Radiation after surgery instead of before

[Beckster]

I figure I would ask the experts on this forum for my answer.

A friend of mine had colon cancer about 2 1/2 years ago saying it was between stage 1 and 2. What the hell does that mean? ....I thought you were either stage I or stage II. He said it was left sided and they placed a titanium ring to join the intestines to the rectum area. I am thinking either sigmoid or rectosigmoid....After surgery, he received chemo and radiation. From joining this forum over 6 months ago, I did not read of anyone having radiation after surgery. I am assuming that he had rectal cancer, but why radiation after surgery and not before?
Now 1 1/2 years after dx, he has four liver mets. Secondly, he had surgery in October and did not start chemo/radiation until January.

Does this sound correct? I do not want to say anything to him, but I seriously question his oncologist. Has anyone here received radiation after surgery. From what my onc told me about myself, he said that they do not give radiation for colon cancer because your intestines are moving around and not stationary.

I am trying to make sense of his situation.

[Mercy110]

I think radiation do take place after surgery, but it is rare for colon cancer patient to have radiation coz as u said, the colon moves around and hard to fix the location for radiation.
At least that's what I heard from Hong Kong.

[weisssoccermom]

People DO have radiation after surgery - it is not that uncommon. Sometimes people with colon cancer lower down in the tract find that after surgery the pathology report indicates that clean margins were not obtained. In that case, it is very common for the patient to have radiation. Generally, the CLINICALLY stage I rectal cancer patient (staged prior to any treatment) is not offered neoadjuvant (prior to surgery) chemoradiation. However, in some of those cases, after surgery, the pathology report indicates that perhaps one or more nodes were involved or perhaps the tumor really wasn't a T1/T2...but rather a T3. So, the pathology report really is the indicator if the patient needs adjuvant chemoradiation.

There have been members on this board who have had radiation after surgery.....while not the 'norm' it is not that uncommon. As for the diagnosis of cancer being between a stage I and II....well again, that depends. My gut feeling says that your friend had rectal cancer and just doesn't want to say it.....but that's just my speculation. Rectal cancer patients are clinically staged based on tests....the EUS, & CT and/or MRI. No test is 100% perfect and each medical professional interprets the depth penetration ever so slightly differently....unless, of course, the views are clearly and plainly seen. In my case, my EUS report states that the views seem to indicate penetration into the.....so the radiologist erred on the side of caution and stated that the tumor was a T3. However, my surgeon, who also looked at the same picture (months later....I changed surgeons) said, in her opinion, the tumor was a late stage T2. That would have meant the difference between a stage IIA or a stage I. I was staged a stage IIA....but who knows if I truly was a stage I? It really doesn't matter though.....nothing is going to change anything.

No two cases are the same. If your friend had surgery in say late October, he would have had to wait at least 6 weeks to recover before starting any treatment. Now, if his wound didn't heal, if he was sick, if he wanted to wait until after the holidays....any number of things, it could easily be possible that chemoradiation didn't start until January. Not saying it is ideal but....do you know all of the reasons WHY he didn't start treatment until January? It could be that he didn't really even want to have the treatments and had to be talked into them.

As for the mets showing up, nothing about cancer is predictable. Personally, I wouldn't be bringing up anything to your friend about questioning his oncologist. There are more members than you think who were originally diagnosed as stage I/II who later developed distant mets. Without having to do much thinking, I can think of Eric (brownbagger), Terry, Nancy and "C" (I am not sure she wants her name revealed) who were all either initially staged as either stage I or II and who all ended up getting mets. Your friend is undoubtedly going through some tough times right now and honestly, I wouldn't put the idea in his head that 'if he had done this' or 'if his doctor had only done this', etc. because whhat good does it do...what is it going to change? Absolutely nothing. What has happened has happened and he needs to deal with the hand that he has been dealt without speculating about the 'what ifs'. Trust me....he's doing enough of that himself...wondering why he didn't get scoped earlier or why he ignored his symptoms, etc.

I've been on this board for over 10 years now and have read so many stories and have made a lot of friends here. My advice....just be there for your friend. If he wants to talk....be there to listen but let him take the lead.

[Lee]

People DO have radiation after surgery - it is not that uncommon. Sometimes people with colon cancer lower down in the tract find that after surgery the pathology report indicates that clean margins were not obtained. In that case, it is very common for the patient to have radiation. Generally, the CLINICALLY stage I rectal cancer patient (staged prior to any treatment) is not offered neoadjuvant (prior to surgery) chemoradiation. However, in some of those cases, after surgery, the pathology report indicates that perhaps one or more nodes were involved or perhaps the tumor really wasn't a T1/T2...but rather a T3. So, the pathology report really is the indicator if the patient needs adjuvant chemoradiation.

There have been members on this board who have had radiation after surgery.....while not the 'norm' it is not that uncommon. As for the diagnosis of cancer being between a stage I and II....well again, that depends. My gut feeling says that your friend had rectal cancer and just doesn't want to say it.....but that's just my speculation. Rectal cancer patients are clinically staged based on tests....the EUS, & CT and/or MRI. No test is 100% perfect and each medical professional interprets the depth penetration ever so slightly differently....unless, of course, the views are clearly and plainly seen. In my case, my EUS report states that the views seem to indicate penetration into the.....so the radiologist erred on the side of caution and stated that the tumor was a T3. However, my surgeon, who also looked at the same picture (months later....I changed surgeons) said, in her opinion, the tumor was a late stage T2. That would have meant the difference between a stage IIA or a stage I. I was staged a stage IIA....but who knows if I truly was a stage I? It really doesn't matter though.....nothing is going to change anything.

