Tattoo during scope?

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lakeswim
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Tattoo during scope?

Postby lakeswim » Sun Apr 15, 2018 1:52 pm

Hi! I was on here 2 weeks ago after a pathology of a "large" rectal tumor (found during a colonoscopy ordered due to blood in stool) was found to be positive for cancer. But I had - and still have - little other info. other than tumor is 10 cm from my anal verge and large and poorly differentiated (which I understand is not great news).

I *finally* met with a surgeon this past Thursday (waited an extra excruciating week for the surgeon I wanted). I had a chest/abdomen/pelvic CT (with and w/o contrast) on Friday and have a pelvic MRI scheduled for this Wednesday. My surgeon is planning to present the info to her tumor board on Friday. I also meet with oncologist on Thursday. (Is this all normal process?)

My big question right now is TOMORROW. They scheduled me for a scope (think it's a sigmoidoscopy) early tomorrow under general anesthesia during which they will tattoo my tumor. I asked tons of questions during our appt. She told me the standard protocol for RC (pre-surgical chemo, rest time, surgery, post surgical chemo), mentioned radiation (but not necessarily as part of that protocol), and said specifically that she couldn't tell me anything for sure about my situation until after my scans/tests.

All of these appts were scheduled so quickly on Th/Fr that I was unable to ask WHY they are tattooing the tumor? Is this so they know where it is for something later? (She said she is scheduling the scope to see the exact location of my tumor. She tried to do something in the office with a tube, but I was unable to tolerate it .... and they didn't really push it either. I kind of wish they'd pushed it because I'm not excited about the general anesthesia if it's not truly necessary.)

If anyone can tell me the purpose of the tattoo and if the tattoo (and the scope) is normal protocol at this stage, I would appreciate it. (Does the tattoo tell me anything about what lies ahead?)

I look forward (I guess...) to getting more info after this week's tests so I can round out my signature here and ask more pointed questions here. You all are so amazing. Thank you so much for all your support!

S
49 - Female
DX: RC
Tumor Location: 10 cm from anal verge.
Tumor type: Adenocarcinoma
Tumor size: 5-6 cm
Tumor grade: G3: Poorly differentiated (high grade)

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O Stoma Mia
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Re: Tattoo during scope?

Postby O Stoma Mia » Sun Apr 15, 2018 2:42 pm

lakeswim wrote:...My big question right now is TOMORROW. They scheduled me for a scope (think it's a sigmoidoscopy) early tomorrow under general anesthesia during which they will tattoo my tumor....If anyone can tell me the purpose of the tattoo and if the tattoo (and the scope) is normal protocol at this stage, I would appreciate it. (Does the tattoo tell me anything about what lies ahead?)

I really don't know why they would do a tattoo for a large tumor like yours. I suppose that this information could be useful to help the surgeon find the exact location of the tumor when it comes time for the surgery, but I'm not sure that that's the reason. The surgery will probably be a resection done by making the upper and lower cuts from the outside of the rectum, rather than a trans-anal excision done by cutting from inside. In this case, they need to have a good idea where the tumor is located when they are viewing the rectum from the outside. Maybe this kind of tattoo is done in such a way that the tattoo can be seen also from the outside of the rectum. If so, then when they start the surgery they would first look for the part of the rectum where the tattoo can be seen, and then they will know where they need to make the upper and lower cuts so that the tumor is sure to be in the center of the removed section.

This would be important, because when it comes time for surgery they must not cut into the malignant tumor itself. They will be making cuts a good distance away so as not to pierce or cut into the tumor during the tumor removal process. Maybe the tattoo is a way for them to be sure that they are making the cuts far away from the edges of the tumor.

All of this is pure speculation on my part, however, since I am not familiar with using tattoos in this context. I hope you get some clarification on this after you talk to the doctor.

Please post your scan results when you find out about them, as they are an important part of the staging process. Good luck tomorrow!

