Stage II2b - T4 - need help

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Stage II2b - T4 - need help

Postby cgx123 » Sun Jul 15, 2018 2:15 pm


My father is trying to decide whether to have chemotherapy or not. He is 80 and recently had surgery to remove a T4 tumor in the hepatic flexure. He is having trouble deciding because of his age and treating Stage II with chemo seems to be a matter of debate. Can anyone provide any words of wisdom or similar stories? What is the current preferred treatment regimen? Are there any tests we should be requesting to help in making a decision? He would rather have the oral treatment, is that proving effective for treatment at this stage? Thanks for any advice.

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Re: Stage II2b - T4 - need help

Postby Lee » Sun Jul 15, 2018 6:58 pm

Stage II is such a gray area. IF I understand correctly, stage II2b would require chemo, butt in an 80 year old man, traditional chemo regiment might be overkill. Maybe look into "light" chemo. Either 5FU or the pills form of it.

Maybe a 2nd opinion at a major cancer treatment center might be a good ideal

rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

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Re: Stage II2b - T4 - need help

Postby Beckster » Sun Jul 15, 2018 8:51 pm

I agree with Lee.... I am a stage II, but with a T3 tumor. My oncologist did tell me that if I had a T4, it would require chemo. I did opt for chemo, but I was 57 years old and in good health. At the age of 80, depending on other health issues, the normal protocol chemo, Folfox, might be to harsh. I would also opt for Xeloda or infusion 5/FU. The oncologist would be able to give you the best treatment, which could include observation. Seek a second opinion at a major cancer center might help you make the best decision.
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3 (path) G2 (pre-op)
LN: 0/24
LVI present
Surgical margins: clear
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion
1/2/17 to 6/9/17- Xeloda monotherapy
6/17, 12/17, 6/18, 12/18, 6/19 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1
Clear Colonoscopy 10/17 :D

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Re: Stage II2b - T4 - need help

Postby CRguy » Sun Jul 15, 2018 9:04 pm

Here is a recent study which may give you a bit more info on the topic of geriatric use of capecitabine (Xeloda)
= "oral" chemo version of a 5FU, which is a pro-drug, the body metabolizes into active chemo ... /3516/2499
Toxicity is less with dose-reduced capecitabine than with historical full-dose capecitabine, with only a small trade-off in efficacy, seen as a lower objective response rate. The improved tolerability could lead to an increased number of cycles of therapy, and pfs appears to be consistently higher at the lower dose. Those observations should, in the absence of a head-to-head clinical trial, be viewed as compelling evidence that 1000 mg/m2, or even 750 mg/m2, twice daily is an appropriate dose in elderly or frail patients with acrc.
Their use of a lower dose does target lower side effects with little change in efficacy, and even considers the use of longer term treatment with overall higher progression free survivals.

MY input :
I had oral chemo with Xeloda, with various doses, before and after resection = tolerable for a 55 - 59 year old Stage IV patient

My father (86) did not do well on his chemo for mesothelioma (( a different chemo )) but was OK with surgery and IMRT radiation therapy.
I believe that stronger chemo = FOLFOX would not likely benefit your Dad's quality of life at his age = JMO.

I was there to advocate ...VOCALLY and aggressively for my father .... so if you can be there too,
maybe consider the lower dose oral chemo and remember
... IT IS HIS BODY AND HIS LIFE .. so if Dad says ENOUGH ! ...
you can always reduce the dose more, change options .... or quit, it is HIS decision.

Another point I have to mention :
80 year old patient ..... the docs will be looking at and SHOULD be talking with you/Dad about the "benefit" of doing chemo at his age
REGARDLESS of efficacy / toxicity etc.

sorry just the way the medical system works and I believe you may have encountered this thought process :

how long would the patient live without advanced treatments ?
how long would the patient live with advanced treatments ?
what is the "cost" = toll on the patient to DO treatment ? ... at what benefit
what is the "cost" = toll on the patient to NOT DO treatment ?... at what benefit

I have walked in your shoes as caregiver
I am still "walking" in your father's shoes today as patient

PM me anytime as this is not an easy path you are on

BUTT ... you have friends here

Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Deb m
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Re: Stage II2b - T4 - need help

Postby Deb m » Mon Jul 16, 2018 8:49 am

My husband was also a stage IIbt4. Stage II b is a very high risk stage for spread. He did six month of folfox. He was 50years old at the time though. In my opinion, he needs to do some kind of chemo, I would even start the folfox, which is what is standard for this stage, and he can always quit and change to something lighter if it's to much for him. My father who also has cancer and is 86 years old just completed treatment for stage III lung cancer which was six treatments of chemo every week with radiation every day . He's pretty worn out, but he made it thru. We would of had him stop if he needed to, but he made it thru and he's glad he did because it will for sure give him more time. I realize the chemo for lung cancer is different than the one used for colon, but my point is that he may do ok, and if not he can stop when it gets to much.

This is for sure a decision he will have to make and be comfortable with. Before they started my dad on treatments they did all kinds of tests, echo on his heart etc. to be sure he could withstand it. He was/is a healthy 86 year old otherwise. The oncologist said he was healthier than a lot of 60-70 year olds. So a lot will depend on your fathers health otherwise. I also think a second opinion with tests to see what kind of shape the rest of his body is in would be a good idea.

I wish you peace in your decision making.

deb m

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