The Colon Club

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

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

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

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

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

KathyLynn

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

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.

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

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.)

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

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

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

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.

Quest Diagnostics
(east of the Mississippi River)
http://www.questdiagnostics.com
CELLSEARCH®
CTC TEST 16011

mBC, 16812
mPC,16811
mCRC

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

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/