No two cases are the same. If your friend had surgery in say late October, he would have had to wait at least 6 weeks to recover before starting any treatment. Now, if his wound didn't heal, if he was sick, if he wanted to wait until after the holidays....any number of things, it could easily be possible that chemoradiation didn't start until January. Not saying it is ideal but....do you know all of the reasons WHY he didn't start treatment until January? It could be that he didn't really even want to have the treatments and had to be talked into them.

As for the mets showing up, nothing about cancer is predictable. Personally, I wouldn't be bringing up anything to your friend about questioning his oncologist. There are more members than you think who were originally diagnosed as stage I/II who later developed distant mets. Without having to do much thinking, I can think of Eric (brownbagger), Terry, Nancy and "C" (I am not sure she wants her name revealed) who were all either initially staged as either stage I or II and who all ended up getting mets. Your friend is undoubtedly going through some tough times right now and honestly, I wouldn't put the idea in his head that 'if he had done this' or 'if his doctor had only done this', etc. because whhat good does it do...what is it going to change? Absolutely nothing. What has happened has happened and he needs to deal with the hand that he has been dealt without speculating about the 'what ifs'. Trust me....he's doing enough of that himself...wondering why he didn't get scoped earlier or why he ignored his symptoms, etc.

I've been on this board for over 10 years now and have read so many stories and have made a lot of friends here. My advice....just be there for your friend. If he wants to talk....be there to listen but let him take the lead.

Ditto to what Jaynee said. Be a supportive friend. Stage II is such an open end, anything can happen, and for many, you are suddenly a stage IV.

Lee

[JJH]

... I am assuming that he had rectal cancer, but why radiation after surgery and not before?...

I had radiation after surgery. This was because it was an emergency surgery to remove a T4b blockage and there was no time to think about doing 5 weeks of neoadjuvant chemorad.

[Beckster]

People DO have radiation after surgery - it is not that uncommon. Sometimes people with colon cancer lower down in the tract find that after surgery the pathology report indicates that clean margins were not obtained. In that case, it is very common for the patient to have radiation. Generally, the CLINICALLY stage I rectal cancer patient (staged prior to any treatment) is not offered neoadjuvant (prior to surgery) chemoradiation. However, in some of those cases, after surgery, the pathology report indicates that perhaps one or more nodes were involved or perhaps the tumor really wasn't a T1/T2...but rather a T3. So, the pathology report really is the indicator if the patient needs adjuvant chemoradiation.

There have been members on this board who have had radiation after surgery.....while not the 'norm' it is not that uncommon. As for the diagnosis of cancer being between a stage I and II....well again, that depends. My gut feeling says that your friend had rectal cancer and just doesn't want to say it.....but that's just my speculation. Rectal cancer patients are clinically staged based on tests....the EUS, & CT and/or MRI. No test is 100% perfect and each medical professional interprets the depth penetration ever so slightly differently....unless, of course, the views are clearly and plainly seen. In my case, my EUS report states that the views seem to indicate penetration into the.....so the radiologist erred on the side of caution and stated that the tumor was a T3. However, my surgeon, who also looked at the same picture (months later....I changed surgeons) said, in her opinion, the tumor was a late stage T2. That would have meant the difference between a stage IIA or a stage I. I was staged a stage IIA....but who knows if I truly was a stage I? It really doesn't matter though.....nothing is going to change anything.

No two cases are the same. If your friend had surgery in say late October, he would have had to wait at least 6 weeks to recover before starting any treatment. Now, if his wound didn't heal, if he was sick, if he wanted to wait until after the holidays....any number of things, it could easily be possible that chemoradiation didn't start until January. Not saying it is ideal but....do you know all of the reasons WHY he didn't start treatment until January? It could be that he didn't really even want to have the treatments and had to be talked into them.

As for the mets showing up, nothing about cancer is predictable. Personally, I wouldn't be bringing up anything to your friend about questioning his oncologist. There are more members than you think who were originally diagnosed as stage I/II who later developed distant mets. Without having to do much thinking, I can think of Eric (brownbagger), Terry, Nancy and "C" (I am not sure she wants her name revealed) who were all either initially staged as either stage I or II and who all ended up getting mets. Your friend is undoubtedly going through some tough times right now and honestly, I wouldn't put the idea in his head that 'if he had done this' or 'if his doctor had only done this', etc. because whhat good does it do...what is it going to change? Absolutely nothing. What has happened has happened and he needs to deal with the hand that he has been dealt without speculating about the 'what ifs'. Trust me....he's doing enough of that himself...wondering why he didn't get scoped earlier or why he ignored his symptoms, etc.

I've been on this board for over 10 years now and have read so many stories and have made a lot of friends here. My advice....just be there for your friend. If he wants to talk....be there to listen but let him take the lead.

Thanks weisssoccermom for the clarification. I too was clinically diagnosed as Stage I by tests and surgeon, but pathology came back as IIA. He said he was between stage I and II after pathology report. I know how he is feeling and do not to make matters worse. I guess, because he is not going to a major cancer center, I myself is questioning the treatment plan. They told him it was ok to wait until after the holidays to start treatment. On the other hand, my onc told me the golden window is within 8 weeks, so I started the day after Christmas. He did not give me a choice. He had a liver resection this past January. They had him stop 3 treatments before surgery and yesterday they found another met. I just feel so bad for him...