Rectal cancer diagnose with isolated tumor cells (ITC)

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KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Sat Jan 20, 2018 6:06 pm

Hi All,
I was diagnosed with Stage 1 after surgery
But I have an issue with a lymph node (N0) that had ITC when removed after surgery
I went to an oncologist/radiatologist at one university. They are totally leaving the treatment up to me. They said there is not much on this and the university would treat it as standard treatment for Stage 3. Rad/chemo
But also said, if I wanted to be watched and tested every three months with no treatment that would be ok too.
Has anyone had ITC and if so, what treatment did you have if any
I have a second opinion on Wednesday and a third at John Hopkins in Baltimore. That appointment is the first week of February.

Thanks,
KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

Lee
Posts: 5505
Joined: Sun Apr 16, 2006 4:09 pm

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby Lee » Sun Jan 21, 2018 5:08 pm

If I understand you, there was some cancer cells in one of the lymph nodes removed?

I was stage III, I had no choice, had radiation, surgery then chemo.

I don't have a lot to offer, getting 2nd opinions at major cancer hospitals or treatment centers may be a good idea. Generally they don't do chemo with stage I unless there are other factors/risks involved.

What type of surgeon did your surgery, a general surgeon or a "board certified" colon rectal surgeon.

Good luck with upcoming opinions,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Sun Jan 21, 2018 5:31 pm

The way they explain this is, the isolated tumor cell is less than 0.1mm in a lymph node.
I had my samples done by another pathology. They said it was one cell. (2 reports done)
I’m really confused. They said some over treat ITC. But then what is under treat??
My surgeon was a board certified colon rectal surgeon
They also consider this a N0 not a N1
I’m having my second opinion this week and a third at John Hopkins
I don’t think there’s much research on this.
Thanks Lee

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

Lee
Posts: 5505
Joined: Sun Apr 16, 2006 4:09 pm

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby Lee » Sun Jan 21, 2018 5:55 pm

KathyLynn wrote: . . . I’m really confused. They said some over treat ITC. But then what is under treat??
KathyLynn


Thank you, now I understand. Stage I and stage II can really be such a grey area. Sometimes I think it comes down to what the patient feel most comfortable with. My understanding of under treat is to do nothing. A watch and see approach is a valid approach. Sometimes I believe some people have taken the oral pill of 5FU just to be on the safe side. See what the other opinions say.

Good luck,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Sun Jan 21, 2018 5:59 pm

Thanks Lee
I’m hoping for just chemo
My surgeon does not want me to have radiation
I’ll be in touch

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

Lee
Posts: 5505
Joined: Sun Apr 16, 2006 4:09 pm

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby Lee » Sun Jan 21, 2018 6:08 pm

KathyLynn wrote:My surgeon does not want me to have radiation
I’ll be in touch
KathyLynn


I agree about the radiation. Generally it is done prior to surgery. Since your surgeon was a board certified, I know you were in good hands.

Let us know how it goes,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

User avatar
O Stoma Mia
Posts: 1202
Joined: Sat Jun 22, 2013 6:29 am
Location: Budapest

Research studies on colorectal ITCs (isolated tumor cells)

Postby O Stoma Mia » Sun Jan 21, 2018 11:51 pm

KathyLynn wrote:... I don’t think there’s much research on this...

There's not much research on this in the U.S,. but there are some studies on colorectal ITCs done overseas. Here are two examples from Europe. The first study is from Italy, and the second one is from Switzerland.

Isolated Tumor Cells in Regional Lymph Nodes as Relapse Predictors in Stage I and II Colorectal Cancer
http://ascopubs.org/doi/full/10.1200/jco.2011.35.9539
Conclusion
In patients with pN0 CRC, cancer relapse was significantly associated with ITCs in regional LNs. ITCs should be considered among the clinicobiologic variables that identify high-risk patients who can benefit from adjuvant chemotherapy.


Isolated tumor cells in stage I & II colon cancer patients are associated with significantly worse disease-free and overall survival
https://bmccancer.biomedcentral.com/articles/10.1186/s12885-016-2130-7
Conclusions
This study provides compelling evidence that ITC in stage I & II colon cancer patients are associated with significantly worse disease-free and overall survival. Based on these data, the presence of ITC should be classified as a high risk factor in stage I & II colon cancer patients who might benefit from adjuvant chemotherapy.

