Colon rectal cancer found during routine colonoscopy

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DarknessEmbraced
Posts: 3182
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Colon rectal cancer found during routine colonoscopy

Postby DarknessEmbraced » Mon Apr 09, 2018 7:40 am

I'm so sorry you're going through this and hope you get more answers soon! Welcome to the forum and hope your appointment goes well!*hugs*
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17

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O Stoma Mia
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Re: Colon rectal cancer found during routine colonoscopy

Postby O Stoma Mia » Mon Apr 09, 2018 7:45 am

Lotus wrote:You can’t go back and do radiation after surgery? And surgery can make cancer spread?

  • You can do radiation after surgery. That's what I did.
    .
  • Surgery can indeed make cancer spread. This is why it is so important to have a Board Certified colorectal surgeon doing the surgery, because he/she will have been trained on how to handle malignant tissue so that it doesn't cause any spread to occur. If you want to try to minimize surgery-induced spread during and after surgery, then there are some additional things that you can do that might minimize the problem, for example, taking Tagamet (Cimetidine) during this time. See posts by rp1954 on Cimetidine and other "peri-operative" measures to take.
    Examine new, alternative, or supplementary therapies early on, before they start you automatically on the 'accepted standard of care'. For example, the post by rp1954 in another thread, and the post by voxx66 in this thread, fall in this category -- There are some potentially very useful and not-too-expensive treatments like Cimetidine that could have a dramatic effect if taken before initial surgery, but which are not so useful if applied long after surgery has occurred. This also applies to type of surgery to remove the primary tumor....

mozart13
Posts: 140
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Colon rectal cancer found during routine colonoscopy

Postby mozart13 » Mon Apr 09, 2018 7:56 am

Morning Lotus, first good luck to you today!
Yes I didn't have surgery, had so call "complete clinical response". About 25% of people after chemo/rad have complete clinical response. Out of 25%, 18% will never need surgery, remaining 8% will need surgery.
There is more to it on this forum:
viewtopic.php?t=53498

Surgeons like to shrink cancer first with radiation, as it is easier to obtain clear edges, my surgeon told me that they like to get it out in one piece without pocking wholes.
Some studies suggest if cancer cells are cut through, there is chance of spreading.
Radiation after surgery is not practical, it would interfere with healing procces, there are probably people that had it after surgery.

All the best!
55 year at the time of diagnosis, male
Diagnosed with T1,T2 N0 M0 rectal cancer
Total neoadjuvant therapy or TNT (chemoradiation followed by systemic chemotherapy)
Negative since Feb. '17
No surgery
Watch&Wait approach 8)
I don’t come much to forum , so if this is not updated it means I remain negative!
Wish good luck to all!

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O Stoma Mia
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Re: Colon rectal cancer found during routine colonoscopy

Postby O Stoma Mia » Mon Apr 09, 2018 8:09 am

Lotus wrote:4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge

There's something in your signature that seems a bit puzzling. You say that the MRI report shows " left lateral wall thickening of the rectosigmoid junction" -- but does your MRI report give an interpretation of this finding? What does this finding actually mean?

In my opinion (a layman's opinion) this looks to me like evidence of collateral damage done to the colon by the " hot polypectomy" procedure that the gastroenterologist did on the polyp a week or so earlier. He used a hot snare to remove the polyp in 3 different fragments, and for each of these fragments a hot cauterization was done at the base of the polyp, thus producing three different sections of scar tissue. It looks to me like the MRI is picking up this scar tissue as " lateral wall thickening" -- but I could very well be wrong. It seems to me that the wall thickening is not due at all to cancer but probably came about during the procedure to remove the polyp in a piecemeal fashion.

There is also the issue of the India ink tattoo that was placed near there. This kind of tattoo is know to cause deterioration of the surrounding mucous tissue and may cause such tissue to be fused with the colon wall.

So, what I would like to know is what was said in the INTERPRETATION section of the MRI report to explain this " lateral wall thickening" finding?

Does the report give any explanation for this?

And what do you think the EUS procedure will find in that area, when they eventually get around to doing it?

