New to board: Rectal Cancer 2a

[Sammy2067]

Im new to the board and wanted to introduce myself. Im Sammy DeFriese. Im 51 and live in Chattanooga, TN. Ive gotten so much information and inspiration from reading the posts and learning about everyones journey. Ive been really touched by the courage and strength so many of you show.

I wanted to encourage everyone to keep moving forward, stay positive, and enjoy every minute of your time with friends and family.

For my RC, I had a great surgery, node negative 0/21, and no mets was fortunate. I had symptoms for 3 years and ignored them. Just really dumb. Finally did Colonoscopy and found tumor. I was very lucky it was slow growing and hadn't spread. I have a few high risk factors but surgery was great and Margins were all negative with negative nodes. CEA after surgery .5 with CA-19 at 2.9.

Currently, I tried Capox but the Oxyplatin caused incredible vomiting and serious nasuea for 4 straight days so we stopped Oxy. I might still do Xeloda monotherapy. My Oncologist admittedly just doesn't know if I need it. Deciding this week.

Any thoughts on "mop up" chemo for Stage 2a with a few high risk factors like LVI and PNI but low risk factors like 0/21 node negative, clear margins, and low CEA and CA 19-9 post op would be welcomed.

[boxhill]

Well, it's only my personal opinion, but given the fact of LVI I would want to do adjuvant/mop-up chemo. I would want to minimize the chances of a recurrence Which one is another matter.

What do you mean by a bad reaction to Oxi? Are you talking typical side effects, or an allergic reaction? If the latter, do you know whether you were given a steroid to minimize the chances of that before every infusion? I, for example, am on FOLFOX, and always have the steroid (dexy something) and anti nausea drug(s) administered through the port before the oxi/leucovrin drip starts. I gather that it is possible to desensitize a person to oxi, and it can also be given over 3 hrs instead of 2.

What is PI?

[Sammy2067]

Thank you for the opinion. The OXY caused incredible vomiting for 4 days. Just didnt go well. Lost 15 pounds. From 150 to 135. Along with jaw pain and cold sensitivity, the Dr. thought the Oxy was the problem vs. the Xeloda. IM getting my strength and weight back and then deciding on Xeloda by itself or not at all.

CEA levels at .5 CA19-9 at 2.9 with clear margins and 0/21 node negative with a well differentiated tumor 8 cm above the anal verge. All positive low risk factors.

The only real high risk factor pathology report said LVI present. The word "present" is very vague. Wish there was more detail on what Present meant. Its also my understanding that different pathologist will report different things concerning LVI. Some will identify while others use different methods and not identify it. Seems loose goosy regarding LVI.

[susie0915]

I was stage 2A. Did chemo/radiation, surgery, and xelox again. When I finished chemo/radiation surgeon did sigmoidoscopy and said all that's left is scar tissue. The pet scan showed no sign of cancer, and he said after surgery I may not need chemo. I was thrilled. When the pathology from surgery came back it did show minimum residual cancer cells where the tumor was, margins were clear, no lymph node involvement, lymph-vascular invasion, or perineurial invasion. When I met with my oncologist after, she said even though the risk of recurrence was low, she could not guarantee no cancer cells got into the blood stream. She recommended 6 rounds of xelox, which I did. I didn't want to wonder "what if" if I did have a recurrence. I was pretty disappointed, but went ahead. No regrets. I would finish the xeloda just sho you know you did all you could. Just my opinion.

[peanut_8]

Hi Sammy, Welcome to Colon Talk.

I was in a very similar situation to you when I was diagnosed almost 5 years ago. 2A, RC with 0/24 nodes and possible LVI. My onc originally suggested FOLFOX (CAPEOX would be comparable). We discussed the additional benefit that oxaliplatin added. There really aren't any studies specifically for stage 2, and benefits have been extrapolated from stage 3. Apparently you get about a 3% additional gain to using 5-FU or Xeloda alone. That wasn't worth the additional side effects, and invasive nature of the oxi infusions, IMO. I suggested going with Xeloda alone, and my onc said it was a perfectly acceptable solution.

If that's what you decide to do, let us know, and we can help manage side effects. (drinking lots of water is important)

Best Wishes,
peanut

[Kick'nAssCancer'sAss]

You're new.

If you've been here as long as I have (four years) you would've read many post from members who did not do the mop up chemo and regretted it. I was in the same stage as you were (see my sig) and you said you had a few high risk factors.

Seriously this is a NO BRAINER!!!

Put the final nail in the cancer coffin do the mop up.

[boxhill]

Okay, so you had ONE infusion of Oxi, followed by horrible nausea, am I correct? What anti-nausea measures were taken? Did you get Dexy, Sustol (an injection), any other anti nausea meds with the infusion and after? Ativan, onandsetron, etc?

There are options such as cutting the oxi dose, doing xeloda or 5FU w/o oxi, and so forth.

If you don't understand the nuances of your pathology report you should talk to your doctor about it. Make a list of questions before you go. There is also the option of asking for a second opinion from a cancer center. It's done all the time: path samples and scans are sent there. Another set of eyes on the LVI issue might help you make up your mind what to do.

Do you have any genetics on your tumor? That would help also.

[Sammy2067]

Thanks guys! Your information was very helpful.

I will be doing 4-6 months of Xeloda only! 1,000 Millgrams twice daily. Its the right move and Im finally comfortable we have a plan for better or worse. Time to move on and let the anxiety and stress behind and let the process take its course. Easier said than done!