Chemoradiation therapy: Can it Delay Surgery?

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GeoChicago
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Joined: Fri Mar 03, 2017 1:46 pm

Chemoradiation therapy: Can it Delay Surgery?

Postby GeoChicago » Wed Mar 29, 2017 2:07 pm

Hi All,
I'd posted several weeks ago that my father, who is 86, has rectal cancer, Stage 3 (T3N2 I think it is). There's about a 4.4 cm tumor and it's quite slow growing they said ("well differentiated" cells I think is the term). In any case, the original doctor has suggested chemo-radiation therapy for 30 or so days followed a couple months later by surgery. My father will be getting a second opinion soon, but wishes to say "to hell" with all of it and ride this out until the end without doing anything because he keeps hearing stories about how awful chemotherapy and radiation therapy is and also figures that since it's slow growing he may be okay for a couple more years. However, I understand radiation therapy may not be too bad, and that there are ways to alleviate chemo side effects. I think down deep he just doesn't want to do the surgery which would involve a "bag" for a few months whilst he heals and then have his insides re-attached after that.

My question then is: Can chemo-radiation treatment alone slow or delay the progress of the cancer such that perhaps he can do without the surgery? Can a shrunken tumor stay "in situ" without having it be removed surgically? Any knowledge shared is appreciated. Thanks.

Regards,
ChicagoGeo

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CRguy
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Joined: Sun Feb 10, 2008 6:00 pm

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby CRguy » Wed Mar 29, 2017 2:26 pm

Chemoradiation therapy: Can it Delay Surgery ?

absolutely and with very active monitoring ( watch and wait ) some patients may not need surgery at all.
please see this topic Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

I had complete pathological response = pCR( had surgery later so my diagnosis was based on actual full surgery resection samples ) and many folks have cCR = complete clinical response which presumes the tumor is completely gone. Either situation can still lead to local recurrence and distant mets so monitoring is essential.

JMO : if I were 86 I would do chemo-radiation, see what the results are and decide later about further surgery.... BUTT the chemo can be tougher on an older patient just so you know. I was 55 when I started and at 65 now, I would still do the same thing .... BUTT I may be more selective at 86 !

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

GeoChicago
Posts: 10
Joined: Fri Mar 03, 2017 1:46 pm

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby GeoChicago » Wed Mar 29, 2017 5:37 pm

Thank you for your reply. Interesting that some people have had good results with just chemo-radiation therapy. Any other replies appreciated.

Regards,
GeoChicago

weisssoccermom
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Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby weisssoccermom » Wed Mar 29, 2017 6:30 pm

I'm going to also contribute my 2 cents. Like Crguy, I would also do the chemoradiation and then make a decision about surgery after that. You're right, chemoradiation isn't necessarily 'easy' BUT....when most people hear about radiation, they tend to be talking about radiation to other areas of the body. There are some side effects BUT....if one knows about them ahead of time, it is possible to minimize them.

As for a cancer being 'slow growing', honestly it is unrealistic to think that once a person has a tumor such as your father's would be 'ok' for a few more years. If the cancer has already spread to the nodes, it is just a matter of time before the cancer sets up 'shop' somewhere else in the body such as the lungs/liver. Chemoradiation and even more monotherapy such as Xeloda alone (pill form) could very well buy your father that couple of years or maybe even longer.

I am one of those who had rectal cancer, stage IIA who opted to be treated with chemoradiation, a local excision (not a major surgery at all) and more radiation and here I am, over ten years later and doing fine. It will be 11 years in June since my diagnosis and 10 years next month since my surgery. Now, it's not 'standard of care' and given the chance, I would do the same thing again.

IMO, if I was diagnosed again around age 86, I wouldn't opt for the major surgery but would easily consider doing the chemoradiation again and 'chemo lite' such as Xeloda and even undergoing an excision again. I would also consider the Habr-Gama W&W protocol but this has to be your father's decision. One thing I would tell your dad is this. Doing nothing isn't the way to go. I remember vividly having more than one doctor tell me that if I did nothing, the tumor/cancer WOULD continue to grow and spread and it would be very painful to have my pelvis/colon, etc. taken up by a big tumor in addition to likely having cancer in other parts of my body. That had a HUGE impact on me so it is something to consider. Even IF your dad had a few years left without doing anything, it's likely NOT going to be years that would be comfortable. There's no way that a doctor can definitely tell a patient that his/her cancer is slow growing and/or will be slow growing in the future. Cancer cells are constantly changing...morphing if will....and it's just not realistic to believe that what may have been a slow growing tumor will continue to be.

