Subtotal or Hemi...don’t know how to decide

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MarcusAurelius
Posts: 2
Joined: Mon Oct 15, 2018 7:48 am

Subtotal or Hemi...don’t know how to decide

Postby MarcusAurelius » Mon Oct 15, 2018 8:22 am

Hi all,

I am a 55 yo man. Did a screening colonoscopy in July that found 3 large ascending colon polyps; 1 transverse; 1 descending; 1 sigmoid.
Pathology showed that the descending polyp was an adenocarcinoma and showed signs of spreading to the submucosa.

Genetic testing show none of the markers. My CEA has never been above 1.

Surgery was recommended. My GP said if you have to get cancer, this is as good a way to get it as there is.

Im given the decision to make of whether to do a subtotal (part of the sigmoid will be left in place) or takeout the descending only. Surgeon says in terms of disease, they are equally weighted in terms of outcomes (I.e. no greater mortality risk either way).

The subtotal will allow for follow-up checks to be done with a flexible scope, no sedation and the only prep needed an enema the day of. Frequency will be at 1-year anniversary then every 1-2 years assuming no recurrence.

Hemi will of course require those checks to be via colonoscopy, with all that entails. I had tolerated my July prep reasonably well - just wasn’t much fun obviously.

I was leaning towards the less radical approach but the other day he said in my shoes he would do the subtotal. So now I’m confused again and struggling to know what to do.

Any advice out there?
55 M
Dx 07/18 CC - 5 pre-cancerous polyps, one adenocarcinoma in descending colon
10/18 - Lap converted to open hemi-colectomy
cTis G2 pN0 M0

Nohogirl
Posts: 78
Joined: Sun Oct 14, 2018 12:15 am

Re: Subtotal or Hemi...don’t know how to decide

Postby Nohogirl » Tue Oct 16, 2018 6:36 am

I can't give you any advice. But it sounds that they caught it very early. Good luck on whatever you decide
04/18 DH 49 diag.stage 2A T3N0M0 rectal cancer moderately differentiated.
05/18 chemorad. (Xeloda) 28 days
08/18 Surgery- 24 cm including entire rectum out
Stage II T2N0M0 moderate to poorly diff. adenocarcinoma
0 of 15 lymph nodes
No PNI
No LVI
Clear margins
Regression Grade 3
10/29 Started Folfox

Utwo
Posts: 221
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: Subtotal or Hemi...don’t know how to decide

Postby Utwo » Tue Oct 16, 2018 6:48 am

Have they removed these polyps during colonoscopy or not?
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

MarcusAurelius
Posts: 2
Joined: Mon Oct 15, 2018 7:48 am

Re: Subtotal or Hemi...don’t know how to decide

Postby MarcusAurelius » Wed Oct 17, 2018 5:40 am

Yes all, the polyps were removed during the colonoscopy
55 M
Dx 07/18 CC - 5 pre-cancerous polyps, one adenocarcinoma in descending colon
10/18 - Lap converted to open hemi-colectomy
cTis G2 pN0 M0

Utwo
Posts: 221
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: Subtotal or Hemi...don’t know how to decide

Postby Utwo » Wed Oct 17, 2018 8:46 pm

MarcusAurelius wrote:Yes all, the polyps were removed during the colonoscopy
What was your "T" score (a part of TNM)?
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

lpas
Posts: 1007
Joined: Wed Nov 19, 2014 11:11 pm

Re: Subtotal or Hemi...don’t know how to decide

Postby lpas » Wed Oct 17, 2018 8:53 pm

I was in a similar position 4 years ago and opted for the colectomy. My biggest concern was the potential for major changes in bowel function with a sub-total. Basically, I didn't want to risk spending the rest of my life running to the bathroom.
11/14 Dx sigmoid CC @ 45yo
12/14 Colectomy + hysterectomy
Stage IIIB, T3N1bM0, 2/20 nodes, MSS, G2, KRAS(A146T), TP53, SMAD4, ERBB2, CEA 1.0
2/15-7/15 XELOX & Celebrex
3/16 Ovarian mass removed. Benign fibroid
9/16 clean scope
4/18 clean CT
Ongoing Celebrex, Tagamet & other carefully-targeted supplements
Post-chemo CEA 3.0, 2.5, 2.3, 2.0, 1.6, 1.3, 1.8, 2.1, 1.8, 2.0, 1.8, 1.9, 1.7, 1.5, 1.6, 1.5, 1.4, 1.4, 1.3, 1.3, 1.6, 1.6, 1.3, 1.4, 1.6, 2.2, 2.4, 2.1
Mom to a 4 & 6yo

AppleTree
Posts: 246
Joined: Fri Mar 18, 2016 8:16 am

Re: Subtotal or Hemi...don’t know how to decide

Postby AppleTree » Wed Oct 17, 2018 10:30 pm

I have serious issues with diarrhea. Even though my tumor was very close to the verge and I was prepared for a permanent bag, during surgery the surgeon tried to do me a favor by making it temporary. When I was put back together, diarreah issues started. I went from 150 to 103 pounds this last round of chemo. Some nights too weak to hold my head up. I take Lomotol daily and a Sandostatin shot monthly. To be fair, the Drs tell me to give it 6 weeks after chemo and I am just approaching that mark now. I will probably give it another 6 months. But if I do not start gaining weight back and still struggle with this diarrhea, I am going to ask for a permanent bag and get on with my life. So, I do not know. Everyone is different. I do know that my surgeons had to cut into my sphincter muscles to get the margins and that may be a big part of my issues. You might not have these issues.
Just make sure you have a board certified colo rectal surgeon. And remember, getting a 2nd opinion is never a bad idea. Different people explain things differently and a 2nd opinion might help you make up your mind.
Diag Feb 5, 2016 Age 45
3 cm tumor 5 cm from verge
Radiation + Xeloda pills - 3000mg 5x week
3/14 - 4/16 - 25 sessions
Shrank just over 50% L nodes 0/13
Remove rectum with temp Ileo 6/17
Reversal 7/20 due to infection
Acute hepatitis August. Chemo cancelled
June to September 2016 - 58 days in hospital

2017
6/16, MRI shadow in lung
Pet - 6.6mm Met in Upper right lobe
7/30 VAT surgery Mass General/Boston
8/24 port
8/30 - 4/28 Folfox. 12 rounds
2018
June CT shows new lung Mets.
July PET...CLEAR!


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