Colon rectal cancer found during routine colonoscopy

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

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Sat Apr 07, 2018 12:46 pm

Utwa
I live in the US. Thank you
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

User avatar
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 » Sat Apr 07, 2018 3:43 pm

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? ...

I'm sorry to hear that you have been sick all week. This must have made it very difficult for you to focus on preparation for your meeting with the surgeon on Monday (tomorrow).

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.

Utwo
Posts: 227
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: Colon rectal cancer found during routine colonoscopy

Postby Utwo » Sat Apr 07, 2018 5:03 pm

Thank you, O Stoma Mia,
You perfectly described what happened in my case.

However I had no input in this process except my concent for "prophylactic" laparoscopic surgery.
I just followed the flow.
Back there I had no desire neither to Google nor even to read my own reports.
I blindly followed any doctor's recommendation after it was approved by my son (who has just finished medical school and was starting his residence at that time).
I even had no knowledhe of what EMR was.

My primary concern was waiting time and I had rather limited opportunity to chose a doctor (because I live in Canada).

O Stoma Mia wrote:Here is an article that you could read in preparation for your meeting with the surgeon on Monday:

Removing a Large Flat Colon Polyp by EMR without Surgery
http://www.sease.com/polyp/emr.html
Thank you O Stoma Mia for this educational article! I learned quite a bit.
My own photos were very similar, except for the last one that had black charred patches, they were results of using hot wire to stop bleeding.

Jim Sease had no need for subsequent surgery, because his polyp was non-canceros.
In my case a "review board" recommended further surgery because 1) my polyp was canceros and 2) histologyst was not 100% sure whether margins were clear or not.

P.S. That department has "Therapeutic endoscopy" name and they proudly display several posters of conferences where they taught other doctors. So it can probably be labelled as "leading".
Last edited by Utwo on Sat Apr 07, 2018 5:36 pm, edited 5 times in total.
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

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

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Sat Apr 07, 2018 5:27 pm

Thank you both so much for your input. I just read on another thread that flat polyps are much more dangerous than mushroom polyps. This makes me fear that EMR may not be invasive enough? At any rate, I’ll bring that question to the surgeon Monday....day after tomorrow. Right now I am very anxious that my respiratory infection that has disabled me is going to delay my treatment for a long time. My husband got this before me and he has been very ill for 2 solid weeks....still terrible coughing and body aches, fatigue. I am on day 6 and have seen no improvement. Day 3 antibiotics have made no improvement as of yet. Couldn’t have gotten infection at a worse time.
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

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

Re: Colon rectal cancer found during routine colonoscopy

Postby mozart13 » Sun Apr 08, 2018 12:02 pm

Lotus, sorry to hear about your resp. infection. Maybe change antibiotic.
Couple of weeks won’t make much difference, you are low stage, it took years for cancer to grow. Use the time to boost your immune system, maybe check if you have any cavity, as those could create problem during treatment.
Surgeon is the one who makes dessicion about radiation. When I went to see my radiologist, he wasn’t trilled, per him surgery would be more than sufficient.
I also went to see some one who is very good in trans anal surgeries, but dropped that idea after reading that most of the cancers that are removed this way come back.

Problem with these earlly stages is, some times they get under diagnosed, once radiation is skipped, and surgical procedure takes place, you can’t go back, damage is done. Surgeons like to take cancer out in one piece, without pocking wholes as there is posibility of cancer spreading from surgical procedure.
If cancer is under staged, it’s more dificult to obtain clear edges without shrinking it first with radiation.
It wasn’t easy dessicion, but what I learned from my line of the work, if in doubt, to treat problems by starting high than mowing low, instead of try to chasse it all the way up, and waste valuable time and opportunity. So using that formula I pushed for radiation first, at the end it’s my life, worked very well for me.

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!

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

Re: Colon rectal cancer found during routine colonoscopy

Postby Lotus » Sun Apr 08, 2018 4:13 pm

mozart13 wrote:Radiation/chemotherapy is standard approach to shrink cancer, and maybe completely erase it. Chemotherapy combined with radiation is usually in form of pills called xeloda.
You will not get full dose, as you would if you do only chemotherapy.
I did it, it was fairly easy for me, hardlly any symptoms. Cancer was completlly erased.

There is no easy way in treating cancer.
They like to shrink cancer first, as it is easier to operate on it. When cancer is smaller there is less chance of cutting through, surgeons try to get it out in one piece without pocking through, as there is chance that cancer will multiplly very fast if pocked or cut through.

MRI will give complete picture on cancer, and stage it.
I also had short MRI and CT scan by radiation therapy team for proper staging pointing radiation therapy to the right spot.

There is big trial going on now, leading hospital is Memorial Sloan from NY, chemo/rad than chemo in form of folfox, than re-assessment if one needs surgeryor not, or chemo first(folfox), than chemo/rad, than re-assessment.

On this forum you can find a lot’s of usefull info and links:
viewtopic.php?t=53498

Right now focus on what is in front of you, that being chemo/rad, how to get most out of it, also is very important how they focus radiation, with me they told me that they gona focus on lymph nodes, even though lymph nodes weren’t involved.

Good luck to you!


Can you share why they focused on lymph nodes even though they weren't involved? Also, can you share why you had radiation chemo with T1 T2 staging? I thought they did not use chemo radiation for stage 1. Thank you for sharing your story with me. really appreciate it
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 » Sun Apr 08, 2018 4:19 pm

mozart13 wrote:Lotus, sorry to hear about your resp. infection. Maybe change antibiotic.
Couple of weeks won’t make much difference, you are low stage, it took years for cancer to grow. Use the time to boost your immune system, maybe check if you have any cavity, as those could create problem during treatment.


