Surgery Considerations

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O Stoma Mia
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Re: Indistinct fat plane

Postby O Stoma Mia » Mon Jan 21, 2019 12:35 am

I mentioned this earlier, but I'll mention it again: One thing you could do before your upcoming MRI in mid February is to read some of the literature on MRIs and the fat plane that is supposed to exist to form a barrier between the rectum and the uterus (see link below). Apparently, your previous MRIs were unable to confirm the existence of a fatty pad in this location, and this is apparently the current concern of the tumor board. Your large T4 tumor may have brushed up directly againt the uterus wall without being blocked by an intervening fat plane.

You can ask you doctors to explain this in greater detail.
http://radiologyassistant.nl/en/p56195b237699d/rectal-cancer-mr-staging-20.html

lakeswim
Posts: 229
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Mon Jan 21, 2019 10:05 am

Thanks for this link again. I have looked at it before but it’d be good to review again and try harder to understand it all.

While I won’t pretend I fully understand everything the doctors tell me ... at the end of the day, it’s apparently unclear even to the experts and they have to move forward assuming it’s the more aggressive scenario. And a distinct fat plane is required for W&W.

My cousin, a radiologist, is thrilled with my results. He has seen all my scans and says he wouldn’t know where to find my tumor site now if he hadn’t seen the original staging MRI with the big tumor. That said, while he has decades of experience, he’s not an oncology radiologist and acknowledges that.

He and I found a study that said most healthy people don’t have distinct fat planes in that area to begin with. But the surgeon said it was a CT study and ended that discussion. But my cousin (again, not an Onc Rad) seems to think it’s an impt point. (Too bad he can’t come with me to my appts!)

Thanks again for bringing this to my attention, O. At the end of the day, I need to trust my experts, right?
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
.....W&W surveillance 2019,2020,2021,2022,2023....
Jan 24 - approaching 5 years this Spring with W&W surveillance to end.
*grateful*

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O Stoma Mia
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Location: On vacation. Off-line for now.

Re: Surgery Considerations

Postby O Stoma Mia » Mon Jan 21, 2019 2:52 pm

lakeswim wrote:... At the end of the day, I need to trust my experts, right?

I suppose you're right, but my position is this: If it is not yet "the end of the day" then there is still time to do some "due diligence" to check out whether the so-called expert advice is indeed good advice.

What about the idea to do another 4 weeks of radiation?

lakeswim wrote:...My team and I agreed that we will do another MRI in mid Feb to see if another 4 weeks of radiation working can positively affect the indisinct fat plane. (Doctors don’t believe it will but worth a try. They suggested this plan.)...


Did the doctors explain all of the risks and benefits of this plan? For example, did they mention what effect an additional 4 weeks of radiation would have on your pelvic muscles and tissues, and how it would impact the severity of the eventual LARS syndrome?

lakeswim
Posts: 229
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Mon Jan 21, 2019 4:15 pm

O Stoma Mia wrote:
lakeswim wrote:... At the end of the day, I need to trust my experts, right?

I suppose you're right, but my position is this: If it is not yet "the end of the day" then there is still time to do some "due diligence" to check out whether the so-called expert advice is indeed good advice.

What about the idea to do another 4 weeks of radiation?

lakeswim wrote:...My team and I agreed that we will do another MRI in mid Feb to see if another 4 weeks of radiation working can positively affect the indisinct fat plane. (Doctors don’t believe it will but worth a try. They suggested this plan.)...


Did the doctors explain all of the risks and benefits of this plan? For example, did they mention what effect an additional 4 weeks of radiation would have on your pelvic muscles and tissues, and how it would impact the severity of the eventual LARS syndrome?


Nope. No mention of this. Good point! I was looking at positive effects of 4 more weeks but perhaps have not considered drawbacks.

Would surgery automatically halt the continued radiation process for surrounding pelvic muscles?
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
.....W&W surveillance 2019,2020,2021,2022,2023....
Jan 24 - approaching 5 years this Spring with W&W surveillance to end.
*grateful*

lakeswim
Posts: 229
Joined: Sat Mar 31, 2018 9:37 am

Re: Surgery Considerations

Postby lakeswim » Mon Jan 21, 2019 4:19 pm

Wait. My head is swimming. To add to my above response - we aren’t waiting that much longer, really. MRI would be scheduled for around the time of originally scheduled surgery. Surgery would only be delayed 2 weeks. Still a delay, I realize.
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
.....W&W surveillance 2019,2020,2021,2022,2023....
Jan 24 - approaching 5 years this Spring with W&W surveillance to end.
*grateful*

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O Stoma Mia
Posts: 1709
Joined: Sat Jun 22, 2013 6:29 am
Location: On vacation. Off-line for now.

Re: Surgery Considerations

Postby O Stoma Mia » Mon Jan 21, 2019 10:38 pm

Best wishes for a successful surgery and a swift recovery! :)

Packing for a hospital stay: The 15 things you’ll be glad to have:
https://carezone.com/blog/packing-for-a-hospital-stay-the-15-things-youll-be-glad-to-have


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