Lotus
Posts: 46
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Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Mon Apr 09, 2018 9:19 am

O Stoma Mia wrote:
Lotus wrote:...Can I not assume that the surgeon will refer me to less invasive treatment if that is in fact what can fix my issue? ...



You are fortunate to have received some good feedback from Utwo, who has had prior experience dealing with a large difficult, malignant polyp. What you might try to do in your case is to get a second opinion on removing the remnants of your polyp by less-invasive endoscopic mucosal resection (EMR) instead of by surgery.. As the webpage cited below explains, you would probably have to make direct contact with a highly experienced EMR doctor yourself because your surgeon, for whatever reasons, is unlikely to suggest this possibility. (The webpage in the link below gives some reasons why surgeons don't automatically refer these kinds of cases to EMR experts.)
...the most important next step is probably to contact an experienced EMR doctor for a second opinion about your condition. Be aware that if you ask a mainstream gastroenterologist or a surgeon about EMR you are likely to get discouraging answers. You need to communicate directly with EMR experts if you want to know what they can do for you."
Reference: http://www.sease.com/polyp/emr.html
.

I realize that this doesn't solve the immediate problem of how to handle your meeting with the surgeon tomorrow. More than likely the surgeon will tell you that there is no other option right now except for surgery, as this has somehow become the 'standard of care' for dealing with large, flat malignant polyps.

But if you look at Utwo's signature, you will see that he did in fact start off by removing the large, adenocarcinoma polyp by EMR, (therapeutic endoscopy). But only later did he end up having surgery (ultimately as a preventive measure). So, this might be a strategy that you could propose : First, try EMR to remove whatever was left of the polyp after the gastroenterologist's "hot polypectomy". This might be possible if advanced EUS imaging shows that the polyp residual fragments have not gone too far into the colon wall already. Then you could propose to consider an actual surgery (probably a LAR) later on if it turns out that the EMR procedure was not able to remove all of the residual.

Thus, this would be essentially a two-step proposal: EMR now, and maybe surgery later if really necessary. It looks like this is how Utwo approached the issue, but he would be the one to elaborate on this, since I don't have any direct experience with polyp removal.


O stoma mia
I read about EMR....is that procedure typically done for malignant polyps? Or just benign?
female age 71
3/21/18 Routine colonoscopy. Dx "rectal mass" colonic adenocarcinoma
3/22/18 Ct scan no distant metastatic disease
4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge. Overall lesion 3.5 cm. No progressive adjacent adenopathy.
Depth T2 no evidence for lymph node spread.
Stage 1 t2n0
3/22/18 CEA 0.8 range 0.0-3.0
10/24/18CEA 0.9
4/16/18 Robotic Assisted LAR
Pathology negative for malignancy

Lotus
Posts: 46
Joined: Thu Mar 29, 2018 10:03 pm

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Mon Apr 09, 2018 9:23 am

O Stoma Mia wrote:
Lotus wrote:4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge

There's something in your signature that seems a bit puzzling. You say that the MRI report shows " left lateral wall thickening of the rectosigmoid junction" -- but does your MRI report give an interpretation of this finding? What does this finding actually mean?

In my opinion (a layman's opinion) this looks to me like evidence of collateral damage done to the colon by the " hot polypectomy" procedure that the gastroenterologist did on the polyp a week or so earlier. He used a hot snare to remove the polyp in 3 different fragments, and for each of these fragments a hot cauterization was done at the base of the polyp, thus producing three different sections of scar tissue. It looks to me like the MRI is picking up this scar tissue as " lateral wall thickening" -- but I could very well be wrong. It seems to me that the wall thickening is not due at all to cancer but probably came about during the procedure to remove the polyp in a piecemeal fashion.

There is also the issue of the India ink tattoo that was placed near there. This kind of tattoo is know to cause deterioration of the surrounding mucous tissue and may cause such tissue to be fused with the colon wall.

So, what I would like to know is what was said in the INTERPRETATION section of the MRI report to explain this " lateral wall thickening" finding?

Does the report give any explanation for this?

And what do you think the EUS procedure will find in that area, when they eventually get around to doing it?

