Surgery Considerations

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lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Surgery Considerations

Postby lakeswim » Thu Aug 23, 2018 8:11 pm

Hi. I will do Round 7 (of 8) FOLFOX of neoadjuvant chemotherapy next week. I will have chemo/radiation in October (which I have tons of questions about, but will start a new topic for that). Right now, my question is about SURGERY because I feel as if I need to research this before radiation starts (and I have those additional side effects to deal with) and I assume things happen fast after that. (I was told by one surgeon's office - out of town - that I need to tell them on my last day of radiation if I want to use them for my surgery!)

I have poked around here and I am quite overwhelmed with all the considerations for surgery - esp considering LAR Syndrome. (The surgeons told me I'd have increased urgency/frequency - and that's all I'd experience!)

I feel like you all have your Rectal Cancer PhD and I'm in the 101 class. You're all very knowledgeable (and it's both comforting and intimidating)!

What questions do you recommend I ask in terms of my surgery? I have two surgeons I am considering. One is extremely highly respected - as is the cancer center where this surgeon works - but it is 4 hours away (and I felt as if they kind of "blew me off" when they called me with their recommendations after their tumor board, which left me feeling down on them). I am leaning towards local too because, luckily enough, the surgeon came here from a (different from above) highly-respected cancer center and our hospital is pretty respected and not a community hospital. But I don't know.

Also, how do people deal with their ostomy (ileostomy?) and any other potential post-surgical problems if their surgeon and hospital is 4 hours away? What if there are complications? (I hear surgeons don't like to touch other surgeons work?)

- I guess I should ask if it will be laproscopic or robotic or open surgery? (I think the surgeon here wants to do robotic. How is this different from laproscopic?)
- It seems there are different types of surgery. All I was told is that I'd have my rectum (and probably my uterus) removed and a "neorectum" created. (There was no "technical" name given to me and I didn't know then to ask.)
- It seems there are very specific questions I need to ask about nerves and things involved in the surgery. (This is where it gets confusing/overwhelming to me.)
- Clearly, based on the LAR syndrome thread, I need to ask about post surgery care? I assume you mean long-term - after the bag is removed and the surgery reversed?

Is there a thread anywhere with a list specific questions to ask your surgeon? I clearly didn't have enough info when I met with them (it was so early on!).

Anyway, the medical jargon stops me when I start reading about things to consider for my surgery. And then I wonder how I get my questions answered. I already traveled to see the surgeon out of town. I guess I'd need to make another appt and travel again? I met with the surgeon here twice but didn't know anything the first time and the second time (after I had the second opinion out of town), she seemed rushed, and I still didn't really know much more to ask pointed questions. I assume there must be a time you meet with your surgeon before you plan the surgery?

I realize this post is all over the place. That's kind of how I feel when I research this stuff. Half the time, I don't feel well enough to research and the other half, when I feel well enough, I don't want to think about it and/or it's overwhelming to me. Thanks for any guidance.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

boxhill
Posts: 125
Joined: Fri Apr 06, 2018 11:40 am

Re: Surgery Considerations

Postby boxhill » Fri Aug 24, 2018 7:59 am

I don't have rectal cancer, but I have noted, here and elsewhere, that those with experience emphasize that for rectal cancer it is very important in terms of results to have a ***board-certified*** CRC surgeon.
F, 64 at DX CRC Stage IV (or "3 1/2" per Dana Farber consult, LOL)
3/17/18 blockage, emergency surgery, r hemicolectomy
11 of 25 nodes
5 of 5 mesentery nodes, matted
0.5 cm sub-capsular liver met removed
pT3 pN2b pM1
Neg CEA, neg BRAF, KRAS G12D, germline mut ATM
dMMR, MSI-H, Neg for Lynch
5/4/18 FOLFOX
Added Neulasta 6/28/18
7/9/18 CT scans show no masses or enlarged nodes, 2mm indeterminate lung nodule
11/20/18 CT scans NED. Lung nodule likely calcified granuloma. Enlarged spleen.

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O Stoma Mia
Posts: 1464
Joined: Sat Jun 22, 2013 6:29 am

Questions to ask the surgeon

Postby O Stoma Mia » Fri Aug 24, 2018 8:12 am

lakeswim wrote:... What questions do you recommend I ask in terms of my surgery? ...
Is there a thread anywhere with a list specific questions to ask your surgeon? I clearly didn't have enough info when I met with them (it was so early on!)..

Also, here is a link to one of several threads on this board that deal with questions to ask your doctor:

"Colonoscopy identified cancer -- What questions should I prepare for the doctor?"
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=59518&p=472245#p472245

NHMike
Posts: 1862
Joined: Fri Jul 21, 2017 3:43 am

Re: Surgery Considerations

Postby NHMike » Fri Aug 24, 2018 8:26 am

I have to run in a few minutes but will post more later on. You won’t have to deal with LARS until after your reversal and that will be sometime down the road so you should focus on living with an ileostomy for now.

