Recently diagnosed CA in cecum - need to clear some confusion

[cyansagar]

Hello I'm new here.Recently my father(49) has been diagnosed with cancer in the cecum . According to MRI report it was a T4 tumour (T4N1)that spread to multiple adjacent mesenteric lymph nodes i.e. stage 3. A right hemicolectomy has been done successfully on 20th Nov . After few days biopsy of the tumour shows there was no metastases in lymph nodes as they removed 18 lymph nodes ,no microscopic perforation was seen , tumour budding low.Result was pT3N0Mx i.e. i think stage 2. Oncologist has suggested for adjuvant chemo for 3 months. I'm confused in lymph node issue and I want to know what side effects could appear during and after chemo treatment.Dr told no significant side effects will be there but I don't think so as I read in the Internet about some side effects. Any suggestion would be very helpful.

[Beckster]

Welcome!

I too had cancer of the cecum...Stage 2A. Due to 2 high risk factors (LVI and high grade), I was on Xeloda for 6 months. Xeloda is the pill form of 5/FU. It was doable..side effects included fatigue and hand/foot. It got worse as the cycles continued. I had 8 cycles. However, according to your post, your father is only doing half that amount. My side effects did not really start until I was half way through, so his side effects should be minimum. I have been off of chemo for 6 months...everything is back to normal. High risk factors determine chem....T4, High grade tumor, LVI,PNI, perforation, obstruction and less than 12 lymph nodes. If you have any other questions, please feel free to email me.

Good luck.....wishing a speedy recovery.

[Deb m]

My husband was 50 years old when he also was diagnosed with cancer in his cecum. He had 24 nodes removed all that were neg for cancer. He under went 6 months of folfox due to two high risk factors which were being a t4 and LVI. He did pretty well over all with the chemo. He was monitored very closely for two years, scans and cea every 3 months, then every 6 months and has now been cut loose being ned for coming up on 7 years now.

Thank God yours was a n early find as well. Hand in there, you'll get thru this!

deb m

[cyansagar]

Thank you @Beckster & @Deb m for replying. Congratulation you fought well and recovered
Biopsy report says my father had moderately differentiated adenocarcinoma, microscopic perforation was not identified, LVI not identified ,Perineural invasion was identified ,tumour budding low . But I am concerned whether the surgeon was able to remove the affected mesenteric lymph nodes that had been shown in MRI as they found 18 lymph nodes with no tumour in biopsy and if they were not able to remove those lymph nodes is it possible to cure the cancer with only 3 months of chemo. I was trying to find some answer from the surgeon about this lymph node issue but he refused me telling "you are not a doctor" and he said biopsy report was very good. Oncologist suggested 4 cycle of chemo for 3 months. Each cycle is for 21 days i.e at first day chemo through IV with oral tablets for 14 days and next 7 days rest.
I'm in confusion why MRI report differs from the biopsy report.

[O Stoma Mia]

...Oncologist has suggested for adjuvant chemo for 3 months. I'm confused in lymph node issue and I want to know what side effects could appear during and after chemo treatment......

If this is Stage 3 with lymph node involvement, the adjuvant chemo would probably be either FOLFOX, or XELOX. Both of these involve infusions of oxaliplatin, which causes troublesome reactions in many patients.

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44542&p=321388#p321388

If this is Stage 2 with no lymph node involvement, the adjuvant chemotherapy might only involve Xeloda monotherapy (i.e., no oxaliplatin).

Please verify the name of the chemo regimen that will be used, since that could make a difference with respect to side effects.

Also, note that chemotherapy can have both short-term and long-term side effects, and that every patient is different.

http://www.healthline.com/health/cancer/effects-on-body
.
http://www.cancer.net/survivorship/long-term-side-effects-cancer-treatment
.
.

[peanut_8]

...Oncologist has suggested for adjuvant chemo for 3 months. I'm confused in lymph node issue and I want to know what side effects could appear during and after chemo treatment......

If this is Stage 3 with lymph node involvement, the adjuvant chemo would probably be either FOLFOX, or XELOX. Both of these involve infusions of oxaliplatin, which causes troublesome reactions in many patients.

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44542&p=321388#p321388

If this is Stage 2 with no lymph node involvement, the adjuvant chemotherapy might only involve Xeloda monotherapy (i.e., no oxaliplatin).

Please verify the name of the chemo regimen that will be used, since that could make a difference with respect to side effects.

Also, note that chemotherapy can have both short-term and long-term side effects, and that every patient is different.

http://www.healthline.com/health/cancer/effects-on-body
.
http://www.cancer.net/survivorship/long-term-side-effects-cancer-treatment
.
.

