Resection Distance / Margins - what were yours?

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sandkeeper
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Location: London, UK

Resection Distance / Margins - what were yours?

Postby sandkeeper » Tue Jan 16, 2018 6:11 am

I was just going through my records before my next meeting with the oncologist, and noticed the pathology report listed a distance of 18mm between the edge of the tumour and the closest margin (probably the distal margin since my tumour was sigmoid/rectosigmoid and I had a sigmoid colectomy).

We all know that clear margins are a good thing, but doesn't 18mm seem a little close? I know in rectal cancer surgeons often work with closer margins, but those are aided by the chemoradiation which I didn't have - I'm firmly classified as a colon cancer patient.

I'd be interested to know what the margin distances of others were. I can't find too much about this and wondering if I'm overthinking this.
31 year old male, dx Oct 17
Staged IIA post sigmoid colectomy
T3b N0 M0

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susie0915
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Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Resection Distance / Margins - what were yours?

Postby susie0915 » Tue Jan 16, 2018 1:08 pm

Mine was rectal cancer 5 cm from anal verge and my closest margin was .9 cm which I think is 9 mm. Yes I had chemo/radiation. Your margin is twice the length of mine so I'm not sure.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoid/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
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change

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WriterGirl1969
Posts: 492
Joined: Sat Mar 05, 2016 3:48 pm
Location: Central NY

Re: Resection Distance / Margins - what were yours?

Postby WriterGirl1969 » Tue Jan 16, 2018 10:36 pm

sandkeeper wrote:I was just going through my records before my next meeting with the oncologist, and noticed the pathology report listed a distance of 18mm between the edge of the tumour and the closest margin (probably the distal margin since my tumour was sigmoid/rectosigmoid and I had a sigmoid colectomy).

We all know that clear margins are a good thing, but doesn't 18mm seem a little close? I know in rectal cancer surgeons often work with closer margins, but those are aided by the chemoradiation which I didn't have - I'm firmly classified as a colon cancer patient.

I'd be interested to know what the margin distances of others were. I can't find too much about this and wondering if I'm overthinking this.


I had to go back to my pathology report for this one, but here's what I'm reading...
"...mass is located 4.5 cm from the nearer resection margin and 6.0 cm from the farther resection margin." It goes on to say that "...fragments of mucosa and serosa measuring 1.5 and 4.5 cm each displayed embedded sutures and sections are labeled as 'A1. Margin closer to mass en face; A2. Margin farther from mass en face; A3. Mesenteric margin closest to mass en face."
Not sure what that last part means. I'm assuming it's measurements of the end pieces of the resection.

With regard to what constitutes "clear margins," Breastcancer.org had this to say:
"In some hospitals, doctors want 2 millimeters (mm) or more of normal tissue between the edge of the cancer and the outer edge of the removed tissue. In other hospitals, though, doctors consider a 1-mm rim of healthy tissue — and sometimes even smaller than that — to be a clear margin. As you talk with your doctor about whether your margins were clear, positive, or close, you also can ask how “clear” is defined by your medical team."

I saw these measurements echoed in an article about prostate cancer as well. Another article noted that a more aggressive type cancer might indicate the desire for up to 6mm for clear margins, but this seemed to be unsubstantiated or at least unconfirmed as of the time the article was written, which was 2017.

So I'd say your 18mm measurement would be a great follow-up question for your surgeon. 18mm is 1.8 cm (Susie had the right conversion math). That might not seem big, but if you measure out it's about .7 of an inch. When dealing with microscopic things like cells that's probably better than it sounds. Again, all good stuff to ask, but try not to let it stress you out.

Hope this helps!
Tracy
DX 3/4/2016 Colon Cancer; age 46 Mom of 4-yr-old
Stage IIIB: T3N1M0
3/31/16 Left Hemi
4 to 10/2016: Xeloda Monotherapy
CEA: 10/16 0.56, 1/17 0.54
3/6/17 CT clear; 4/17/18 CT clear;
NED 2 years
“If I can help somebody as I walk along, then my living shall not be in vain.”

sandkeeper
Posts: 6
Joined: Tue Dec 19, 2017 4:58 am
Location: London, UK

Re: Resection Distance / Margins - what were yours?

Postby sandkeeper » Thu Jan 18, 2018 12:48 pm

WriterGirl1969 wrote:
sandkeeper wrote:I was just going through my records before my next meeting with the oncologist, and noticed the pathology report listed a distance of 18mm between the edge of the tumour and the closest margin (probably the distal margin since my tumour was sigmoid/rectosigmoid and I had a sigmoid colectomy).