I will look at the mri report. Eus is scheduled for April 25. They told me it will tell EXACT location and depth of mass
More so than MRI could. The more I think about this, the more I feel it important to go somewhere else for treatment
Esp after reading what you wrote above. I hope he hasn’t damaged my colon
I will bring this u to the surgeon today
female age 71
3/21/18 Routine colonoscopy. Dx "rectal mass" colonic adenocarcinoma
3/22/18 Ct scan no distant metastatic disease
4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge. Overall lesion 3.5 cm. No progressive adjacent adenopathy.
Depth T2 no evidence for lymph node spread.
Stage 1 t2n0
3/22/18 CEA 0.8 range 0.0-3.0
10/24/18CEA 0.9
4/16/18 Robotic Assisted LAR
Pathology negative for malignancy

Lotus
Posts: 46
Joined: Thu Mar 29, 2018 10:03 pm

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Mon Apr 09, 2018 9:40 am

O stoma mia
MRI report states
Indication
New diagnosis rectal carcinoma
Comparison.
CT chest abdomen and pelvis 3.22.2018

Technique. Multiplayer, multisequence MR imaging was performed of the pelvis prior to and following gadolinium contrast. 10 mL of Multihance contract material was administrated intravenously for the examination. This study was acquired following the IV administration of contrast material, given the patients indications for the exam. If IV contrast material had not been administered, the likely of detecting abnormalities relevant to the patients condition would have been substantially decreased.

Findings
Left lateral wall thickening of the rectosigmoid junction originating approximately 13 cm from the anal verge. No progressive adjacent adenopathy. Overall lesion measures 3.5 cm in length. No fluid in the pelvis. Bladder decompressed. Uterus age appropriate. Motion limits full assessment of transferal extension of the lesion. This is felt to represent at least T2 lesion. No acute or aggressive osseous lesions.
Impression
1. Region of suspected rectosigmoid lesion as outlined above. No adenopathy. Please note that motion limits the study.
That concludes report

My words: When I asked oncologist about at least T2 lesion....he said the technician exaggerates these and that he is reasonably confident that it is not more than T2
female age 71
3/21/18 Routine colonoscopy. Dx "rectal mass" colonic adenocarcinoma
3/22/18 Ct scan no distant metastatic disease
4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge. Overall lesion 3.5 cm. No progressive adjacent adenopathy.
Depth T2 no evidence for lymph node spread.
Stage 1 t2n0
3/22/18 CEA 0.8 range 0.0-3.0
10/24/18CEA 0.9
4/16/18 Robotic Assisted LAR
Pathology negative for malignancy

Lotus
Posts: 46
Joined: Thu Mar 29, 2018 10:03 pm

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Mon Apr 09, 2018 9:49 am

Thanks to all of you for wishing me well today. Really appreciate it. I'm getting ready to go now. Im feeling a little better but no where near my normal well. And this is the last day for antibiotic. Maybe I need a stronger one, I'm not sure. Also feeling like I need to go on an ssri medicine for anxiety. it has been through the roof.
female age 71
3/21/18 Routine colonoscopy. Dx "rectal mass" colonic adenocarcinoma
3/22/18 Ct scan no distant metastatic disease
4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge. Overall lesion 3.5 cm. No progressive adjacent adenopathy.
Depth T2 no evidence for lymph node spread.
Stage 1 t2n0
3/22/18 CEA 0.8 range 0.0-3.0
10/24/18CEA 0.9
4/16/18 Robotic Assisted LAR
Pathology negative for malignancy

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O Stoma Mia
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Joined: Sat Jun 22, 2013 6:29 am

Re: Colon rectal cancer found during routine colonoscopy

Postby O Stoma Mia » Mon Apr 09, 2018 11:25 am

Lotus wrote:O stoma mia
I read about EMR....is that procedure typically done for malignant polyps? Or just benign?

I think EMR is mainly for large benign polyps. I think that the procedure is a two step process when dealing with large polyps. First step is to do a biopsy of the top of the polyp to see if it is malignant.Second step is to do EMR sraight-away if the polyp biopsy turns out to be benign but to refer the removal task to a surgeon for major surgery if the polyp biopsy turns out to be malignant. That's just my opinion. I suppose there are exceptions.

