Post-surgery colonoscopy and cimetidine

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mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Post-surgery colonoscopy and cimetidine

Postby mpbser » Sat Jun 24, 2017 6:55 am

Two unrelated questions:

Did any of you have a colonoscopy shortly following CRC surgery? How long after the surgery did you wait? What do people on this board think about 6 weeks post surgery?

For those people who are taking or who have taken cimetidine, here are a few sub-questions:
1. If you have stopped, how long did you take it for? Why did you stop? What was your daily dosage?
2. If you haven't stopped, what is your daily dosage? Are you aware of any issues with long term use?

Thanks in advance everyone!
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

TXLiz
Posts: 249
Joined: Thu Sep 22, 2016 3:31 pm

Re: Post-surgery colonoscopy and cimetidine

Postby TXLiz » Sat Jun 24, 2017 10:56 am

I have read that sometimes the surgeon will do a colonoscopy on the patient before surgery. If so, I think it is recommended to have another colonoscopy at the one year mark.

If not, a colonoscopy is recommended at the 6 month mark.

http://www.gastro.org/guidelines/colono ... -resection

Here is one source for suggested follow up colonoscopy.

This is just what my onc has recommended and I have gathered from poking about the internet; there's way more knowledgeable people here that may have better info.

I also wanted to add that at the 6 month mark, I received a contrast CT and a double contrast barium enema at MDA. I did not know that was recommended and a bit taken aback but glad they did so, as it is recommended to have it done.

I am going for my colonoscopy soon and determined to be awake. I have done it before awake and there's no way they are putting me out and I am waking up to bad news. If some jackass tumor is in my colon, I want to see it and give it a piece of my mind while it's onscreen.
Vomiting and blockage 9/19/16 46 y F
R hemi colectomy 9/20/16
Stage 3 B CRC, located in cecum
3 out of 16 lymph nodes positive
perineural invasion/lymphovascular invasion
infiltrating, mod differentiated adenocarcinoma with a mucinous component
separate tumor nodules present in pericolonic adipose tissue
MSI-high
Baseline PET scan clear 9/16 CEA 0.5
FOLFOX 10/16- 3/17
April 16th, CT scan clear. CEA 1.1
Lynch "inconclusive"
Colonoscopy 10/5/2017 clear

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Post-surgery colonoscopy and cimetidine

Postby mpbser » Sat Jun 24, 2017 1:00 pm

Thanks for the link, TXliz.

My primary concern is whether or not it is too soon to be digging around in there with the left surgical site still healing. None of husband's doctors seem to think its a problem, but how often do they get a patient who might have more tumors in a distant part of the colon that are discovered a few weeks after the hemi-colectomy....

Good luck with your colonoscopy. If anything is found, give it hell!
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

KimT
Posts: 695
Joined: Sat Feb 20, 2010 8:53 pm

Re: Post-surgery colonoscopy and cimetidine

Postby KimT » Sat Jun 24, 2017 6:34 pm

I had a colonoscopy around 3 months later. No colonoscopy is pleasant but it wasn't any worse. I don't think you have a lot of choices given the circumstances. If it see me, I would want to investigate any areas that lit up on pet scan. I had several pet scans after my resection as I was involved in a clinical trial and no areas lot up once my primary tumor was removed. I had pet scans immediately after surgery and 2 and 4 weeks out.
2/10 dx colon cancer
right hemicolectomy 3/19/10
Stage 2a 0/43 nodes
Lynch syndrome
3/14/10 colon resection/ removal of metal clips
Nov 11 dx ovarian cancer

User avatar
GrouseMan
Posts: 888
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Post-surgery colonoscopy and cimetidine

Postby GrouseMan » Mon Jun 26, 2017 7:30 am

My wife took cimetidine for three and a half years 800 mg per day. Ended when she went into a clinical trial that they wouldn't let her take it any longer. Her normal oncologist was OK with it, but the trial coordinator wasn't.