We all know that clear margins are a good thing, but doesn't 18mm seem a little close? I know in rectal cancer surgeons often work with closer margins, but those are aided by the chemoradiation which I didn't have - I'm firmly classified as a colon cancer patient.

I'd be interested to know what the margin distances of others were. I can't find too much about this and wondering if I'm overthinking this.


So I'd say your 18mm measurement would be a great follow-up question for your surgeon. 18mm is 1.8 cm (Susie had the right conversion math). That might not seem big, but if you measure out it's about .7 of an inch. When dealing with microscopic things like cells that's probably better than it sounds. Again, all good stuff to ask, but try not to let it stress you out.

Hope this helps!
Tracy


Thanks for the response. I won't get chance to meet with my surgeon anytime soon, but I did ask my oncologist. He said he's not worried about it given that the margins themselves are negative, and - similar to you - gave a breast cancer analogy comparing the margins of a lumpectomy vs mastectomy and the negligible difference in outcome (I know nothing about breast cancer so it might be totally different). I did do some Googling (bad idea) on colon cancer margins and came up with conflicting evidence about 5cm being best, but I think it really depends. Perhaps those numbers are just guidance for surgeons to ensure their chances of getting a clear margin and the resulting distance is less important.

I'm going to try and stop worrying about this... I just have occasional mental images of cancerous lymph nodes hiding more than 18mm from the tumour that didn't get removed.

I swear I used to be a rational thinker before cancer arrived...
31 year old male, dx Oct 17
Staged IIA post sigmoid colectomy
T3b N0 M0

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WriterGirl1969
Posts: 492
Joined: Sat Mar 05, 2016 3:48 pm
Location: Central NY

Re: Resection Distance / Margins - what were yours?

Postby WriterGirl1969 » Fri Jan 19, 2018 10:37 pm

sandkeeper wrote:I'm going to try and stop worrying about this... I just have occasional mental images of cancerous lymph nodes hiding more than 18mm from the tumour that didn't get removed.

I swear I used to be a rational thinker before cancer arrived...


Hah - didn't we all used to be?!? :)

I totally understand. It's hard not to let your thoughts get away from you sometimes - for all of us. I didn't read anything about 5cm, but that's when you can rely on your medical team having your best interests at heart. I think you mentioned you are not having chemo, is that correct? I seem to recall seeing some studies about whether or not adjuvent chemo was as effective for Stage II patients, etc. It's your oncologist's job to weigh everything together (the margins, your pathology, your overall situation) and give you the best options.

You can always get a second opinion if you're really questioning the validity of the assessment. The bottom line is to be comfortable with your plan. There's no point in looking back and saying, "If only I'd done this or that." Nothing is for sure, especially with stupid cancer. But there's also something to be said for peace of mind, and the benefits of having a calm, positive outlook too. Try to find a lane that works for you, and don't apologize to anyone for riding in it. :)

Hugs from me,
Tracy
DX 3/4/2016 Colon Cancer; age 46 Mom of 4-yr-old
Stage IIIB: T3N1M0
3/31/16 Left Hemi
4 to 10/2016: Xeloda Monotherapy
CEA: 10/16 0.56, 1/17 0.54
3/6/17 CT clear; 4/17/18 CT clear;
NED 2 years
“If I can help somebody as I walk along, then my living shall not be in vain.”

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Stomatrooper
Posts: 488
Joined: Fri Dec 31, 2010 11:56 pm
Location: Auckland New Zealand

Re: Resection Distance / Margins - what were yours?

Postby Stomatrooper » Tue Jan 23, 2018 2:16 am

Mine was "Less than 1 mm", to quote my surgeon..............My results were late to my surgeon because the lab was going over and over trying to establish if anything was positive on the fringe, there was discussions of further chemo etc though nothing further was done.............this following sphincter sparing surgery (ULAR) and I had lost half of my sphincter.............caused a bit of concern over 7 years ago, no associated effects since (fingers crossed) - enjoying a full and active life...............BTW, don't visit here often these days and only logged in by chance after re-setting my bookmarks bringing this old one up - good luck.
John, Diag. 20 5 2010 @55
Rectal, 2cm dia, 3cm from anal verge
T2N0M0
5.5 Wk Chemorad
ULAR Oct 2010
Temp Ileo, infection; blockage; incisional hernia
Takedown Jan 2011
Hernia fix - June 2011
Clean CT 2011; 2012 & 2015
Clean scope May 2013


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