Surgery is over!

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Aqx99
Posts: 320
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Surgery is over!

Postby Aqx99 » Thu Nov 30, 2017 3:58 pm

It was explained to me that the tissue was so fragile after chemoradiation that the temporary ileostomy was needed to allow for proper healing. It's also why I took daily Miralax before my surgery, because even pushing too hard for a bowel movement could have torn my rectum.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
2/21/17 Diagnosis, Age 39
2/21/17 CEA 0.9 ng/mL
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR w/temp loop ileostomy, ovaries & fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 - 12/18/17 CapeOx, 6 Cycles
7/24/17 Diagnosed w/ovarian cancer
9/6/17 CA 125 11.1 U/mL
11/27/17 CEA 2.6 ng/mL
12/5/17 CT showed NED
12/13/17 CEA 2.9 ng/mL
1/11/18 CA 125 8.6 U/mL
1/23/18 Reversal

KathyLynn
Posts: 39
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Thu Nov 30, 2017 6:08 pm

I wish I knew more on this... My Chart was set up
With wrong information and I’m looking into that now
As far as where the tumor was, I’m pretty sure 6 cm from the anal verge
I had so many opinions from oncologist, and I went with the one with GBMC because he ran more test and was really helpful. I stayed with my doctor since day one.
I just felt very comfortable with his decisions
My bowels are working with no issues
And no pain at all
Now if the lymph node comes back as positive then he will have me in treatment.
KathyLynn
59 yr old. Mom of 3 daughters.
7/2017. Started taking probiotics. 2 weeks later blood in stool
8/2017. Colonoscopy. Rectal Cancer
9/2017. PET/CT. MRI. T2 or T3. NO MO
10/2017. Endo Ultrasound. T2 NO MO
11/27/2017. Robotic LAR.
12/2017. NED.
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
In one lymph node removed at surgery
Less than .1mm

KathyLynn
Posts: 39
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Fri Dec 01, 2017 6:12 pm

Hi All,
I just got home today from the hospital. I feel really good. Some cramping, but I think that is expected
It was a long ride from the hospital to my home
I told a nap and I woke up to my husband talking to my doctor
All margins and all biopsies came back negative
So, I don’t need any follow up treatment. I am a T2 N0M0
I still have all confidence in my medical team
I will have tons of follow up test, but I’m there!!
We are all individuals, and I hope we all make the right decisions with this nasty disease.

Thanks everyone
KathyLynn
59 yr old. Mom of 3 daughters.
7/2017. Started taking probiotics. 2 weeks later blood in stool
8/2017. Colonoscopy. Rectal Cancer
9/2017. PET/CT. MRI. T2 or T3. NO MO
10/2017. Endo Ultrasound. T2 NO MO
11/27/2017. Robotic LAR.
12/2017. NED.
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
In one lymph node removed at surgery
Less than .1mm

User avatar
Robino1
Posts: 294
Joined: Fri Aug 11, 2017 12:09 pm
Facebook Username: Robin.lawthers
Location: Florida

Re: Surgery is over!

Postby Robino1 » Fri Dec 01, 2017 6:29 pm

Thank you for the update and the good news!

May your healing process be easy on you :)
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

NHMike
Posts: 854
Joined: Fri Jul 21, 2017 3:43 am

Re: Surgery is over!

Postby NHMike » Fri Dec 01, 2017 7:01 pm

KathyLynn wrote:Hi All,
I just got home today from the hospital. I feel really good. Some cramping, but I think that is expected
It was a long ride from the hospital to my home
I told a nap and I woke up to my husband talking to my doctor
All margins and all biopsies came back negative
So, I don’t need any follow up treatment. I am a T2 N0M0
I still have all confidence in my medical team
I will have tons of follow up test, but I’m there!!
We are all individuals, and I hope we all make the right decisions with this nasty disease.

Thanks everyone
KathyLynn


A great report.
6/23/17: ER rectal bleeding; Colonoscopy
7/13: Stage 3B rectal. T3N1bM0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/30: LAR, Temp Ileostomy, Path Complete Response
12/20: Started CapeOx

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susie0915
Posts: 649
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Surgery is over!

Postby susie0915 » Fri Dec 01, 2017 7:09 pm

Good news. Glad you are home and feeling good.
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

User avatar
Atoq
Posts: 54
Joined: Wed Oct 25, 2017 9:31 am

Re: Surgery is over!

Postby Atoq » Sat Dec 02, 2017 4:31 am

This was very good news! I am glad for your report!