As for a colonoscopy after surgery, I wish they had done one at intervals after my wife's initial resection surgery. Might have detected/shown the tumor that ended her life earlier and allowed them to snip it out before it caused the blockage that they could do nothing about in the end. She went from a very active woman (Riding a horse working dogs) to a wasted away shell in little over three weeks time. It was awful! See if you can't get them to add this to your monitoring procedure.

Regards,

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

Swirdfish
Posts: 290
Joined: Sun Jun 19, 2016 3:57 am

Re: Post-surgery colonoscopy and cimetidine

Postby Swirdfish » Mon Jun 26, 2017 8:49 am

I had my colonscopy today. You can see my surgery dates in my signature. I mainly had to wait until after reversal so i could do the prep. Flushing the bowels with a bag is difficult and mine didnt work. I think 6 weeks is what they suggest is okay. Main reason i did it was for a incomplete original colonoscopy. I think its a year after then every 3 here.

RP1954 could answer you a few questions for point number 2
06/2016 Went in for colonoscopy came out with a tumor. Age 35
12cm from verge at junction. Rectal cancer.
Clinical stage T3 NO MO
Temp illestomy
Completed 5FU and Radiation
LAR surgery planned 13 Oct 2016
Completed ULAR surgery 11-10-2016.
0/22 nodes
pT3 N0 M0 R1
Stage 2A

Pathology reviewed and changed
ypT3 N0 M0 R0

Started folfox 21-11-2016
5-4-17 NED
Reversal 12-4-17

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Post-surgery colonoscopy and cimetidine

Postby mpbser » Mon Jun 26, 2017 9:37 am

Grouseman, So sorry to hear... I wonder why surveillance colonoscopies were not employed. Or perhaps they were, just at too long intervals... Thanks for the information on the cimetidine.

I find it interesting that the discovery of additional adenocarcinoma in the same organ within 1 year time of the original diagnosis is considering "synchronous." From what our surgeon friend has told us, the type of cancer my husband has is not fast growing so anything that might be found in the transverse colon was there before his hemicolectomy. IF a tumor is there, this will demonstrate how fallible CT scans can be since nothing at all in that area was picked up.

swirdfish, "I think 6 weeks is what they suggest is okay." I haven't seen that anywhere but not for the lack of trying. The procedure will be just under 6 weeks by a day or two.

Epithelial cells are quick to divide and thus quick to repair, from what I understand. "Epithelial cells are continuously renewed every 4–5 days through a process of renewal and migration." Since intestinal lining consists of epithelium, I can imagine that the lining of the colon is quite back to normal by now and that is what I think would be most important.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

rp1954
Posts: 1853
Joined: Mon Jun 13, 2011 1:13 am

Re: Post-surgery colonoscopy and cimetidine

Postby rp1954 » Tue Jun 27, 2017 9:53 am

mpbser wrote:For those people who are taking or who have taken cimetidine, here are a few sub-questions:
1. If you have stopped, how long did you take it for? Why did you stop? What was your daily dosage?
2. If you haven't stopped, what is your daily dosage? Are you aware of any issues with long term use?


I've always broken the "how long" decision into two periods, "perioperative" - say, a month before to a month after surgery, and "long term", out to a year or more. The cimetidine stats for surgery are so favorable, and so little personal information is available this early, that the general LEF recommendation is for everybody to do 800-1000 mg, maybe 1600 mg, where about half of men may not tolerate 1600 mg well long term. Females do better.

My wife, who has the bad biomarkers, took cimetidine for 6 straight years, often at 1600 mg but this is likely too high for most guys. She's been irregular on a lot of non chemo items this past year.

