Thoughts on chemo for stage II patients?

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kc1948
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Location: Shawnee, KS

Thoughts on chemo for stage II patients?

Postby kc1948 » Fri Nov 03, 2017 9:34 pm

T4bN0M0 tumor removed about a month ago. No cancer found in surrounding 22 lymph nodes. Tumor had grown from large intestine, through the wall, and into the small intestine. Surgeon got it all out.

CT scan showed shadows in the lungs they're going to keep an eye on. Scan also showed something on the liver (maybe), but surgeon said it felt fine.

Oncologist recommends 6 months of FOLFOX, but also mentioned 3 months of CapeOx. She said she wants to treat it as if it were stage III since it was a T4b.

From what I've read, the research is murky about chemo with stage II patients. What does everyone else think?
Friend has cancer, not me
69 yo female with T4bN0M0, stage II
Dx Sep 2017, colon resection Oct 2017

Beckster
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Location: New Jersey

Re: Thoughts on chemo for stage II patients?

Postby Beckster » Sat Nov 04, 2017 6:22 am

kc1948 wrote:T4bN0M0 tumor removed about a month ago. No cancer found in surrounding 22 lymph nodes. Tumor had grown from large intestine, through the wall, and into the small intestine. Surgeon got it all out.

CT scan showed shadows in the lungs they're going to keep an eye on. Scan also showed something on the liver (maybe), but surgeon said it felt fine.

Oncologist recommends 6 months of FOLFOX, but also mentioned 3 months of CapeOx. She said she wants to treat it as if it were stage III since it was a T4b.

From what I've read, the research is murky about chemo with stage II patients. What does everyone else think?


Welcome! I am stage IIa, which means my tumor was a T3 instead of T4. My surgeon said that he got it all out, but T4 is considered a high risk feature. I also had high risk features (G3 and LVI). I did 6 months of chemo and do not regret it. I started with CapeOx, but due to an allergic reaction to the Oxi, I just took the second part of Capeox (Xeloda). Xeloda is an oral form of 5/FU. I tolerated it well and now I am in surveillance. As you can see by my signature, there are many things that determine chemo.
57/Female
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Tumor type: Adenocarcinoma
Tumor size: 3.5 cm x 2.5 x 0.7 cm
Tumor grade: G3 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
lymph nodes: 0/24
Lymphovascular invasion
Surgical margins: clear
Lynch- Negative
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/26/17, 12/12/17 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8
Clear Colonoscopy 10/17 :D

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peanut_8
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Location: Capital of Texas

Re: Thoughts on chemo for stage II patients?

Postby peanut_8 » Sat Nov 04, 2017 10:50 am

Like Beckster, I'm a stage 2a. I also did 6 months of chemo. In my case I opted for Xeloda.

I don't regret it, and IMO as a stage 2b, you should definitely chemo.

Best Wishes,
peanut
Terri aka peanut
diagnosed Jan 14, RC stage 2a, age 56
permanent colostomy
MSS
April 14, 28 chemo/rad with Xeloda
June 14 adjuvant Xeloda 6 rounds
currently NED

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mypinkheaven
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Re: Thoughts on chemo for stage II patients?

Postby mypinkheaven » Sat Nov 04, 2017 11:13 am

I was dx as IIB because a very, very small part of the tumor had invaded the outer layer of the colon. No lymph node involvement. I opted out of chemo with my oncologist's blessing. Three years later my uterus was found to be totally taken over by cancer. I don't know how much a difference chemo would have made, but if I had to do it over. . . . .
MSS, KRAS Wild
9/2012 Colon Cancer IIB Lft Colectomy 0 lymph nodes 0 Chemo
10/2013 CT clear
11/15 CEA 2.7 to 4.6
11/15 Metastasis to uterus. Hysterectomy
2/16 Pelvic radiation - 25, brachytherapy - 3.
4/16 - 6/16 Xeloda
6/16 CT Several lung nodules less than 5 mm.
8/16 CT Nodules still present. Most stable. Some growth
10/16 CT Same ^. Onc recommends no tx :evil:
11/16 Transfer to UCSD Moores Cancer Center
12/16 Folfox + Avastin failed
2/17 Folfiri + Erbitux
8/17 5FU+Erbitux No 5FU bolus

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O Stoma Mia
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Joined: Sat Jun 22, 2013 6:29 am

Re: Thoughts on chemo for stage II patients?

