The Colon Club

Dear mom has Stage 3 Rectal Cancer (T3CN2M0), 6.5cm from anal verge, with 30mm invasion into Mesorectal Fascia (CRM positive). She is being treated with neoadjuvant Chemo-Radiation (Xeloda + CT guided Radiation) before surgery and maybe subsequent chemo.

They did not find any mets in liver, kidney, etc; but I was surprised that they did not do a lung CT before staging it as M0. I am thinking I should immediately bring this to the doctor's attention.

I am a layman, can someone kindly shed light into these two questions I have?
1. Is it normal to postpone Lung CT for Rectal cancer until the end of neoadjuvant chemo-radiation? Should I bring it up with doc immediately?
2. She has already done 1.5 weeks of Chemo-Radiation. If there were lung mets, would they have become undetectable already?

Hello and welcome. Sorry about your mother's diagnosis. You did not say what type of testing was done to ascertain that your mother had no mets in her liver, kidney, etc. Why are you so certain that the test that was done (MRI, CT, PET) didn't involve looking at the lungs? Usually, the diagnostic CT (or MRI) is always done of the chest, abdomen and pelvis so likely they did look at her lungs and you may just not be aware of it.
In any case, even if she did have lung mets, the 1.5 weeks of chemo (which, btw, is at a lower dose when combined with radiation) wouldn't have made any lung mets undetectable. The radiation, which is aimed at the pelvic area, would have no effect on any mets outside of the radiation area.

You may want to ask the doctor to see if her CT included viewing the lungs and if not, you could ask why but you have to be careful about alienating your oncologist. That being said, if you feel that the doctor isn't doing the best for your mother, then switch doctors. The easiest thing to do is get a copy of the CT report and see what it says. If it says that the lungs are clear, you have your answer and shouldn't worry anymore.

I have a difficult time believing that the doctor would knowingly clinically stage someone (with rectal cancer, a patient is clinically staged from tests....rather than being staged from a pathology report) with no mets and not look at the lungs. My guess is that when the MRI/CT was done, all body parts from the neck to the pelvis were examined and determined to be free of cancer (except, of course, the rectum). You also have to understand that no test is 100% perfect. It is always possible, even with an MRI or CT that there actually is a met in the lung, liver, kidney, etc. that is too small to show up.

It sounds as though your mother is getting the first appropriate step in the treatment for rectal cancer. Her cancer treatment is a LONG process which will include numerous CT/MRI/PET scans in the future. Rest assured that if her lungs weren't already scanned, they will be soon.

My mom is 77 has her 1st rad. oncology appt tomorrow. She was suggested the same as your mom. She has stage 3A rectal cancer and was suggested to do the neoadjuvent therapy for 6 weeks (xoloda with rad) mon- fri. Then take a 2 month break, then have the colorectal surgery, then lastly do the chemo again. She weighs 116 pounds and will take 2 in the am and 2 at night. 1300mg total. I'm concerned as my mom was taking osteoporosis meds fosomax and was wondering if the rad tx and chemo will make her bones weaker. We are all nervous about this chemo oral med. I used to work in rad oncology and most patients were so sick.
I wish your mom the best. It seems like your mom and my mom have the same EXACT diagnosis and plan. I have been reading about the sore in mouth and hands. We are seeing a wig specialist tom. My mom is in pain. She has to take ibprofen every 3 hours or so. Is your mom in pain yet? Best wishes, and happy summer.

Hi weisssoccermom, thank you for your kind words. I checked with the Scan-Center/Lab and it seems to have been an omission on their part. However, I am not entirely sure why the physicians decided not to perform the additional CT. My assumption is that they decided against it since it would not alter the course of treatment.
And because a PET scan is forthcoming (at 8 weeks) after initial chemo, perhaps they did not want to subject mom to an additional scan. The physicians seem to be nice people and we trust them completely, so I could check with them this week.

Hi ocstacy, my mom feels tired on chemo days but otherwise she seems to be fine. Luckily no side effects yet. She's eating well and resting sufficiently.
Wish your mom and everyone else on this forum a good recovery.