My husband had a hemorrhoid removed via local excision (LE) three weeks ago. We were surprised to find out that there was a tumor along side the hemorrhoid. The tumor was T1, CT and MRI indicate no evidence of cancer anywhere in the body, low-grade, well-differentiated to moderately differentiated, the tumor was 3.3cm, CEA 1.4, and presence of lvi (small vessel lymph-vascular invasion). Our treatment options were 1) observe 2) chemo/radiation or 3) radical resection. We do not want to do option 3 (concerned about long-term morbidity/quality of life) so option 2 is what we primarily discussed with the doctors. They did not provide any information about observation. It seems their main concern is LVI, but I am wondering if LVI is a sufficient stand alone in advocating chemotherapy/radiation, if other factors are good? It seems that the doctors ignored everything else in the pathology report and focused on LVI; but in doing further research on LVI, there isn't much information about LVI, T1 rectal cancer and (LE). There are studies that indicate LVI is an independent predictor for Stage II and Stage III, but we are wondering if this is the case for stage 1. We are concerned about long-term radiation effects and also concerned about the possibility of recurrence with active observation. The doctor says there is a 30% change it has spread to lymph nodes, but I keep wondering about the 70% chance it's not there. Does anyone have any additional information about LVI and the role it should play in treatment options? Or are there any studies that talk about active surveillance considering the specifics of my husband's pathology report? What about CEA? Is this a useful indicator of whether or not cancer is in the bloodstream? Is the doctor's treatment plan normal for this stage? Finally, are there less invasive ways to determine lymph node involvement besides radical resection? Has anyone had stage 1 and opted for active observation? I apologize for asking so many questions and we know there are risks with whatever option we decided, but we just want to be able to make an informed decision. We will seek a second opinion, but I thought I'd post here to see if anyone had any additional insights. Thank you for taking time to read this and offer advice.
luvisme77 wrote:Overall, these are not easy decisions to make, as I am sure you all are aware, but I think he maybe leaning toward being actively observed every 3 to 6 months. We have one more appointment next week, with the surgeon.
Again, I just wanted to thank you all for taking time to address my concerns.
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