All the best!

thank you mozart13, I didn't see this response when I posted above....what do you mean by "cavity"? Do you mean dental cavity?
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

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

Re: Colon rectal cancer found during routine colonoscopy

Postby mozart13 » Sun Apr 08, 2018 6:42 pm

Hi Lotus,
yes dental cavity, eliminate any kind of possible source of infection, as chemo and rad will kill your immunity.
Stage 1 usually doesnt get chemo/rad, surgery only, but my initial surgeon is very aggressive when it comes to cancer, I kind knew him personally, thats why he got picked up by me. My thought was that he would make best dessicions, and he did.
Radiologist mentioned few times that I dont need radiation, but I never commented on that, and new that he wouldnt cross surgeon.
Focus was on lymph nodes, my Radiologist dessicion, there was one questionable nodal involment(on MRI), that vanished after radiation. Wheter that node was positive or just swollen will never know.
After 25 sessions of chemo/rad, cancer was completlly erased, no scarr or any kind of demage to the site was present.
Had Colonoscopy, MRI and CT scan within 2 weeks after finished chemo/rad, all negative.
2 months after same tests were done, all negative.
Started folfox ,scheduled 10 rounds, my oncologist said that she will try to get at least 8 in me. Managed to get 8 plus 2 rounds of xeloda.
All the tests have been negative so far. Will have MRI and CT this month.

If you have any more questions feel free to ask.

Best of the luck to you!
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!

Utwo
Posts: 227
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: Colon rectal cancer found during routine colonoscopy

Postby Utwo » Sun Apr 08, 2018 9:36 pm

Deleted
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

User avatar
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 » Sun Apr 08, 2018 10:03 pm

Good luck on your Monday appointment. Be sure to take good notes on what the surgeon says.

I sent you a PM. Did you receive it?

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 5:04 am

O Stoma Mia wrote:Good luck on your Monday appointment. Be sure to take good notes on what the surgeon says.

I sent you a PM. Did you receive it?


Yes and I answered but my pms will not send. I have tried a few They sit in outbox. I started a thread above about the issue. EUS scheduled April 25. I don’t know how to fix my message fail to send
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 5:05 am

O Stoma Mia wrote:Good luck on your Monday appointment. Be sure to take good notes on what the surgeon says.

I sent you a PM. Did you receive it?


If he allows I will tape it with my iPhone
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 5:09 am

mozart13 wrote:Hi Lotus,
yes dental cavity, eliminate any kind of possible source of infection, as chemo and rad will kill your immunity.
Stage 1 usually doesnt get chemo/rad, surgery only, but my initial surgeon is very aggressive when it comes to cancer, I kind knew him personally, thats why he got picked up by me. My thought was that he would make best dessicions, and he did.
Radiologist mentioned few times that I dont need radiation, but I never commented on that, and new that he wouldnt cross surgeon.
Focus was on lymph nodes, my Radiologist dessicion, there was one questionable nodal involment(on MRI), that vanished after radiation. Wheter that node was positive or just swollen will never know.
After 25 sessions of chemo/rad, cancer was completlly erased, no scarr or any kind of demage to the site was present.
Had Colonoscopy, MRI and CT scan within 2 weeks after finished chemo/rad, all negative.
2 months after same tests were done, all negative.
Started folfox ,scheduled 10 rounds, my oncologist said that she will try to get at least 8 in me. Managed to get 8 plus 2 rounds of xeloda.
All the tests have been negative so far. Will have MRI and CT this month.

If you have any more questions feel free to ask.

Best of the luck to you!


You had no surgery?
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 5:24 am

mozart13 wrote:Lotus, sorry to hear about your resp. infection. Maybe change antibiotic.
Couple of weeks won’t make much difference, you are low stage, it took years for cancer to grow. Use the time to boost your immune system, maybe check if you have any cavity, as those could create problem during treatment.
Surgeon is the one who makes dessicion about radiation. When I went to see my radiologist, he wasn’t trilled, per him surgery would be more than sufficient.
I also went to see some one who is very good in trans anal surgeries, but dropped that idea after reading that most of the cancers that are removed this way come back.

Problem with these earlly stages is, some times they get under diagnosed, once radiation is skipped, and surgical procedure takes place, you can’t go back, damage is done. Surgeons like to take cancer out in one piece, without pocking wholes as there is posibility of cancer spreading from surgical procedure.
If cancer is under staged, it’s more dificult to obtain clear edges without shrinking it first with radiation.
It wasn’t easy dessicion, but what I learned from my line of the work, if in doubt, to treat problems by starting high than mowing low, instead of try to chasse it all the way up, and waste valuable time and opportunity. So using that formula I pushed for radiation first, at the end it’s my life, worked very well for me.

All the best!


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

User avatar
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 » Mon Apr 09, 2018 7:23 am

Lotus wrote:
O Stoma Mia wrote:Good luck on your Monday appointment. Be sure to take good notes on what the surgeon says.

I sent you a PM. Did you receive it?


Yes and I answered but my pms will not send.

Your PM to me will not "send" until I get back to the house and check my messages. After I check my messages, then your PM to me should transfer automatically from your Outbox to your Sent Box.

You can try to refresh your browser to see if it will now recognize the change in status of your PM.

View messages: Outbox
http://coloncancersupport.colonclub.com/ucp.php?i=pm&folder=outbox

View messages: Sent messages
http://coloncancersupport.colonclub.com/ucp.php?i=pm&folder=sentbox


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