If a large polyp is benign, then it doesn't matter so much if the polyp is removed in a series of fragments, since any cells or tissue that happen to be missed or left behind would likely be benign and probably not cause a problem. For large malignant polyps, on the other hand, removal by a series of fragments poses a problem since cancer cells or malignant tissue may be dropped or may escape during the removal process and might lead to a later incident of "local recurrence."

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O Stoma Mia
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Re: Colon rectal cancer found during routine colonoscopy

Postby O Stoma Mia » Tue Apr 10, 2018 2:56 am

How did your appointment go yesterday with the surgeon?

Lotus
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Joined: Thu Mar 29, 2018 10:03 pm

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Wed Apr 11, 2018 3:14 am

Sorry for long delay. Met with surgeon. He explained in detail what he recommends and won my confidence. He has excellent reputation. He will perform robotic LAR Monday April 16. He will remove part rectum part colon. He said it is very high up and even tho it’s being referred to as rectal cancer, it more resembles colon cancer. He thinks it is very early stage ....will know for sure after. I’ll update after surgery. Thanks for all your support I’m praying for everyone who is walking this path with me. Now it’s time to fight.
female age 71
3/21/18 Routine colonoscopy. Dx "rectal mass" colonic adenocarcinoma
3/22/18 Ct scan no distant metastatic disease
4/1/18 MRI shows left lateral wall thickening of the rectosigmoid junction originating app 13 cm. from the anal verge. Overall lesion 3.5 cm. No progressive adjacent adenopathy.
Depth T2 no evidence for lymph node spread.
Stage 1 t2n0
3/22/18 CEA 0.8 range 0.0-3.0
10/24/18CEA 0.9
4/16/18 Robotic Assisted LAR
Pathology negative for malignancy

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O Stoma Mia
Posts: 1450
Joined: Sat Jun 22, 2013 6:29 am

Re: Colon rectal cancer found during routine colonoscopy

Postby O Stoma Mia » Wed Apr 11, 2018 3:16 am

Lotus wrote:Sorry for long delay. Met with surgeon. He explained in detail what he recommends and won my confidence. He has excellent reputation. He will perform robotic LAR Monday April 16. He will remove part rectum part colon. He said it is very high up and even tho it’s being referred to as rectal cancer, it more resembles colon cancer. He thinks it is very early stage ....will know for sure after. I’ll update after surgery. Thanks for all your support I’m praying for everyone who is walking this path with me. Now it’s time to fight.

Thanks for the update. Did the surgeon say anything about the possible need for a temporary ileostomy after the surgery?

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O Stoma Mia
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Hospital Packing Lists

Postby O Stoma Mia » Wed Apr 11, 2018 4:30 am

Lotus wrote:... Met with surgeon.... He will perform robotic LAR Monday April 16...


NHMike
Posts: 1838
Joined: Fri Jul 21, 2017 3:43 am

Re: Colon rectal cancer found during routine colonoscopy

Postby NHMike » Wed Apr 11, 2018 5:43 am

The hospital should have literature on planning the logistics for your surgery and hospital stay and they should have a pre-surgical visit about a week before for tests and education. It's good to plan out as much as you can to avoid various minor problems.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal

justin case
Posts: 4225
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Colon rectal cancer found during routine colonoscopy

Postby justin case » Sun Apr 15, 2018 11:08 am

Lotus wrote:Sorry for long delay. Met with surgeon. He explained in detail what he recommends and won my confidence. He has excellent reputation. He will perform robotic LAR Monday April 16. He will remove part rectum part colon. He said it is very high up and even tho it’s being referred to as rectal cancer, it more resembles colon cancer. He thinks it is very early stage ....will know for sure after. I’ll update after surgery. Thanks for all your support I’m praying for everyone who is walking this path with me. Now it’s time to fight.

I had a large tumor in the sigmoid, and one very low in the rectum. After treatment, radiation and surgery with chemo, I'm doing fine . If your tumor is high up in the sigmoid rectal junction, you may be able to avoid a temp illio. Good luck. It sounds like your surgeon is well qualified for this surgery. I live in Houston and I used a lessor known hospital for my treatments. Not every situation needs an MD Anderson . Good luck tommorrow !
Michael
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012


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