Best

Claudia
45 year old, mother of 2
Dx rectal cancer October 2017
At least T3N2aMX (suspect metastasis to one lung 8 mm)
Lynch negative
Neoadjuvant chemoradiotherapy Xeloda + 25x2 Gy
05.12.17 laparotomic surgery for blockage, colostomy

DarknessEmbraced
Posts: 2886
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Surgery is over!

Postby DarknessEmbraced » Sat Dec 02, 2017 12:45 pm

I'm glad your surgery went well and hope your recovery goes well!*hugs* Wonderful news! :)
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17

KathyLynn
Posts: 39
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Wed Dec 13, 2017 1:25 pm

Hi All,
I had my follow up yesterday
I feel really good
I have a question, my report shows:
T2N0M0
Question is.....a comment on my report..

“Since the focus of adenocarioma identified in one of fifteen lymph nodes is less than 0.2 mm in size, it is considered N0 for staging purposes”

Very confusing to me

Doctor suggested to see an oncologist to see what he may want to do with this

Anyone had this result?

Thanks
KathyLynn
59 yr old. Mom of 3 daughters.
7/2017. Started taking probiotics. 2 weeks later blood in stool
8/2017. Colonoscopy. Rectal Cancer
9/2017. PET/CT. MRI. T2 or T3. NO MO
10/2017. Endo Ultrasound. T2 NO MO
11/27/2017. Robotic LAR.
12/2017. NED.
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
In one lymph node removed at surgery
Less than .1mm

MissMolly
Posts: 455
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Surgery is over!

Postby MissMolly » Wed Dec 13, 2017 6:06 pm

For those individuals who are wondering why the placement of a temporary ileostomy, Ann (Aqx99) has expressed the reasoning and rationale.

Aqx99 wrote:It was explained to me that the tissue was so fragile after chemoradiation that the temporary ileostomy was needed to allow for proper healing. It's also why I took daily Miralax before my surgery, because even pushing too hard for a bowel movement could have torn my rectum.


Radiation has adverse effects on the soft and connective tissues of the pelvic cavity as well as the remaining rectum and it’s dense muscular layers. Radiation tends to thin the collagen component of tissue, making soft and connective tissues more frail and fragile. This heightens the risk that carefully placed sutures will not hold - causing failure of the anastamosis. Failure of the anastomosis with incomplete healing where there is no temporary ileostomy would lend to leakage of fecal material and bacteria into the abdominal and pelvic cavities with resultant peritonitis and possible systemic sepsis.

It is the adverse effects of radiation for rectal cancer that warrant placement of a temporary ileostomy. The location of the rectal tumor in reference to the anal verge is not a primary deciding factor of whether a temporary ileostomy is placed. It is the Health or lack of health of the soft/connective tissues post radiation that is the deciding factor for the surgeon at the time of the LAR or ultraLAR. A surgeon may make the call for no ileostomy if the pelvic tissues are patent with little/no radiation after effects. But this is a small minority. The potential of a life-threatening sepsis if the anastamois were to fail due to tissue fragility generally takes precedence lending the majority of surgeons to place a temporary ileostomy as a measure of safety.

As people have noted in their individual experiences, the length of time for healing of the anastomosis can vary. Individuals where the pelvic tissues are relatively unscathed by the radiation may have their temporary ileostomies reversed earlier than 6 months. People have different rates of healing. Healing of the anastamosis is tested prior to scheduling of the reversal. A barium study of the resting rectum is performed using fluoroscopy imaging, often referred to as the “leak test.” Barium is infused into the rectum and visualed on fluoroscopy. If no barium leaks into the pelvis the anastomosis is considered sufficiently healed and the reversal scheduled.

While a temporary ileostomy can be frustrating and exhausting, it’s placement is necessitated by the adverse effects of radiation on soft and connective tissue. The transient inconveniences of a temporary ileostomy are far less than the pain and tragedy of a failed anastomosis and sequela of systemic sepsis.

I have a permanent ileostomy. In the 6 years that I have had an ostomy, my stoma has become routine and a part of me - just as my hands and feet are a part of me. Keeping a sense of humor and levity are helpful when you have a stoma sharing space on your abdomen.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

KathyLynn
Posts: 39
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Thu Dec 14, 2017 8:43 am

KathyLynn wrote:Hi All,
I had my follow up yesterday
I feel really good
I have a question, my report shows:
T2N0M0
Question is.....a comment on my report..

“Since the focus of adenocarioma identified in one of fifteen lymph nodes is less than 0.2 mm in size, it is considered N0 for staging purposes”

Very confusing to me

Doctor suggested to see an oncologist to see what he may want to do with this

Anyone had this result?