Postby O Stoma Mia » Sat Nov 04, 2017 8:53 pm

kc1948 wrote:... She said she wants to treat it as if it were stage III since it was a T4b.

From what I've read, the research is murky about chemo with stage II patients. What does everyone else think?

What I think is that your friend's oncologist is right, There are 3 stages in Stage Ii, i.e., Stage IIA, Stage IIB, and Stage IIC.

For Stage IIC the research is not murky at all. It is imperative that a Stage IIC patient have adjuvant chemotherapy because the T4b tumor has already grown outside the colon and already attached itself to other organs, and there are likely many cancer cells remaining that need to be 'mopped up'.
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Understanding TNM Staging
http://www.cancer.net/cancer-types/colo ... cer/stages

weisssoccermom
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Re: Thoughts on chemo for stage II patients?

Postby weisssoccermom » Sat Nov 04, 2017 11:48 pm

I was diagnosed a stage IIA and from my signature I've been around this board for a long time now.....11 year survivor.
I opted for a less invasive surgery and yes, I went for the chemo. One dose of oxi....really bad reaction but finished up with Xeloda. If I had to do it over I would DEFINITELY go the Xeloda route again. The murkiness that you reference may be for the additional efficacy of adding oxi....but, IMO, I would to the Xeloda (way prefer it over the infused 5FU). Talk to your onc. At least take 4 - 6 months of Xeloda. Skip the oxi if you want but please, don't forgo some form of chemo. It's a short blip of your life but the benefits are all too well known.
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

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Robino1
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Re: Thoughts on chemo for stage II patients?

Postby Robino1 » Sun Nov 05, 2017 8:34 am

My only regret in life is that I didn't have chemo following my resection. I don't dwell on it but I am fighting for my life 3 years later.

I would highly suggest doing some form of chemo.
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217 CEA 219
FOLFOX started 6/17
CEA 202 Not genetic
8/29/17 CT excellent melting of tumor. Ascites is gone.
12/8/17 Markedly decr ant peritoneal nodularity since 8/29/17 compat w/ marked posi respns to therapy
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3
BRAF V600e

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susie0915
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Re: Thoughts on chemo for stage II patients?

Postby susie0915 » Sun Nov 05, 2017 9:04 am

I was told by my surgeon after chemo/radiation that I may not need chemo after surgery because all that was left was scar tissue. When the pathology report came back and showed minimal residual cancer cells he recommended chemo. I was very disappointed. My oncologist explained that even though my risk of recurrence was low, she wouldn't want me to wonder "what if" if I didn't do the chemo. I went ahead with 6 rounds of Xelox. There were some rough patches, but I made it through and in hind sight I'm glad I did. I also would recommend doing chemo. I know I had rectal cancer vs. colon cancer, but my tumor was T3 and I was stage 2A.
58 yrs old Dx @ 55
5/15 DX T3N0MO/ 2A
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod onc feels scar tissue
7/17 no change lung nodule
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule or scarring/inflammation

Beckster
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Location: New Jersey

Re: Thoughts on chemo for stage II patients?

Postby Beckster » Sun Nov 05, 2017 12:20 pm

Robino1 wrote:My only regret in life is that I didn't have chemo following my resection. I don't dwell on it but I am fighting for my life 3 years later.

I would highly suggest doing some form of chemo.


Robino1

I am happy that your chemo is working. If I may ask...what stage 2 cancer were you diagnosed with...2A,2B, or 2C?
57/Female
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Tumor type: Adenocarcinoma
Tumor size: 3.5 cm x 2.5 x 0.7 cm
Tumor grade: G3 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
lymph nodes: 0/24
Lymphovascular invasion
Surgical margins: clear
Lynch- Negative
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/26/17, 12/12/17 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8
Clear Colonoscopy 10/17 :D

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Robino1
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Facebook Username: Robin.lawthers
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Re: Thoughts on chemo for stage II patients?

Postby Robino1 » Sun Nov 05, 2017 12:24 pm

Beckster wrote:
Robino1 wrote:My only regret in life is that I didn't have chemo following my resection. I don't dwell on it but I am fighting for my life 3 years later.

I would highly suggest doing some form of chemo.


Robino1

I am happy that your chemo is working. If I may ask...what stage 2 cancer were you diagnosed with...2A,2B, or 2C?