What will really help is a WOC nurse to help you get the right setup for you. Being far away can make things harder. I only needed one visit after surgery with the WOC nurse to get it working right but I was only one hour out from the hospital.

More later
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

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Fri Aug 24, 2018 8:35 am

O Stoma Mia. Thank you very much for the links! I took a quick look at the links (have to get the kids places soon) and it seems, on first glance, like these are mostly questions for the first appointments. I am thinking of the more detailed/specific types of questions that folks in the LAR Syndrome topic bring up - which nerves they will be cutting, post-operative support, etc. (I don't know the etc.!)

I've seen many of the the "general questions for your surgeon" and asked those questions up front in my initial appointments (with board certified surgeons!) but those seem to be the tip of the iceberg. I try not to get overwhelmed on here, but folks seem so informed, and I want to be informed too as I approach this surgery (especially because I read many people on here say, "I wish I had known that or asked that question.) It seems that the "iceberg" questions (specifics that the surgeons don't get into or discuss or perhaps gloss over) are important ones and I need to find/look into those and figure out how (within this process) I get them answered.

I'll keep browsing the forum and make some notes. I will also dive deeper into your links because you always provide such valuable information. Thanks again.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Fri Aug 24, 2018 8:37 am

NHMike. I am still a while away from surgery (have radiation and then surgery) but I'm just thinking about this in terms of questions for surgeons as I make the choice between two surgeons, which I will need to do (and may need to schedule appts between end of chemo and start of radiation to ask any questions I have). Also, it seems that the surgery/surgeon/surgical method you choose can have an affect on whether you get LARS after your reversal? Or am I misunderstanding (which is totally possible)?

This is all so overwhelming. Thanks for your help.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

NHMike
Posts: 1862
Joined: Fri Jul 21, 2017 3:43 am

Re: Surgery Considerations

Postby NHMike » Fri Aug 24, 2018 9:55 am

In regard to asking questions: I will often just use the hospital portal to ask questions if I don't have an appointment in the near future. I think that it is unreasonable to travel four hours to ask questions if there isn't a need for you to be physically there.

I asked my surgeon why she did the kind of surgery she did instead of something else and she said that I had a small pelvis which limited options on the type of surgery she could do.

I am not sure about the order of things you're having done. You indicate an ileostomy so I assume that this gets installed during the LAR (or variant). The ileostomy catches waste at the small intestine so your large intestine will be offline until the ileostomy is removed. During this time, your waste will go into a bag and you won't need to use your large intestine so the concerns about LARS are post-reversal.

My surgeon is an hour away and I had problems with my ileostomy after surgery. I was scheduled to see the WOC nurse two weeks after surgery but she had to reschedule for a month later and I had moderate issues with leaks during that time which caused some pain. The WOC nurse got me different equipment which fixed the leaking issues. But it would have been far better if they could have been resolved two weeks after surgery.

There may be visiting nurses in your area but the quality of visiting nurses varies widely. I had a few come over and was not impressed with their knowledge of ostomies (one ordered me colostomy supplies when I asked for ilesotomy supplies). It may be that you can get a hold of a WOC nurse locally that could help you fine-tune your equipment for your needs.
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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O Stoma Mia
Posts: 1464
Joined: Sat Jun 22, 2013 6:29 am

Re: Surgery Considerations

Postby O Stoma Mia » Sat Aug 25, 2018 5:22 am

lakeswim wrote:(...)
- I guess I should ask if it will be laproscopic or robotic or open surgery? (I think the surgeon here wants to do robotic. How is this different from laproscopic?)
- It seems there are different types of surgery. All I was told is that I'd have my rectum (and probably my uterus) removed and a "neorectum" created. (There was no "technical" name given to me and I didn't know then to ask.)
- It seems there are very specific questions I need to ask about nerves and things involved in the surgery. (This is where it gets confusing/overwhelming to me.)
- Clearly, based on the LAR syndrome thread, I need to ask about post surgery care? I assume you mean long-term - after the bag is removed and the surgery reversed?
(...)