Note: Here is a link to your original thread two weeks ago:
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=59672

lakeswim
Posts: 8
Joined: Sat Mar 31, 2018 9:37 am
Location: NY State

Re: Tattoo during scope?

Postby lakeswim » Sun Apr 15, 2018 2:48 pm

Thank you for your reply. But didn’t they already cut into the tumor to get the material for pathology?

I will post with scan results when I have it. I will look to see if there are colon talk group guidelines for this as I’m not sure of the protocol.

Thank you.
49 - Female
DX: RC
Tumor Location: 10 cm from anal verge.
Tumor type: Adenocarcinoma
Tumor size: 5-6 cm
Tumor grade: G3: Poorly differentiated (high grade)

Tim UK
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Re: Tattoo during scope?

Postby Tim UK » Sun Apr 15, 2018 4:39 pm

Hi

My understanding is that is simply a way to mark the location and edges of the tumor. So when the surgeon goes in they can quickly and easily do the excision.

Tim
https://youtu.be/qoQbY4A5RNA
05/15 L hemi-colectomy - robotic, laparoscopic
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kids: 11,7
BRAFm mucinous - KRASw
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06/15 - 09/15 6 x FOLFOXIRI+Avastin
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8/16 progression (PET)
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benben
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Location: Washington State

Re: Tattoo during scope?

Postby benben » Sun Apr 15, 2018 4:56 pm

Tim's correct. Tattoos are used for marking of the margins. One is placed in area of the cuts to be done during resection surgery.
I had tattoos done as well. The nurse was joking about it afterwards telling me she was glad to have been the one to give me my first tattoos - as I don't have others.
----------------------
3/29/17 diagnosed CRC - 44 y/o Male
4/17/17 ULAR - Straight anastomosis - no ostomy.
Path: low grade T3n1m0 - moderate diff.
KRAS - NO, MLH1/PMS2/MSH6/MSH2 - Normal.
5/3 med port install
5/22 folfox - first treatment.
3rd treat, delayed - low ANC - reduced to 90% OXI
Granix given, Now Zarxio treatments every session.
Treatment 7 reduced to 75% OXI
Treatment 8-12 - NO OXI, just Luke and 5FU
Current - 12 treatments done, CBC good, CEA decreasing.
10/20/17 CT-SCAN - CLEAR! - NED

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O Stoma Mia
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Re: Tattoo during scope?

Postby O Stoma Mia » Sun Apr 15, 2018 10:47 pm

Here is an article on pre-operative endoscopic tattooing:

"Conclusions: All colonic lesions that appear to be malignant should be tattooed during endoscopy to improve surgical localization. Tattoo endoscopy is a safe and effective method for preoperative tumor localization..."

Reference:
Preoperative Localization of Colorectal Tumors with Endoscopic Tattooing for Laparoscopic Surgery
https://www.omicsonline.org/open-access/preoperative-localization-of-colorectal-tumors-with-endoscopic-tattooing-for-laparoscopic-surgery-2167-0870-1000227.php?aid=55052

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peanut_8
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Re: Tattoo during scope?

Postby peanut_8 » Mon Apr 16, 2018 8:10 am

Hi lakeswim

It sounds like you're going to get radiation + chemo (chemo/rad) prior to surgery. Some people have a complete response to this treatment. I'm including a link for further info in case you're interested...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716052/

If a complete response occurs, the tattoos will show where the tumor was, in case further treatment is indicated.

Best Wishes,
peanut
Terri aka peanut
diagnosed Jan 14, RC stage 2a, age 56
permanent colostomy
MSS
April 14, 28 chemo/rad with Xeloda
June 14 adjuvant Xeloda 6 rounds
currently NED

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horizon
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Re: Tattoo during scope?

Postby horizon » Mon Apr 16, 2018 8:15 am

I had this done as well. Sigmoidoscopy after a recent colonoscopy was not fun. My surgeon said it would help him know exactly where the tumor was for the lapro surgery.
I'm just a dude who still can't believe he had a resection and went through chemo (currently 6 years NED). Is this real life?

mozart13
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Re: Tattoo during scope?