Good luck to you and your family. It's a difficult decision and not one to be taken lightly. IMO, I'm shocked that a doctor would even consider doing such a drastic surgery on your dad at his age. Please don't rule out the chemoradiation and above all, find an oncologist who will work with you....and think 'outside of the box'. What might be the right choice for a patient in his/her 40 - 60's isn't necessarily the best choice for a patient who is 86.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

Nelbel
Posts: 37
Joined: Thu Nov 17, 2016 11:02 pm

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby Nelbel » Wed Mar 29, 2017 8:34 pm

Hi ChicagoGeo,

I'm sorry to hear about your dad :( . Having been through chemoradiation, surgery and chemotherapy, if it were my dad, at the age of 86 I would suggest he not do the radiation. It was awful and I'm a young 40 something. That being said, I would however, look into the new proton radiation where they have the ability to really target it at the tumor. My uncle just did it for prostate cancer and it was no big deal. He told them about my awful experience and asked if they do rectal cancer and they said yes. I'm guessing youre in Chicago (not sure if your dad is also) and there is a center in Wheaton I think. My uncle is on the north side and made the drive. I too am on the north side and would have made the drive every day in a heart beat if they could just blast the tumor and not hit the area around as well. The other thing you could look into is just the chemo only to reduce the tumor size. Chemo was a lot easier IMO. At that age I would not go through much, but I guess you would worry about it growing and causing a blockage so some chemo could shrink it?

My two cents, for what it's worth.
DX Dec 2015 at age 41
Stage 3 RC
Radiation and xeloda
May 2016 LAR and temp ileo
8 rounds chemo
Nov 2016 ileo reversed!

User avatar
CRguy
Posts: 10473
Joined: Sun Feb 10, 2008 6:00 pm

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby CRguy » Wed Mar 29, 2017 11:18 pm

Nelbel wrote:Hi ChicagoGeo,.... I would suggest he not do the radiation. It was awful and I'm a young 40 something.
My two cents, for what it's worth.

We are ALL entitled to our own opinions, for what it's worth ( great song BTW !!! )...
BUTT " it was awful " = ummmm OK lets get some facts here please ... :shock:

SO awful you would not do it again to save your life ?
So awful you did it ... BUTT would not want to have to do it again ?
So awful it devastated your entire life so you could not function ?

Been a caregiver and CRC Stage IVa survivor ..... = 10 years.
There are very, very few things I WOULD NOT DO ... to still be here.... NOW

chemo / radiation / surgeries = WHY I am here

YMMV, BUTT please let's get our parameters in sync !

Cheers on the Journey
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby weisssoccermom » Wed Mar 29, 2017 11:24 pm

I have to agree with CrGuy.
While no, radiation isn't a 'piece of cake', it is, IMO, a whole lot easier than recovering from major surgery.
It's all relative and while some patients have a more difficult time with radiation than others do, I don't know of very many people who have truthfully had difficulty with the treatments. For me, without those radiation treatments, I wouldn't have been able to have the less invasive surgery that I had. Had it not been for radiation treatments, I wouldn't have had the options that I had.

If patients are aware of the potential side effects and take the precautions UP FRONT to avoid or minimize them, even in the elderly patient, IMO, radiation can easily be tolerated.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

Nelbel
Posts: 37
Joined: Thu Nov 17, 2016 11:02 pm

Re: Chemoradiation therapy: Can it Delay Surgery?

Postby Nelbel » Thu Mar 30, 2017 7:32 am

I don't know how to copy what folks wrote to respond to comment on but to CRGuy, I'm just saying 86 is a lot different than being in 40's or 50's. at 40, I absolutely would go through this to save my life but if I was 86 Im not sure that I would. I don't think I would just not do anything but I would try something a little less harsh.

Does any know, or have experience with the newer proton radiation for rectal cancer?
DX Dec 2015 at age 41
Stage 3 RC
Radiation and xeloda
May 2016 LAR and temp ileo
8 rounds chemo
Nov 2016 ileo reversed!


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