There are some articles around that compare the different kinds of surgery. For example, here are quotes from two of them:
"...Thus, pelvic autonomic nerve preservation during dissection in a narrow or deep pelvis, with adherence to the TME principles, is very challenging for colorectal surgeons. Recent developments in robotic technology enable overcoming these difficulties caused by complex pelvic anatomy....
Reference: https://www.ncbi.nlm.nih.gov/pubmed/26141555


"...Nerve-guided laparoscopic total mesorectal excision for distal rectal cancer is safe and feasible. This technique should be considered whenever possible as a means to prevent autonomic nerve damage and subsequent loss of urogenital function...
Reference: https://www.ncbi.nlm.nih.gov/pubmed/25331006


However, there are other articles that warn against the use of such advanced techniques, specifically when they are done by surgeons who have not had adequate training or experience. For some types of surgery (e.g., open surgery), a surgeon can be judged competent after only 10 surgeries, but for laparoscopic or robotic surgeries it is said to require 30 or more successful surgeries to be judged competent. Thus, when considering one of the advanced types of surgery, it is recommended to first find out how many successful surgeries of this type the surgeon has ever done in the past.

For your information, here are links to a couple of articles that are critical of these newer, expensive, advanced techniques:

Is da Vinci Robotic Surgery a Revolution or a Rip-off?
https://www.healthline.com/health-news/is-da-vinci-robotic-surgery-revolution-or-ripoff-021215#7

Skeptical Scalpel
http://skepticalscalpel.blogspot.com/search/label/robotic%20surgery

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O Stoma Mia
Posts: 1464
Joined: Sat Jun 22, 2013 6:29 am

Re: Surgery Considerations - Questions

Postby O Stoma Mia » Sun Aug 26, 2018 11:31 pm

lakeswim wrote:O Stoma Mia. Thank you very much for the links! I took a quick look at the links (have to get the kids places soon) and it seems, on first glance, like these are mostly questions for the first appointments. I am thinking of the more detailed/specific types of questions that folks in the LAR Syndrome topic bring up - which nerves they will be cutting, post-operative support, etc. ... It seems that the "iceberg" questions (specifics that the surgeons don't get into or discuss or perhaps gloss over) are important ones and I need to find/look into those and figure out how (within this process) I get them answered. ...

I think I understand the problem the you are faced with. It is the problem of extracting good, reliable information from doctors. The surgeons have a lot of knowledge that is based on whatever experience they have had with their past surgeries, but this knowledge is not really organized in any logical way. It is a real challenge to get a doctor to speak candidly and accurately about what he knows from his/her past experience.

Much of the doctor's knowledge is based on selective memory and is not based on any series of randomized, controlled studies. Whenever you ask a question what you usually get for an answer is whatever comes off the top of his head, or whatever he thinks he can say without being directly challenged or confronted, or whatever he can say without freaking you out. So, the kinds of answers you usually get are the vague ones like, "There may be some bowel problems at first, but things will get better over time..."

I think the way to deal with this is to develop your list of questions in such a way that the questions require specific, factual answers where the doctor cannot waffle his way through a reply.

I also think it might help if you could show up for the meeting with a printed diagram of the female pelvic anatomy and ask specifically which nerves, blood vessels, ligaments, muscles, and organs are likely to be removed or damaged during the surgery, and what the implications would be for your long-term quality of life.

For example, if you want clarification about what exactly the doctor means by "neo-rectum" and whether or not he is talking about a J-pouch, then you can develop a series of questions that could clarify this situation.

Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589776/

Pouch Surgery: Robotic or laparoscopic
https://www.j-pouch.org/topic/j-pouch-surgery-robotic-or-laparoscopic

Robotic-assisted laparoscopic surgery for restorative proctocolectomy with ileal J pouch-anal anastomosis.
https://www.ncbi.nlm.nih.gov/pubmed/21417830

There are other questions to ask, too, like how many such robotic-surgery J-pouches has he done in the past, and how many of his robotic surgeries involved malignant cancers rather than benign conditions like Crohn's disease or ulcerative colitis. (Cancer surgeries require much greater skill in order to avoid dropping malignant tissue or cancer cells in the abdominal cavity.)

EDIT - Additional links - Cleveland Clinic

Robotic Surgery Innovations - Cleveland Clinic
https://my.clevelandclinic.org/departments/digestive/research-innovations/robotic-surgery-innovations

About Robotic-Assisted Surgery (Robotic Total Hysterectomy) – Cleveland Clinic
https://my.clevelandclinic.org/health/treatments/16908-about-robotic-assisted-surgery

Understanding J-pouch surgery – Cleveland Clinic]
http://www.youtube.com/embed/krhN254kSNs/?rel=0&autoplay=1

Pouch procedure and recovery - Cleveland Clinic
https://my.clevelandclinic.org/health/treatments/17379-pouch-procedure--recovery
Last edited by O Stoma Mia on Wed Aug 29, 2018 12:36 pm, edited 2 times in total.