Thanks
KathyLynn
59 yr old. Mom of 3 daughters.
7/2017. Started taking probiotics. 2 weeks later blood in stool
8/2017. Colonoscopy. Rectal Cancer
9/2017. PET/CT. MRI. T2 or T3. NO MO
10/2017. Endo Ultrasound. T2 NO MO
11/27/2017. Robotic LAR.
12/2017. NED.
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
In one lymph node removed at surgery
Less than .1mm

User avatar
Shana
Posts: 186
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Surgery is over!

Postby Shana » Thu Dec 14, 2017 9:56 am

Glad to hear of your successful surgery and continued recovery. Great news on being NED! :D

I hope you get some feedback on your question, sorry I'm still too new to this to offer any information.
DX - 12/16
MSS - KRAS wild
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17 - 2 wks on, 1 wk off to lessen side effects
CEA 12/17 - 37.8! CEA 1/17 - 33!
CT-Scan 9/1/17. Shrinkage of liver mets (4 measurable) and no bowel blockage
CT=Scan 12/1/17 Shrinkage of liver mets continue, no blockage

Removal of primary tumor and resection still on back burner. Have to be able to be OFF chemo one month prior and one month after surgery and evaluate benefit vs risk.

KathyLynn
Posts: 39
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Thu Dec 14, 2017 11:37 am

Thank you Shana
It sure can be confusing! Lol
59 yr old. Mom of 3 daughters.
7/2017. Started taking probiotics. 2 weeks later blood in stool
8/2017. Colonoscopy. Rectal Cancer
9/2017. PET/CT. MRI. T2 or T3. NO MO
10/2017. Endo Ultrasound. T2 NO MO
11/27/2017. Robotic LAR.
12/2017. NED.
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
In one lymph node removed at surgery
Less than .1mm

User avatar
O Stoma Mia
Posts: 976
Joined: Sat Jun 22, 2013 6:29 am

Re: Surgery is over!

Postby O Stoma Mia » Thu Dec 14, 2017 3:37 pm

KathyLynn wrote:I have a question, my report shows:
T2N0M0
Question is.....a comment on my report..

Since the focus of adenocarioma identified in one of fifteen lymph nodes is less than 0.2 mm in size, it is considered N0 for staging purposes"

Very confusing to me

Doctor suggested to see an oncologist to see what he may want to do with this

Anyone had this result?

Thanks
KathyLynn

I haven't had this result, but I think that this is covered in the detailed instructions that accompany the colorectal cancer pathology template. In that document they say that a single, small isolated .tumor deposit in a lymph node.has no prognostic value. In particular, in these cases they recommend coding this as pN0
CS3.06e Recording small tumour deposits in lymph nodes needs to take account of the following issues:
* Isolated tumour cells are defined as “single malignant cells or a few tumour cells in microclusters”, not more than 0.2 mm in diameter, present within a lymph node. They may be single or multiple. They may be visible in H&E stained sections or detected by immunohistochemistry. The literature suggests that the finding of such cells is not a marker of an adverse prognosis for the patient.

"...The AJCC TNM 7th edition recommends that cases in which isolated tumour cells are the only form of nodal involvement should be classified as pN0, although the presence of the isolated tumour cells should be noted. Optional designation as pN0(i+) may be used in this situation, although a free-text description might provide clearer communication.


There are several scientific articles that they cite to support their recommendation to code the result this way.

If you want to see the source articles, let me know and I will try to dig up the references.

Essentially, what they are saying is that, all things considered, it is better to code this as T2N0M0 than T2N1M0, to avoid over-treating the patient and causing more harm than good. But you should discuss this with your oncologist to get a medical perspective on this.
.
.
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KathyLynn
Posts: 39
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Thu Dec 14, 2017 4:00 pm

Thank you so much
I thought I was the only one with this diagnose
This really upset me because I was told that everything was the same. Then I saw the comment on the report
My mind has been racing. I can’t tell you how many times I was told something different since I was diagnosed. I’m on such a bad emotional roller coaster right now

Again thank you for the information !!

KathyLynn
59 yr old. Mom of 3 daughters.
7/2017. Started taking probiotics. 2 weeks later blood in stool
8/2017. Colonoscopy. Rectal Cancer
9/2017. PET/CT. MRI. T2 or T3. NO MO
10/2017. Endo Ultrasound. T2 NO MO
11/27/2017. Robotic LAR.
12/2017. NED.
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
In one lymph node removed at surgery
Less than .1mm


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