Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

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rajesh
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Joined: Sun Jun 17, 2018 12:52 pm

Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby rajesh » Sun Jun 17, 2018 3:00 pm

My dad was diagnosed with Ca Rectum recently and gone through a Laparoscopic ULAR (Ultra Low Anterior Resection) surgery, NO chemotherapy or radiotherapy is given before surgery. Doctors said they would let us know on the next steps of treatment to be given on the next review. I am very much worried whether if he could tolerate the side effects of chemotherapy as he is aged and has other medical histories like Diabetes, Hypertension, Ischemic Heart Disease. I am so worried that if the chemotherapy would shorten his lifespan. Now that entire section of a tumour has been removed in the surgery should he be given a Adjuvant chemotherapy? Can someone help me with suggestions, please?

Age: 68
Personal history: South Indian, Non-smoker, Non-Drinker, Follows Vegetarian Diet
Past Medical history: Diabetes Mellitus, Hyper Tension, Ischemic Heart Disease
Past Surgical history: History of PTCA + Stent to LAD in 2012, Urological surgery for bilateral renal calculi in 2005

25/04/2018: Rectal bleeding
16/05/2018: CT Scan: Irregular circumferential wall thickening in the rectum
17/05/2018: Sigmoidoscopy & tumour sample collected
18/05/2018: CEA 3.0 ng/ml
19/05/2018: MRI Scan: Full thickness intrarectal invagination of the anterior wall of mid third of the rectum
19/05/2018: Rectal Biopsy with Intramucosal Carcinoma
29/05/2018: Colonoscopy
02/06/2018: Laparoscopic ULAR (Ultra Low Anterior Resection)
07/06/2018: Pathology report T3 N1 PN0 LV0. (1/14 perirectal lymph nodes identified with evidence of tumour invasion. No evidence of perineural invasion/ lymphovascular tumour emboli.).
Tumor size: 4.5 * 4 * 0.8cm
Microscopic tumor extension: Tumor invades the muscularis propria and perirectal fat. One regional lymph node is positive
Last edited by rajesh on Tue Jun 19, 2018 4:24 am, edited 1 time in total.

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

Re: Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby NHMike » Mon Jun 18, 2018 7:36 pm

Do you have the dimensions of the tumor? It sounds like my staging and I had chemo and radiation before surgery but my tumor was quite large. May his was very small and they felt that they could get it out as is. Adjuvant chemo is rough. There are some 68-year-olds that can handle it because of general health and there are some that have a really hard time with it. I'm 59 and just finished 6 months of it and it was rough stuff but it's indicated for Stage 3 and I'm Stage 3. It would appear that your father is too - did your oncologist provide staging.

You might also look up research on co-morbidity and adjuvant chemo to see the difference between going with it and skipping it for older folks with other health issues.
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

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betsydoglover
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Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby betsydoglover » Mon Jun 18, 2018 7:52 pm

I understand your concern in that your father has some other medical issues. BUT, I am 68------God forbid I should have to do chemo again, but I'd be running to the start line if it was necessary and might / would save my life. Not saying your Dad needs it, but 68 is no where near as old as it may sound to you. Age 68 alone should not be an issue.
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

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PGLGreg
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Location: Waimanalo, HI

Re: Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby PGLGreg » Mon Jun 18, 2018 9:59 pm

I had chemotherapy at 63. Not a problem (but I don't have heart trouble). I think you had best follow the advice of his doctors. Bear in mind that people have very different reactions to chemotherapy, and in case of a bad reaction, the therapy can be modified or stopped.
Greg
stage 2a rectal cancer 11/05 at age 63
LAR 12/05 with adjuvant radiation+5FU,leucovorin 1-2/06
NED for 12 years, cured

rajesh
Posts: 3
Joined: Sun Jun 17, 2018 12:52 pm

Re: Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby rajesh » Tue Jun 19, 2018 4:23 am

NHMike wrote:Do you have the dimensions of the tumor? It sounds like my staging and I had chemo and radiation before surgery but my tumor was quite large. May his was very small and they felt that they could get it out as is. Adjuvant chemo is rough. There are some 68-year-olds that can handle it because of general health and there are some that have a really hard time with it. I'm 59 and just finished 6 months of it and it was rough stuff but it's indicated for Stage 3 and I'm Stage 3. It would appear that your father is too - did your oncologist provide staging.

You might also look up research on co-morbidity and adjuvant chemo to see the difference between going with it and skipping it for older folks with other health issues.


Thanks, NHMike, The doctors said he is on Stage 3A.

Tumor size: 4.5 * 4 * 0.8cm
Microscopic tumor extension: Tumor invades the muscularis propria and perirectal fat. One regional lymph node is positive

NHMike
Posts: 1807
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby NHMike » Tue Jun 19, 2018 10:55 am

rajesh wrote:
NHMike wrote:Do you have the dimensions of the tumor? It sounds like my staging and I had chemo and radiation before surgery but my tumor was quite large. May his was very small and they felt that they could get it out as is. Adjuvant chemo is rough. There are some 68-year-olds that can handle it because of general health and there are some that have a really hard time with it. I'm 59 and just finished 6 months of it and it was rough stuff but it's indicated for Stage 3 and I'm Stage 3. It would appear that your father is too - did your oncologist provide staging.

You might also look up research on co-morbidity and adjuvant chemo to see the difference between going with it and skipping it for older folks with other health issues.


Thanks, NHMike, The doctors said he is on Stage 3A.

Tumor size: 4.5 * 4 * 0.8cm
Microscopic tumor extension: Tumor invades the muscularis propria and perirectal fat. One regional lymph node is positive


About 16 cm^3. That's still big but 1/5th the size of mine. I do think that chemo is indicated for all Stage 3 patients but perhaps less chemo may be indicated for 3A. The protocols are moving towards less chemo overall but I think that I'd want the full dose if I were 3C. I'm 3B and had the full cycles for Xeloda but only six cycles for Oxaliplatin and those at reduced dosages. Your oncologist should know all of the options and what's indicated for Stage 3A.
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

rajesh
Posts: 3
Joined: Sun Jun 17, 2018 12:52 pm

Re: Rectal Cancer: Is chemotherapy advisable for 68 years old Heart patient after LAR surgery

Postby rajesh » Sat Jun 30, 2018 3:48 pm

NHMike wrote:About 16 cm^3. That's still big but 1/5th the size of mine. I do think that chemo is indicated for all Stage 3 patients but perhaps less chemo may be indicated for 3A. The protocols are moving towards less chemo overall but I think that I'd want the full dose if I were 3C. I'm 3B and had the full cycles for Xeloda but only six cycles for Oxaliplatin and those at reduced dosages. Your oncologist should know all of the options and what's indicated for Stage 3A.


Thanks again Mike, now the oncologist has recommended the same drugs to my Dad. 6 cycles of Capecitabine(Xeloda) & Oxaliplatin. His blood samples were taken for a DNA test to see if he is fit for this chemotherapy. Hoping for things to go well.


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