Tim21spurs wrote:Thanks to everyone for you answers. I will give you all the data now:
- My mother is 67 years old. She is quite healthy. Former smoker (after surgery ). The recovery of the colon resection has been really good, she is doing practically complete normal life after 5 weeks.
Related to the cancer:
- No bowel perforation
- 13 Lymph nodes examined, and all of them were clean
- No bowel obstruction
- The cells were moderately differenciated, grade 2, so, as far as I know, it isn't a risk factor
- No lymphovascular vessels invaded
- Related to microsatellites,they didn't detected MLH-1 expression, so, the diagnosis was MSI. But we don't know until now if it is MSI-H or MSI-L
So, the only "risk factor" is the preoperative CEA level, aproximately 11. 20 days after surgery, CEA level go down to a level of 1.5.
Considering the "good" prognosis of my mother case, I was surpised when the oncologist recommended FOLFOX just for the preoperative CEA level. As far as I know, preoperative CEA level could be related with a little poor prognosis. But I havent find any study in which FOLFOX worked better than just Xeloda, just considering preoperative CEA level. And I don't see any article in which CEA level could be a risk factor at the same level of previously mentioned factors (perforation, obstruction, grade...etc)
We are trying to avoid oxaliplatin, due to neuropathy side effect. But, on the other side, we don't want to fight with the oncologist, altough we don't agree with the proposed treatment. So, according to my mother case, what do you think we should do? We can also ask for a second opinion in another hospital.
Again, thanks to everyone!
daisydaisy wrote:Hi, I've noticed that the tumor was MSI - from what I know, 5-FU or Xeloda (and 5-FU is a part of Folfox regimen) is useless for MSI tumors. Good thing is that msi-tumors are considered as having better prognosis. Please confirm with your oncologist or get a second opinion, because your mother might be exposed to absolutely unnecessary chemo. I think you can even google papers about this. Otherwise, oral chemo - xeloda - is usually handled well. best of luck to your mother!
peanut_8 wrote:Hi Tim,
Sorry to hear about your Mom's diagnosis.
A few questions for you. Is your Mom being treated in the US? Seems like treatment recommendations vary from country to country, and stage 2 is a controversial topic.
Does the treatment center do the FOLFOX infusions themselves? Unfortunately some places might recommend a more aggressive treatment approach such as FOLFOX, for economic reasons. Since the oxaliplatin in FOLFOX can only be administered by infusion, that becomes an income producing factor for the treatment center.
Your Mom should be able to determine the best course of treatment for her with the facts at hand. How risk averse is she? I've seen figures anywhere from 1-5% where oxaliplatin increases your survival odds. Probably, really something like 3% better odds. At least in my opinion, that was not sufficient enough to get the oxi. My oncologist originally suggested FOLFOX, and I countered with Xeloda (pil,l so no infusion). He said that was a perfectly acceptable solution. He did mention that for RC, it is not Standard of Care in the US, IMO covering his butt for potential lawsuit issues.
If your Mom's current oncologist isn't receptive to Xeloda instead of FOLFOX, you probably should get a second opinion.
Best Wishes,
peanut
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