Margins not clear?

[Swirdfish]

Hi all,

Okay I have two questions

I got my path report back and I'm pT3 N0 R1. 0/22 node involvement. Dukes B. So everything looks excellent besides the R1. R1 being residual mucin producing adenocarcinoma extending into the meso-rectum is noted with a single focus of possible peri-neural infiltration.

What does this mean?? A margin was not clear? Other then that I'm happy about the results but if there is anything left in there I want it out.. my Tumor had a grade 3 response to neoadjuvant therapy. Go back in laparoscopically? Anyone had anything similar.

Also I had my para-aortic lymph node removed, now my drain after surgery is removing lymph fluid a lot of. I hope this settles down so I can get out of here. Anyone leaked lymph fluid and how did they overcome this??

It just keeps on giving doesnt it!!!

Regards

Swordfish

[Swirdfish]

Okay so Abit of Google means R1 there is microscopic cancer left behind at one the margin sites. What now?? Has anyone had a re-resection? Due to initial response being limited for chemo radiation prior to surgery I would rather go a surgery way again.

Anyone had chyle or lymph fluid draining from their drain after surgery?? It's about 1.5ltrs per day and doesn't seem to be slowing down..

I'm happy with the surgery and having no nodes etc, but now I'm onto the next step to get rid of this cancer for good.

Any help is appreciated.

[jhocno197]

I am not sure what they will do here. More chemo? Another surgery? Did they check the margins during surgery & wait for the results then, so they knew margins weren't clear, or had they gone as far as they could with surgical removal & were unable to cut out any more?

[Swirdfish]

I am not sure what they will do here. More chemo? Another surgery? Did they check the margins during surgery & wait for the results then, so they knew margins weren't clear, or had they gone as far as they could with surgical removal & were unable to cut out any more?

Jhoco197,

I'm not sure about any of your questions.. I guess I'll find out soon. Just wondering if anyone else had experienced a similar situation and what happened.

[Lydia666]

Was the para aortic node benign after all?

[lpas]

Was the para aortic node benign after all?

Yes, I was wondering about this too.

I've never heard of an R1 designation but maybe that's because my cancer was in the colon rather than the rectum. Hopefully someone with more info will chime in.

[Swirdfish]

Was the para aortic node benign after all?

Hi LYdia,

No the para aortic node was fine and checked out clean. But wasn't a risk I was worth to take leaving it in.

[Swirdfish]

Was the para aortic node benign after all?

Yes, I was wondering about this too.

I've never heard of an R1 designation but maybe that's because my cancer was in the colon rather than the rectum. Hopefully someone with more info will chime in.

Hi IPAs,

Okay so Abit of Google means R1 there is microscopic cancer left behind at one the margin sites.

[Lydia666]

I am glad the node is out and benign! Great news!

[SurvivorsSpouse]

R1 means that there were cancer cells within the resection margin. Depending on distal or proximal, the margin is considered 2mm or 5mm and if it is a radial/circumferential margin, I believe the number is 1mm.

If distal or proximal margin, then it means there was microscopic invasion within the limits at either end of the specimen. If it was a radial margin, then that means there were cancer cells within 1mm of the outside edge of the perirectal fat (green section in the picture below).








Hope this helps.

Good luck!

[Swirdfish]

R1 means that there were cancer cells within the resection margin. Depending on distal or proximal, the margin is considered 2mm or 5mm and if it is a radial/circumferential margin, I believe the number is 1mm.

If distal or proximal margin, then it means there was microscopic invasion within the limits at either end of the specimen. If it was a radial margin, then that means there were cancer cells within 1mm of the outside edge of the perirectal fat (green section in the picture below).








Hope this helps.

Good luck!

Thanks Survivor,

Yeah I was worried about the above. I'm sure they will maybe say chemoradiation and I've already had that prior to surgery so not keen to do it again and the responses wasn't that great.

Perhaps a TME surgery laparoscopic? As yes it appears in the mesorectal fat. Can they go in twice?? I hear most the time they have one chance at this.

Since I'm so young it would be a shame to leave this to chance especially with no nodes or any other invasion elsewhere.

Super worried.

[lpas]

Was the para aortic node benign after all?

Yes, I was wondering about this too.

I've never heard of an R1 designation but maybe that's because my cancer was in the colon rather than the rectum. Hopefully someone with more info will chime in.

Hi IPAs,

Okay so Abit of Google means R1 there is microscopic cancer left behind at one the margin sites.

That's very, very good news about the para-aortic lymph node!

As far as the R1 designation is concerned, it's my understanding that the margins are always much smaller when removing rectal tumors, which is why rectal cancers have a higher rate of local recurrence. You can remove a lot of colon without a big impact but the rectum is a different story. Definitely ask your doctor, but I suspect they aren't going to be able to go back in a second time (unless maybe you're willing to consider a bigger surgery and a permanent colostomy).

In the absence of more surgery, my suggestion would be to work hard on getting your immune system in tip-top shape, so it can hopefully deal with any microscopic remains. Exercise, get plenty of sleep, eat well, etc. The key is to make your body as inhospitable to cancer as possible. I work with a naturopath who specializes in cancer and immune function. His work is very data driven and he prescribes a number of supplements that can be helpful in this effort. Feel free to PM me if you'd like more info.

Good luck!

[Swirdfish]

Was the para aortic node benign after all?

Yes, I was wondering about this too.

I've never heard of an R1 designation but maybe that's because my cancer was in the colon rather than the rectum. Hopefully someone with more info will chime in.

i IPAs,

I guess I'll have more clarification when I see my surgeon next. I really hope they come up with a plan, as further surgery and a permanent colostomy is not on my wish list at this age if I can avoid it. Was all going so well too I guess it has to have its up and downs as this is cancer!!

At the moment I'm one week post op and still leaking lymph fluid out of my drain although it is slowing down, I hope more intervention isn't required but doesn't look good.

I'll private msg you for a list of those supplements I'm very interested. My wife is fully into that stuff as well and has researched it for many years.

Thanks for your thoughts.

[mypinkheaven]

Have you seen your surgeon or oncologist yet?

[Swirdfish]

Have you seen your surgeon or oncologist yet?

Hi pink,

I've seen the surgeon and he seemed somewhat confused about the results. Also I'm still leaking lymph fluid. I guess he will clarify it Abit further when I have my appointment. They don't seem too concerned but Iam very worried.