Postby mozart13 » Mon Apr 16, 2018 10:10 am

lakeswim wrote:If anyone can tell me the purpose of the tattoo and if the tattoo (and the scope) is normal protocol at this stage, I would appreciate it. (Does the tattoo tell me anything about what lies ahead?)

I look forward (I guess...) to getting more info after this week's tests so I can round out my signature here and ask more pointed questions here. You all are so amazing. Thank you so much for all your support!

S

Tattoo is very important for marking the exact position of polyp/tumor. It's gona be just one dot. Let's assume your polyp vanish after chemo or chemo/rad, how will they find the spot.
That is what happen to me, after chemo/rad, tumor/polyp wasn't there, if they didn't put tattoo in there, it would be impossible to find that spot.
My polyp was about 9 cm from anal verge.
You will have some more tests like MRI to stage properly your tumor, and than they will make decision how to treat it.

Good 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)

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juliej
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Re: Tattoo during scope?

Postby juliej » Mon Apr 16, 2018 5:20 pm

lakeswim wrote:All of these appts were scheduled so quickly on Th/Fr that I was unable to ask WHY they are tattooing the tumor?

Tattooing of tumors is standard practice to prevent an inadequate resection because the tumor often shrinks from the radiation and/or chemotherapy. I also had a rectal tumor, but it shrunk to a small scarred area after treatment. The tattoos enabled my GI surgeon to make sure he resected the whole area, not just the small bit of tumor that was left.

lakeswim wrote:I had a chest/abdomen/pelvic CT (with and w/o contrast) on Friday and have a pelvic MRI scheduled for this Wednesday. My surgeon is planning to present the info to her tumor board on Friday. I also meet with oncologist on Thursday. (Is this all normal process?)

S, this is perfectly normal. The CT and MRI are necessary to see if the cancer has spread to any other part of your body.

Make sure you also get genetic testing (KRAS, BRAF, MLH1, MSH2, etc.). ImmunoHistoChemistry (IHC) testing is usually standard practice on a biopsy with a colonoscopy so they might already have your results. Just ask the oncologist for them at your first meeting. Also ask for your CEA results and any pathology reports. You might request CA19-9 and LDH tests too. They more info the better!

One piece of advice: take a friend or family member with you to the oncologist's office. There's a lot going on - things move fast - and it can be hard to recall everything said at the appointment. That's where your friend comes in - they can write notes (have them bring a notebook and pen) or simply remember things the doc said that you might have forgotten.

I know it's overwhelming at this point, but hang in there. We have all walked in your shoes and can help answer your questions and concerns. Please know that you are not alone. I was diagnosed Stage 4 in 2010 and I am still very much alive and doing well today!

Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 12/13/2017, CEA<1

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WriterGirl1969
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Re: Tattoo during scope?

Postby WriterGirl1969 » Tue Apr 17, 2018 4:22 pm

I see everyone has already provided you with great info. All I wanted to add was that my surgeon also did a sigmoidoscopy after my initial colonoscopy both to mark and recheck location. She said it was standard for surgeons to do this to ensure that the location noted during the colonoscopy was completely accurate. In my case, they had originally noted my tumor to be in the sigmoid. During this follow-up sigmoidoscopy it was found to actually be in the descending. So, at least in my case, not only standard but also a good thing!

This can be a confusing, overwhelming time. As someone else suggested, try to bring a friend or family member with you to take notes for you, and don't be afraid to ask any questions here. As you can see, there is a wealth of information and knowledge among the amazing folks in this group.

Hugs and prayers from me to you.
--Tracy
DX 3/4/2016 Colon Cancer; age 46 Mom of 4-yr-old
Stage IIIB: T3N1M0
3/31/16 Left Hemi
4 to 10/2016: Xeloda Monotherapy
CEA: 10/16 0.56, 1/17 0.54
3/6/17 CT clear; 4/17/18 CT clear;
NED 2 years
“If I can help somebody as I walk along, then my living shall not be in vain.”


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