The Colon Club

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.
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• 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....

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

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
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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 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?

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

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.

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

O Stoma Mia wrote:

• Hospital packing list - If you are having surgery, then you might want to have a look at some of the threads here related to stays in the hospital for colon-cancer related surgeries:
  
  Things that are helpful to have with you in the hospital...
  
  "take to the hospital" list
  
  If you could take to the hospital what would it be?
  
  There are also some web-sites that have more general information in this area
  
  What to pack for hospital
  
  What To Pack For The Hospital
  
  The 10 Most Important Items to Pack for the Hospital
  
  10 Tips: Packing for a Hospital Stay
  
  Going into Hospital
  
  What to Pack for your Hospital Stay
  
  What to Expect for Inpatient Surgery

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.