Neo-Adjuvant Chemo Stage 1 Rectal Cancer?

[kal74]

I’m 43 and was dx with a very low rectal tumor in July 2017, staging before treatment was Stage 1 T2 N0 M0 after meeting with 3 surgeons I decided to do 6 week of Xeloda and Radiation to shrink the tumor to get clear margins and avoid a permanent bag. My tumor shrunk by approx 50% and I’m now 4 weeks out of a successful LAR resection and currently have a stoma for 12 weeks. They removed 35 lymph nodes and all were clear and they said the tumor was a T2 from MRI prior to surgery and after they removed the tumor on the pathology report.
I’m meeting with my on oncologist next week to discuss possible additional chemo, my surgeon is recommending it along with the oncologist to be aggressive since I’m young but I’m feeling like if I’m actually a Stage 1 is additional chemo worth it. I feel like I’d be ok with doing the Xeloda again since I know what to expect and tolerated it well but I’m really scared of getting a port. Has anyone else been faced with a similar decision?

[Rikimaroo]

My doctor told me if there is no disease in the specimen they remove with LAR, then there should be no need for additional chemo. this is called pCR (pathological complete response). Your situation seems to fit this scenario. Sometimes folks do Mop-up chemo just to be safe, but I am not sure, its on an individual basis. I would hit it with all you got if you can handle it, but its rough, Chemo is rough....

This was when I was first diagnosed like you but I didn't do surgery so I am in a little worse of a position, but still curable.

[CRguy]

I feel like I’d be ok with doing the Xeloda again since I know what to expect and tolerated it well but I’m really scared of getting a port. Has anyone else been faced with a similar decision?

pCR is great ... BUTT if you have low rectal and ANY other risk factors / concerns etc. OR they actually stage you differently after resection.....
you could just do the Xeloda as adjuvant chemo ( will be a higher dosage ) ... just IMO

BUTT if both docs recc'd it then I would be inclined to listen to them and maybe have a question about it IF you really are Stage 1
Maybe they have other concerns. ASK the tough questions and DEMAND full answers so you are comfortable with all decisions.

Please feel free to read my signature link for more specifics......
( pCR after neoadjuvant chemorad, adjuvant chemo, 6 month temp ileo ..... lung met resected 2-3 years later with full FOLFOX chemo )

Best wishes
CRguy

[Tdubz]

I wouldn’t be scared of the port. Of course with any surgery there are risks, but getting the port put in was the easiest part of my cancer journey. I was really nervous about getting it too, but I’m glad I got it. Doing labs, chemo, and even ct scans are so easy with a port. I didn’t have any pain after the surgery. The worst part is getting used to the bump on your chest.

[rockhound]

I’m 43 and was dx with a very low rectal tumor in July 2017, staging before treatment was Stage 1 T2 N0 M0 after meeting with 3 surgeons I decided to do 6 week of Xeloda and Radiation to shrink the tumor to get clear margins and avoid a permanent bag. My tumor shrunk by approx 50% and I’m now 4 weeks out of a successful LAR resection and currently have a stoma for 12 weeks. They removed 35 lymph nodes and all were clear and they said the tumor was a T2 from MRI prior to surgery and after they removed the tumor on the pathology report.
I’m meeting with my on oncologist next week to discuss possible additional chemo, my surgeon is recommending it along with the oncologist to be aggressive since I’m young but I’m feeling like if I’m actually a Stage 1 is additional chemo worth it. I feel like I’d be ok with doing the Xeloda again since I know what to expect and tolerated it well but I’m really scared of getting a port. Has anyone else been faced with a similar decision?

I was in a similar situation- decided to go ahead and do FOLFOX chemo and if I started having major side effects, then just stop it cold. Initially the plan was 8 cycles, but my NCI center oncologist overseeing everything (and local onc who oversaw the chemo) both thought 6 would be fine after the ASCO meeting this summer- that was about two weeks before I started. I've got Lynch syndrome, so the 5FU does not really do anything alone and the idea with the chemo was that oxaliplatin might help and was worth doing just to be aggressive given my age. My oncologist talked to other folks at the ASCO meeting about my case who were more familiar with Lynch and they all agreed with doing the chemo.

I may have been over-treated, have minor neuropathy in my finger tips and feet (chemo ended in late August), but I'm allright with my decision. I would not have minded having more lymph nodes removed, but that's allright too and trust my surgeon. My oncologist and surgeon both made the case that even though my pre-treatment MRI showed no lymph node involvement, the radiation would have nuked everything that may have been involved, so to error on safe side, it would be best to just go ahead with the adjuvant chemo. I was staged a bit higher before treatment (MRI report states T2, surgeon and onc told me T3) also and my tumor did shrink a ton via radiation, but it was not completely wiped away.

The port was fine- I had mine installed and then started chemo next morning. It was sore for a few weeks, then I got used to it.. Got it removed when I had my ileostomy takedown in september. Good luck on your decision- it is not easy!

[susie0915]

I was able to do chemo without a port. I had six infusions of oxi 3 weeks apart. I was scheduled to get a port, but had a bowel blockage a week before and ended up in the hospital for 3 1/2 weeks. Had to have surgery to remove scar tissue and surgeon reversed ileo. Made it tougher for chemo as I had diarrhea. Being in the hospital so long and I did have a picc line while in there I just was not in a place to undergo another procedure. My oncologist checked my veins and said I could try without a port, as I could always get one if necessary. It went pretty well, there were a couple time when the nurse had to try more than once to get IV in. Otherwise, no problem, we switched sides each time and had no issues having blood drawn each week. I know the port makes it much easier to administer chemo, and I would've done if infusions were closer together or more than 6. My veins were sore towards the end. Have to stay hydrated, it helps to insert IV. I think most opt for the port though.

[KathyLynn]

I’m also meeting with my oncologist next week
After my surgery the Path report came back as T2N0, but there was one lymph node with isolated tumor cells (ITC) which Sometimes can be overlooked . They don’t even consider it N1. But I’ve been reading and there is a chance that this could be a reason for recurrence in Stage 1 rectal cancer. I’ll know more on Friday when I meet with my oncologist, but I’m sure I’ll have chemo. Maybe you could bring this up at your appointment. Please let me know what you decide to do. I will also ask about the % with and without treatment.

KathyLynn

[NHMike]

I'm in cycle 1 of Adjuvant with Xeloda and Oxaliplatin and I had a port put in. It was minor surgery with a few annoyances for about a week. I figured that it would be easier on my veins than going through my arms. I have problems with IVs and blood draws on my right arm though the left is pretty good. It's a piece of cake compared to the LAR and I was awake, though sleepy for the procedure. I document the procedure in my long blog thread.