Chemo after Surgery?

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Artelo
Posts: 2
Joined: Sat Dec 29, 2018 11:00 pm

Chemo after Surgery?

Postby Artelo » Sat Dec 29, 2018 11:05 pm

Good evening. I am a 41 yo female, recently had LAR for rectal cancer 11 cm from av. Met with oncologist and tumor was T2 with no mestatsis or lymph node involvement. Recommended observation only. I am concerned about no adjuvant therapy. Any advice? Do I push for further treatment? I am concerned about recurrence. I appreciate any and all input.

Thank you

Faith

KimT
Posts: 695
Joined: Sat Feb 20, 2010 8:53 pm

Re: Chemo after Surgery?

Postby KimT » Sun Dec 30, 2018 8:22 am

I did not do chemo and I’m 10 years out from diagnosis. No reoccurrence. I stay on top of my checkups and colonoscopies.
2/10 dx colon cancer
right hemicolectomy 3/19/10
Stage 2a 0/43 nodes
Lynch syndrome
3/14/10 colon resection/ removal of metal clips
Nov 11 dx ovarian cancer

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Chemo after Surgery?

Postby Beckster » Sun Dec 30, 2018 8:31 am

Welcome to the greatest forum on Earth! I did not have rectal cancer, but colon. To rest your mind to make the best decision, I would get a second opinion in pathology from a National Cancer Institute Center https://www.cancer.gov/ Many people on this forum with early cancer had second opinions, which changed their course of treatment. Correct staging is the most important part in making a treatment decision. Best of luck with your decision.


Artelo wrote:Good evening. I am a 41 yo female, recently had LAR for rectal cancer 11 cm from av. Met with oncologist and tumor was T2 with no mestatsis or lymph node involvement. Recommended observation only. I am concerned about no adjuvant therapy. Any advice? Do I push for further treatment? I am concerned about recurrence. I appreciate any and all input.

Thank you

Faith
57/F
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
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 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 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

KathyLynn
Posts: 68
Joined: Thu Aug 31, 2017 3:40 pm
Location: Rock Hall, MD

Re: Chemo after Surgery?

Postby KathyLynn » Sun Dec 30, 2018 8:49 am

I would get a second opinion. I didn’t have any treatment.
8/2017. RC
11/27/2017. Robotic LAR. No chemo/rad
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor.
Lymphovascular and perineural invasion: not identified.
1/13/2018. T2N0M0 with isolated tumor cell (ITC)
7/2018. CEA 2.0. 10/18: 2.0. 1/19: 2.3 11/19. 2.1
11/19 CT NED
06/21 CT NED CEA 1.3

SurvivorsSpouse
Posts: 88
Joined: Sun Nov 22, 2015 12:38 pm

Re: Chemo after Surgery?

Postby SurvivorsSpouse » Sun Dec 30, 2018 11:22 pm

Your case is a little less clear cut because you are on the border of actual Rectosigmoid, which is generally treated as Colon which has no adjuvant therapy in stage 1. However, doctors are even saying that stage 2A is over treated in the case of Rectal cancers and should only get adjuvant therapy in the presence of High Risk factors.

For a data point, my wife was stage 2A (microscopic T3) 11cm from the verge and received no adjuvant therapy. She is 6 years NED.

Good luck. If you get a 2nd opinion, try a major cancer center.

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Chemo after Surgery?

Postby CF_69 » Mon Dec 31, 2018 9:12 am

I’m curious about this post.

I had two colonoscopies as I was getting diagnosed. The first one I had done one Europe as that’s where I was.

That one said I had a 5 cm tumor in the sigmoid near the rectosigmoid junction 15 cm from anal verge.

My doctors in Canada wanted to do another colonoscopy when I got home and said that the tumor was 12 cm from the anal verge.

I’m currently about halfway through 25 Xeloda / radiation treatments, so being treated for rectal cancer?

I guess the idea is to shrink the tumor as much as possible before surgery, and to cut as little out of me as possible after the fact.

It’s not easy to find much info on rectosigmoid tumors.

I’m T3 N1 M0.

One oncologist said I might need to do 4 months of chemo after the surgery.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020

rp1954
Posts: 1853
Joined: Mon Jun 13, 2011 1:13 am

Re: Chemo after Surgery?

Postby rp1954 » Mon Dec 31, 2018 1:31 pm

The question is whether you are in the stage 1 majority that will not recur without treatment, or not. If not, what would be the best diagnostics and treatments now or, overall ? It is possible that there are nonstandard preventative answers - that residual odds can be shifted, like treating hypoxia, inflammation and other biochemical targets with mild or natural treatments. One important biochemical clue is always missed in the US, CA199 tissue stains on the tumor pathology.

Getting more predictive answers specifically for you, soonest, requires more resources with better timeliness, technical support capability and handling than are typically made available. I never found a single commercial source, a "one stop shop". Various partial resources are available with their own limitations. For us, some simple blood tests added on, were useful.

Standard practices reflect a certain balance of effort, cost, convenience, technology, risks, anxiety tolerance and path dependency. It is possible to do better, but it requires substantially consistent outperformance of support to clearly do better. That is, improvements in 1-2 areas might be defeated by a failure (lack of superior answer or performance) in another area.

Examples:
Even if a problem is identified 6 months earlier, are they really prepared enough to substantially improve your quality of life and lifespan much less do a curative treatment?
We found that most doctors (using standard practices) were not, and had to find someone special to do a major surgery that was typically considered futile. We also had to do better than standard practices on monitoring and (immuno)chemo. Yet, their futility assessment was perhaps valid for standard practices, for their normal constraints and practices - we had to improve things in several places. Also the surgery we got is now somewhat more recognized 7 years later but still likely often missed.

Even if a problem is identifiable 6 months earlier, are you really prepared mentally for additional monitoring, like "scanxiety" for each test and small changes, or that your monitoring is more invisible (e.g. monthly blood tests reviewed quarterly but professionally monitored continuously, more incisively).
Most people will suffer some anxiety, that sometimes might be detrimental, if they see extra monitoring without reassurance, perceived benefits or improvements along the way. In our case, we could better see improvements right off the bat; when things were worse, make improvements to the drugs and nutraceuticals.

Several simple, useful blood tests are typically missing in the initial surveys before and after surgery without chemo/radiation: CA199, LDH, hsCRP, ESR, ferritin, ceruloplasmin, 25-hydroxy vitamin D. The first 4 tests we found useful, added on a +-monthly basis. If CA199 is less than 2, more CA199 tests are not going to be useful; if CA199 is over 19 to 22 despite low inflammation levels, it has more potential as a marker outside of heavy chemo affected periods.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements


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