I'd also think that if the tumor was staged T4, and with your father's relatively young age, that you might want a more aggressive treatment plan. One involving oxaliplatin, FOLFOX, or XELOX. (oxi + Xeloda)

Best Wishes,
peanut

[cyansagar]

...Oncologist has suggested for adjuvant chemo for 3 months. I'm confused in lymph node issue and I want to know what side effects could appear during and after chemo treatment......

If this is Stage 3 with lymph node involvement, the adjuvant chemo would probably be either FOLFOX, or XELOX. Both of these involve infusions of oxaliplatin, which causes troublesome reactions in many patients.

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44542&p=321388#p321388

If this is Stage 2 with no lymph node involvement, the adjuvant chemotherapy might only involve Xeloda monotherapy (i.e., no oxaliplatin).

Please verify the name of the chemo regimen that will be used, since that could make a difference with respect to side effects.

Also, note that chemotherapy can have both short-term and long-term side effects, and that every patient is different.

http://www.healthline.com/health/cancer/effects-on-body
.
http://www.cancer.net/survivorship/long-term-side-effects-cancer-treatment
.
.

I don't know the exact stage. It probably stage 3 or stage 2. MRI report says it was a T4N1 but later after surgery biopsy report says it was a T3 tumour with no involvement of lymph nodes pT3N0Mx. That's why I'm confused .Dr didn't tell us what chemo they would use . They only said it should be 4 cycle with each cycle contains 21 days ( first day IV infusion with tablet and from 2nd day to 14th day only tablets then 7 days rest ).

[Beckster]

...Oncologist has suggested for adjuvant chemo for 3 months. I'm confused in lymph node issue and I want to know what side effects could appear during and after chemo treatment......

If this is Stage 3 with lymph node involvement, the adjuvant chemo would probably be either FOLFOX, or XELOX. Both of these involve infusions of oxaliplatin, which causes troublesome reactions in many patients.

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44542&p=321388#p321388

If this is Stage 2 with no lymph node involvement, the adjuvant chemotherapy might only involve Xeloda monotherapy (i.e., no oxaliplatin).

Please verify the name of the chemo regimen that will be used, since that could make a difference with respect to side effects.

Also, note that chemotherapy can have both short-term and long-term side effects, and that every patient is different.

http://www.healthline.com/health/cancer/effects-on-body
.
http://www.cancer.net/survivorship/long-term-side-effects-cancer-treatment
.
.

I don't know the exact stage. It probably stage 3 or stage 2. MRI report says it was a T4N1 but later after surgery biopsy report says it was a T3 tumour with no involvement of lymph nodes pT3N0Mx. That's why I'm confused .Dr didn't tell us what chemo they would use . They only said it should be 4 cycle with each cycle contains 21 days ( first day IV infusion with tablet and from 2nd day to 14th day only tablets then 7 days rest ).

If this is indeed true, it would be considered Stage 2A. However, according to your original post, you stated that the biopsy revealed PNI. this would be the reason for chemo. It is not uncommon for pre and post biopsy's to change. My preoperative tumor was graded as moderately differential, but my surgical biopsy graded it poorly differentiated. Post surgical pathology is the most important because the specimen is visible and measurable. There are people on this forum that the MRI said no lymph nodes involved pre surgery and after surgery, they did have involved lymph nodes. Pre operative testing is just one part of the process. My surgeon told me that according to the tests, I was stage one, but he said pathology would determine if he is right. Well... pathology determined me as stage 2. Peop testing suggested T2 tumor, and pathology T3.

There is a new protocol for chemo...they are finding that 3 months of chemo is as effective as 6 months. Funny...this did not come out until my last treatment. The chemo he will be on is Xeloda...14 days on and 7 days off for 3 cycles. Dosage is based on weight... I took 3000 per day. 3 pills in the morning and 3 pills in the evening.

[Deb m]

When my husband had his pre surgery ct and pet scans, that said that three lymph nodes looked suspicious for cancer. The surgical pathology report showed differently, they were not cancer. Sometimes nodes can be enlarged and look suspicious perhaps because of infection or that they are simply enlarged because they are fighting the cancer. The pathology always trumps what they think they see on scans and MRI's. Of course I worried about these lymph nodes along with a spot they saw during surgery on his vein that couldn't be removed. In the end, it all worked out well and I bet yours will also.

Hang in there,

deb

[cyansagar]

Thank you Beckster & Deb m you have cleared my confusion that doctors could not or may be I could not make them understand what I needed to say. Anyway I think he will be given XELOX as oncologist suggested for IV infusion on the first day of each cycle and it might be Oxaliplatin. I read about its possible side effects so we need to be prepared for this and frankly yes I'm a bit scared about long term side effects of Oxaliplatin . This is an excellent forum and thanks for sharing your experiences. I'll be giving updates when the chemo begins. I hope everything will be fine. And again thank you very much