Given the Matsumoto(2002) paper on metronomic oral 5FU and cimetidine's effectiveness based on CA19-9 and CSLEX tissue stains, I insisted on CA19-9 serum levels before and after surgery. It seems clear that stage II and III patients with tumor tissues marked by CA199 and CSLEX1 antibody stains, in that era were totally screwed if they did not have cimetidine as well as their daily oral chemo. Heavily double biomarker positive stage II and III patients might as well have been early stage IV due to their poor OS. The Matsumoto(2002) paper's OS of double positive CRC stg 2-3 patients appears better than Folfox if taken at face value. It is a small study well done. By the same token, stage 2-3 CRC patients without one or both of these markers may have done a little worse with the cimetidine. CA19-9 covers most of the biomarker based risk, where CSLEX or bioequivalent CD15s antibodies are usually unavailable. Pathologists seem reluctant to do nonstandard staining, so pretreatment serum CA199 is the first, easiest step.

Long term use is going to reduce digestive capacity without digestive support (betaine HCl and/or pancreatic enzyme supplements). Cimetidine may be a slight OS drag on the minority of pts negative for one of or both of the tissue markers, CA199 and CSLEX1.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

cbsmith
Posts: 87
Joined: Sat Nov 28, 2015 11:45 am
Location: New Brunswick, Canada

Re: Post-surgery colonoscopy and cimetidine

Postby cbsmith » Tue Jun 27, 2017 4:53 pm

CT scans aren't great at picking things up in the colon. They are better at detecting cancer in the other organs in your body.
06/14-DX with FAP as 36yo Male
07/14-total colectomy, rectum removal, permanent ileostomy
08/14-DX Stage IIIC, KRAS mutant, MSS
09/14-04/15 - 12 rounds of FOLFOX
07/15-CT showed para-aortic lymph node, onc thght inflammation
10/15-DX Stage IV, CT lymph node tripled in size, 1 small lung met
11/15-FOLFIRI + Avastin
06/16-lymph node is stable, now have a 2nd lung met
01/16-lymph node is stable, lung mets grown 2mm. Still on FOLFIRI + Avastin
11/17 - no chemo since. Lung growth minimal, lymph node is stable

User avatar
LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Post-surgery colonoscopy and cimetidine

Postby LPL » Tue Jun 27, 2017 5:24 pm

I read this article
"Repurposing drugs in your medicine cabinet: untapped opportunities for cancer therapy?"
From (2015) http://www.futuremedicine.com/doi/full/ ... fon.14.244
And one reference there had A LOT of info !!! about Cimetidine. Doses are also mentioned.
Maybe it can be of interest?
Repurposing drugs in oncology (ReDO)—cimetidine as an anti-cancer agent. From (2014) http://ecancer.org/journal/8/full/485-r ... -agent.php
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets

hawkowl
Posts: 132
Joined: Sun Dec 14, 2014 5:29 am
Location: MN/FL

Re: Post-surgery colonoscopy and cimetidine

Postby hawkowl » Tue Jun 27, 2017 6:36 pm

I took cimetidine 800mg twice daily for about a year, increasing dose to 800mg 3x/day when I had my resection or any procedure. I stopped when I developed the first signs of gynecomastia (painful male breast enlargement) and this resolved right away. I have been off it now for about 18 months (other than for a few days when I had my follow up colonoscopy).

My follow up colonoscopy was about 6 months after my last surgery
Dx 12/2014 T3N2MX (distant LPLN) low rectal
12/2014-4/2015: FOLFOX (8 cycles)
4/2015-6/2015: 28 cycles of chemoradiation with xeloda, SBRT
8/2015: Robotic APR with iliac node dissection; path showed ypT0,ypN0 (complete pathological response).
11/2015 scans clear, CEA 2.1
11/2015 parastomal hernia repair
3/2016 CEA 1.7, scans stable...
6/2020 5 years of normal CEA and stable scans
Now dealing with pyoderma gangrenosum.
Totally disabled due to oxaliplatin induced neuropathy and dysautonomia

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Post-surgery colonoscopy and cimetidine

Postby mpbser » Tue Jun 27, 2017 7:22 pm

Thanks cbsmith, LPL. and hawkowl!
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED


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