2B according to the pathology report. 0/11 nodes.
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217 CEA 219
FOLFOX started 6/17
CEA 202 Not genetic
8/29/17 CT excellent melting of tumor. Ascites is gone.
12/8/17 Markedly decr ant peritoneal nodularity since 8/29/17 compat w/ marked posi respns to therapy
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3
BRAF V600e

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horizon
Posts: 1437
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Re: Thoughts on chemo for stage II patients?

Postby horizon » Sun Nov 05, 2017 2:34 pm

I would place substantially more weight on what my oncologist recommended versus "what I've read".
I'm just a dude who still can't believe he had a resection and went through chemo (currently 6 years NED). Is this real life?

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Robino1
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Facebook Username: Robin.lawthers
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Re: Thoughts on chemo for stage II patients?

Postby Robino1 » Sun Nov 05, 2017 3:13 pm

horizon wrote:I would place substantially more weight on what my oncologist recommended versus "what I've read".


That's the thing, I didn't see an oncologist. I went by my surgeon and he said no chemo necessary. I wish I had kept the appointment with the oncologist. I was more afraid of chemo and didn't look anything up online. I was .... stupid, naive .. whatever. Too late to go back so I am dealing with my consequences.

Hind sight is 20/20. Like I said, my only regret. Another platitude: Live and learn. I am working on that VERY much these days. ;)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217 CEA 219
FOLFOX started 6/17
CEA 202 Not genetic
8/29/17 CT excellent melting of tumor. Ascites is gone.
12/8/17 Markedly decr ant peritoneal nodularity since 8/29/17 compat w/ marked posi respns to therapy
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3
BRAF V600e

menreeq
Posts: 44
Joined: Fri Jun 30, 2017 10:26 am

Re: Thoughts on chemo for stage II patients?

Postby menreeq » Sun Nov 05, 2017 5:02 pm

I am stage IIA and opted for adjuvant chemo with Xeloda 6 months. I'm halfway through. I got multiple oncologist opinions, and I think with the new data discussed in the CRC conference this past June, more people will recommend "a little Xeloda" for Stage IIA. A little meaning maybe just 3 months -- the side effect profile would be mild enough to justify its use.

Had I been higher stage or showed any "high risk features," I wouldn't even have debated chemo vs no chemo. I would probably been discussing what kind of chemo instead. We each make a choice. I didn't want to regret anything. My hands and feet are peeling and I can't use touchID to use my phone anymore, but I'm still fully on board with my decision.

Best of luck!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Started Xeloda monotherapy 8/13/17

Hey Daddy
Posts: 32
Joined: Wed Nov 30, 2016 8:42 am

Re: Thoughts on chemo for stage II patients?

Postby Hey Daddy » Sun Nov 05, 2017 6:25 pm

My son had a T4a tumor and dx as stage 2b. His oncologist and the one we got a second opinion from both strongly recommended chemo. His young age was a factor as chemo may be a bit easier to tolerate when you are young and fit, but I would think anyone should try to do the chemo if at all possible with a T4 tumor. He finished 6 months of FOLFOX 8 months ago and so far so good. He has a blood test scheduled for this week so fingers are crossed once again.
DS dx CC Stage IIB (T4N0M0) 3Aug16, 21 yr old
poorly differentiated, lymphovascular and perineural invasion
CEA 29
Colon resection 4Aug16
CEA 2.5
Genetics testing negative
6 mo FOLFOX Sep16 - Mar17
CT Scan Mar17 clear
Colonoscopy Apr17 clear
CEA 1.8
NED

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betsydoglover
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Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: Thoughts on chemo for stage II patients?

Postby betsydoglover » Sun Nov 05, 2017 6:28 pm

Since I am Stage 4, I have a somewhat different perspective - I'd be dead if I had not done chemo.

That said, when I had a lung resection in 2009 - NED after surgery -, my oncologist wanted me to do Xeloda + Avastin for "mop-up". She readily admitted that I could do nothing and things might work out fine - it was a grey area. I decided I could not live with myself if I didn't try chemo and later had a recurrence. I'll never know if that decision is what has made me do so well, but I certainly don't regret it for a second!

My situation with the lung met was kind of like your current situation. And, remember you can always stop chemo if it gets to be too much - also dose adjustments can ease side effects.

Good luck with your decision,
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 11/17


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