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Tue Aug 28, 2018 1:23 pm

This is great information, O. Thank you, as always, for gathering it for me. I will read and digest and then figure out how I get my answers - esp with the surgeon 4 hours away. Thank you. I hope you don't mind if I return in the future to follow up on this..... Thanks again.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

User avatar
O Stoma Mia
Posts: 1464
Joined: Sat Jun 22, 2013 6:29 am

Re: Surgery Considerations

Postby O Stoma Mia » Sat Sep 08, 2018 1:02 pm

More information on robotic surgery controversy, with some info on hysterectomy robotic surgeries.

A study found that deaths and injuries linked to surgery with the robots are going underreported to the U.S. Food and Drug Administration. And the American Congress of Obstetricians and Gynecologists said in a statement last year: “There is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives.”

Reference: https://www.propublica.org/article/ad-endorsing-da-vinci-robot-violated-u-of-illinois-policies-review-finds

HealthTalk
Posts: 6
Joined: Thu Nov 29, 2018 5:43 am
Facebook Username: Allen Baldreich

Re: Surgery Considerations

Postby HealthTalk » Thu Nov 29, 2018 5:56 am

Hi,

There is absolutely no denying the fact that colon cancer is one of the most lethal forms of cancer. And the incidence rate in the USA is shockingly high (1 out of 22 men and 1 out of 24 women will be detected with this type of cancer).

Studies reveal that in the past year more than 135,500 cases of colon cancer were reported in the USA. The most effective surgical considerations for colon cancer are laparoscopic surgery, colostomy, and cryoablation.

However, the ray of hope amongst these dreary facts is that doctors now believe in 90% of the cases the 5-year survival rate can be achieved by proper screening!

If people continue to keep their diet and weight in check, along with undergoing proper screening, the situation might improve soon...

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Thu Nov 29, 2018 11:27 am

O Stoma Mia wrote:More information on robotic surgery controversy, with some info on hysterectomy robotic surgeries.

A study found that deaths and injuries linked to surgery with the robots are going underreported to the U.S. Food and Drug Administration. And the American Congress of Obstetricians and Gynecologists said in a statement last year: “There is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives.”

Reference: https://www.propublica.org/article/ad-endorsing-da-vinci-robot-violated-u-of-illinois-policies-review-finds



Thank you, O Stoma Mia!
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

NHMike
Posts: 1862
Joined: Fri Jul 21, 2017 3:43 am

Re: Surgery Considerations

Postby NHMike » Thu Nov 29, 2018 11:56 am

HealthTalk wrote:Hi,

There is absolutely no denying the fact that colon cancer is one of the most lethal forms of cancer. And the incidence rate in the USA is shockingly high (1 out of 22 men and 1 out of 24 women will be detected with this type of cancer).

Studies reveal that in the past year more than 135,500 cases of colon cancer were reported in the USA. The most effective surgical considerations for colon cancer are laparoscopic surgery, colostomy, and cryoablation.

However, the ray of hope amongst these dreary facts is that doctors now believe in 90% of the cases the 5-year survival rate can be achieved by proper screening!

If people continue to keep their diet and weight in check, along with undergoing proper screening, the situation might improve soon...


My surgeon is trained in the use of robotic surgery but didn't use it in my case. I didn't ask why but I assume that she had a good reason for not using it.

Restaurants and Fast Food establishments are doing a lot of business these days thanks to a robust economy. The diet and exercise piece is going to be a hard one to crack.
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

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Wed Jan 02, 2019 11:33 am

I'm on the forum today researching for my meeting with my surgeon tomorrow. Have pelvic MR and abdomen CT today!

Anyway, I saw the above comments and feel the need to respond. I am a lifelong athlete (marathon, triathlon, masters swimmer), married to a vegetarian (so, very healthy, homemade meals and very little meat eaten here - and mostly poultry and fish), and haven't eaten red meat/pork/deli meat (or fast food, for that matter) since I was a teen. My grocery cart consists of organic veggies and fish (ok, with a few snacks thrown in for my kids) while many others are filled with processed foods and alcohol.

My point? While poor nutrition and fitness may account for some cancers, it clearly does not account for all. Frankly, I do not know how I can eat any better without going vegan (and restricting myself to no fun foods EVER). And though my energy levels have flagged in recent years, I was a picture of fitness until a few years ago. There is a big increase in CRC - esp among young people - in recent years, so there must be something else at play here. (It keeps me up at night in my own case!)

I have been told I have leaky gut (by a holistic MD) on two occasions 10 and 15 years ago. When I cleared gluten out of my diet, my symptoms disappeared. I started eating gluten again about 8 years ago with no symptoms (no symptoms like I had had before and nothing else new/obvious) and have been eating without restriction since. So, in my case, my current theory is that whatever caused my leaky gut has something to do with my cancer (or long term leaky gut caused cancer).

Eating well and being fit certainly can't hurt but is no guarantee.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(


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