the main response I've got on this post and no responses on the others. Given my experience with this post I won't be coming here anymore. Thanks for the lectures. You've more than demonstrated your knowledge.

Wow, sorry you feel that way. We were just making sure you knew.