mpbser wrote:I'm still not convinced about Xelox/Capox. One point difference in the factors of "evidence quality" and "affordability" might provide a scintilla of data that Xelox/Capox is "stronger" than Xeloda, but "stronger" to me does not translate into "better" for me.
mpbser wrote:P.S. You called my husband childish in my other ongoing thread -- well maybe most people act vulnerable and "childish" when they are first diagnosed with cancer. Maybe those who recently almost died from congestive heart failure a month beforehand due to complications from the cancer were more vulnerable than they had ever been in their lives, which is where my husband was at that time. Those people who reacted to him absolutely did not care and did not show the "support" that the purpose of this site says this place is for.
mpbser wrote:. . . this is what you said verbatim: "Hence: Evidence that CapOx works is stronger (Quality of Evidence) than Xeloda"
SO, yes, you did say that I didn't say that Xelox/Capox is "stronger" than Xeloda.
mpbser wrote:P.S. You called my husband childish in my other ongoing thread
mpbser wrote:Those people who reacted to him absolutely did not care and did not show the "support" that the purpose of this site says this place is for.
menreeq wrote:This thread has become somewhat emotionally charged, but I hoped to provide some insight as a physician. I am a Radiologist. But I have seen my share of colonoscopies and lap colectomies during training. And I read cross sectional imaging exams on a regular basis. Nothing I say here should be taken as medical advice, but perhaps it will round out the information you have. Also, I have just been diagnosed, so your husband and I are going through this journey simultaneously. I look to this forum for advice on the non-medical, and I have found it helpful in the harrowing last 3-4 weeks.
Colonoscopy
It is not uncommon to do limited colonoscopies in partially obstructing or obstructing tumors. Even if they can get the scope past the proximal edge of the tumor that they first see, it can be very difficult to maneuver the scope beyond that point. I recall this from my training, but also from watching my second colonoscopy and endoscopic ultrasound on the monitor (I declined sedation that time). It can be fairly painful as they insufflate and bend the scope. So, it is standard of care to do a limited scope at first, get the biopsy you need, get measurements that will help with surgical planning, maybe put some tattoos to help guide the surgeon (usually these are placed a little bit distal to the distal edge of the tumor so the surgeon can know how much colon/rectum to take out). After surgical resection, they go back and make sure there aren't other tumors. I am sorry that they found others.
Laparoscopic Colectomy
Most of the time, tumors are not visible to the surgeon during the lap colectomy. The tumor would have to be fairly locally invasive for them to see it invading the pericolic fat and adjacent organs. These resections are done "en bloc," meaning they take out the segment of colon, the fat surrounding it and any lymph nodes and vessels in it. The surgeries are planned based on the information they are able to gather beforehand, especially from colonoscopy. They will see the tattoos the GI doctor left, and plan distal margin accordingly. Some cancer types are harder than others. I would think that most are not, since they are able to take out a fairly large block of tissue through a linear incision that is usually 5-6 cm (they make it longer if they have to). The tissue has to collapse down to do this, and it can do that because the tumors are not hard. So, even though they palpate the colon, they won't feel most of them. They just do that on the off chance that they do feel something and can do something about it at the time of surgery. Surgeons *are* able to palpate the mobilized portion of colon during laparoscopic surgery. They take the cut end of the colon out through the extraction site (the longest incision), and are thus able to palpate it when it's outside the body (but still connected proximally to the rest of the colon). They cannot palpate the rest of your colon though -- just the distal part that has been mobilized (fat and peritoneum cut so it's not stuck to the back of the abdominal cavity anymore). This means the splenic flexure, transverse colon, and ascending colon are usually not evaluated.
Chemotherapy
I didn't read the discussion carefully enough to know where the confusion stemmed from. But, as someone already mentioned, I think you may find it useful to go the NCCN website and download their guidelines. It will let you know where the current evidence is. The data does change fairly quickly, but the NCCN tries to update their site multiple times a year. It can be reassuring to know that your husband's treatment is following evidence-based guidelines. From my understanding, Xeloda monotherapy *is* considered inferior to combination chemotherapy for metastatic disease. This is not true for Stage II. So you also have to know what subgroup of patients they are talking about. As to XELOX vs CAPEOX vs FOLFOX, I have not done my own research, but it is my understanding that the choice of which combination chemo your Onc recommends is based on things like side effect profiles, personal experience (the Onc's experience with those chemo cocktails), and other patient factors. If there was one cocktail that was shown to be more effective (increasing disease free survival or overall survival) than all the others, everyone would be on that protocol. On the NCCN guidelines, you will see that they mention multiple options for combination chemotherapy (and then there are multiple footnotes!).
Financial Gain
I am biased as to this topic. I am a physician. I know lots of physicians, the overwhelming majority of whom do their jobs to help people and not try to make a profit. It is sad to me how the media portrays our profession. The few bad apples have definitely ruined the reputation of thousands of caring and giving docs. What I would say is that you and your husband do not seem to trust this Oncologist (and perhaps surgeon). I think that the lack of trust will create undue stress for you. You need to find a team that you trust so you can focus on the things you can do to improve your husband's outcome, rather than double checking someone's "claims." If it's not a good fit, just move on. I'm sure this Oncologist will also be glad of it, because they are there to help, and if they're not helping you, they'd rather you be with someone who is. My husband and I have had the benefit of asking multiple medical colleagues for opinions, curbsides or official second opinions. We expect differences of opinion as to treatment strategies, and we find it helpful to hear the rationale behind each person's decisions. I think it is good to have an inquiring mind and to want to be fully informed. Just remember, everyone has the same goal -- and that's to get the best result for your husband as possible.
I wish you luck on this journey.
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