Thoughts on chemo for stage II patients?

[kc1948]

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?

[Beckster]

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.

[peanut_8]

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

[mypinkheaven]

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. . . . .

[O Stoma Mia]

... 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'.

[weisssoccermom]

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.

[Robino1]

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.

[susie0915]

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.

[Beckster]

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?

[Robino1]

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.

[horizon]

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

[Robino1]

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.

[menreeq]

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!

[Hey Daddy]

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.

[betsydoglover]

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,