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Mon Jan 22, 2018 12:03 pm

Wow, this is a lot to take in
I wonder if the treatment after surgery is as successful as before the surgery?
Just the not knowing is driving me crazy
Should I go for chemo/Rad? What does radiation do after surgery? Is it that bad? Or is it the Chemo that’s bad after surgery?

Seems like I went from Stage 1 to Stage 3

Thanks again,
KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

User avatar
O Stoma Mia
Posts: 1202
Joined: Sat Jun 22, 2013 6:29 am
Location: Budapest

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby O Stoma Mia » Mon Jan 22, 2018 2:32 pm

KathyLynn wrote:...Should I go for chemo/Rad? What does radiation do after surgery? Is it that bad? ...

According to the NCCN Guidelines for Rectal Cancer, if radiation is used, it is to be aimed at the pelvic cavity according to the following specifications:
Radiation therapy fields should include the tumor or tumor bed, with a 2–5 cm margin, the presacral nodes, and the internal iliac nodes...

In your case, the tumor bed would be where your anastomosis junction is now located and it would include the part of the sigmoid colon that was brought down to the rectal stump to form your neo-rectum. The new neo-rectum would have its own set of lymph nodes which were originally located in the sigmoid colon area but have now been moved down into the pelvic cavity. So, these lymph nodes as well as the presacral and iliac lymph node areas would all be irradiated. If there were any ITCs in these lymph node areas, they would likely all be destroyed.

The radiation would have to be accompanied by low dose 5FU-equivalent chemo, and this regimen would be followed for about 5 weeks. In contrast to the radiation segment, the low-dose chemo would circulate throughout the entire body.

Then after these 5 weeks of chemo/rad are finished they may want to continue with about 4 months of regular full-dose chemo to make up the 6 months total of adjuvant therapy recommended for all Stage III cases.

You would have to verify the details of all of this with your oncologists. (This is only a suggestion of what might be in store for you. If you indeed decide to opt for adjuvant therapy, then the doctors will likely follow whatever the standard is in your hospital.)

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Mon Jan 22, 2018 3:30 pm

Thanks again, I really appreciate your work on this
I need to stay off google, it takes me everywhere
This keeps my head in the right direction
I’ll bring this up at my next appointment on Wednesday
Why do you think they still say I’m NED?
Does that make sense?

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Mon Jan 22, 2018 3:47 pm

Also, I did check the thread with the girl stating she had ITC. I saw she did no treatment. But she hasn’t been on for awhile. I did send her a message, but haven’t heard back. I wish there was a test for this.

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

Lee
Posts: 5505
Joined: Sun Apr 16, 2006 4:09 pm

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby Lee » Mon Jan 22, 2018 4:12 pm

I'm glad your getting 2nd opinions.

I am not an MD, butt based on the info O Stoma Mia provided, you might want to consider chemo. Radiation is usually done prior to surgery, chemo following surgery as a mop up. I believe based on the info O Stoma Mia provided, you might be a higher risk than most Stage I.

Butt see what the other opinions say,

Good luck,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

User avatar
O Stoma Mia
Posts: 1202
Joined: Sat Jun 22, 2013 6:29 am
Location: Budapest

Re: Circulating Tumor Cell test

Postby O Stoma Mia » Mon Jan 22, 2018 11:14 pm

KathyLynn wrote:... I wish there was a test for this...

There is a test for Circulating Tumor Cells (CTCs) that has been validated for colorectal cancer cells. This test is called CELLSEARCH:
https://www.cellsearchctc.com/about-cellsearch/what-is-cellsearch-ctc-test

.There are specialized labs around the country that can do this kind of test, e.g.

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby KathyLynn » Tue Jan 23, 2018 10:07 am

I’ll check into this, I’m heading to Baltimore tomorrow
They have offices there
My doctor will be on GBMC’s FB Page Live tomorrow at 10:00, just an FYI Dr. DiRocco.
Greater Baltimore Medical Center

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

User avatar
O Stoma Mia
Posts: 1202
Joined: Sat Jun 22, 2013 6:29 am
Location: Budapest

Re: Rectal cancer diagnose with isolated tumor cells (ITC)

Postby O Stoma Mia » Tue Jan 23, 2018 10:33 am

KathyLynn wrote:...My doctor will be on GBMC’s FB Page Live tomorrow at 10:00, just an FYI Dr. DiRocco.
Greater Baltimore Medical Center
KathyLynn

Thanks for letting us know about the event:

Current treatment advancements for colorectal cancer

    Dr. Joseph DiRocco

January 24, 2018 10:00am EST

https://fr-fr.facebook.com/events/2024395587845245/


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