Stage II but puzzle with the chemo.. : (

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esuperbaby
Posts: 21
Joined: Thu Jan 03, 2019 1:55 am

Stage II but puzzle with the chemo.. : (

Postby esuperbaby » Thu Jan 03, 2019 2:18 am

Hi to all, I'm new joiner from Asia..! It’s good to find this nice forum specifically for our needs.

Please see my signature as the quick reference. My most puzzled thing is that the Pathology report shows “Area suggestive but not definite for peritumoral lymphovascular permeation are noted” …
The surgeon said usually Stage II no need chemo but if having LVI , chemo will be suggested. But now with this uncertain comment, surgeon said chemo is not necessary or he said if with chemo, maybe only help 2-3%.

Now, we are waiting for Oncologist consultation for further advise.

May I also hear your valuable comments ..?

Also, any supplementary that I can consider? Like Queretin, Inositol-Hexanicotinate, Fucoidan, Agaricus Mycelia etc etc?

Thank you very much !!
Diagnosised on 12Dec18, surgery done on 17Dec18.
40 Years old/ Male
Ascending colon cancer, 5cm
Moderately differentiated adenocarcinoma
TNM code: T3N0M0
Stage II
Positive lymph nodes: 0 positive out of 26 sampled.
Baseline CEA value: 2.6
Lymphovascular invasion (LVI): Area suggestive but not definite for peritumoral lymphovascular permeation are noted
Perineural invasion (PNI): absent
Surgical margins: clear
MSI status : negative
BMI
Primary surgery type: right colon, laparoscopic right hemicolectomy

Lee
Posts: 5762
Joined: Sun Apr 16, 2006 4:09 pm

Re: Stage II but puzzle with the chemo.. : (

Postby Lee » Thu Jan 03, 2019 10:24 am

esuperbaby wrote:Now, we are waiting for Oncologist consultation for further advise.

May I also hear your valuable comments ..?



Hi and welcome, sorry for the reason you are here.

Good that you are getting input from the Onc. Stage II is such a grey area. Generally penetration of the tumor will determine whether chemo is needed or not with a stage II. My personal opinion, when in doubt, do the chemo now. It is much easier to deal with cancer as a stage II vs it going to a stage IV down the road.

Also getting a 2nd opinion at a major cancer hospital is always a good idea.

Good luck,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Beckster
Posts: 301
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Stage II but puzzle with the chemo.. : (

Postby Beckster » Thu Jan 03, 2019 4:54 pm

Welcome! I am a Stage 2a just like you...ascending colon with 0/24 lymph nodes, but LVI. Even though LVI is subjective,but because of my age, my onc suggested 6 months of Xeloda as an "insurance policy." I go to MD Anderson, which is a major cancer center. I have no regrets and am 26 months out and no recurrence. Stage II is a grey area, but I felt that I wanted to do anything possible to make sure this cancer did not recur. You can get all my information below and if you have any questions, please feel free to reach out to me. Surgeons are not oncologists....I am sure that you will get a better picture after you see the onc.



Beckster
57/Female
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 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/17, 12/17, 6/18, 12/18 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
Clear Colonoscopy 10/17 :D

esuperbaby
Posts: 21
Joined: Thu Jan 03, 2019 1:55 am

Re: Stage II but puzzle with the chemo.. : (

Postby esuperbaby » Thu Jan 03, 2019 8:01 pm

Lee wrote:
esuperbaby wrote:Now, we are waiting for Oncologist consultation for further advise.

May I also hear your valuable comments ..?



Hi and welcome, sorry for the reason you are here.

Good that you are getting input from the Onc. Stage II is such a grey area. Generally penetration of the tumor will determine whether chemo is needed or not with a stage II. My personal opinion, when in doubt, do the chemo now. It is much easier to deal with cancer as a stage II vs it going to a stage IV down the road.

Also getting a 2nd opinion at a major cancer hospital is always a good idea.

Good luck,

Lee



Thanks for your reply.

Frankly, I’m hesitate to do chemo unless it’s necessary to do so....

May I ask the chemo period would be very difficult time and make someone very weak and upset?

Have made 2 appointments for Oncologist advise and see how’s next step...

Thank you!
Diagnosised on 12Dec18, surgery done on 17Dec18.
40 Years old/ Male
Ascending colon cancer, 5cm
Moderately differentiated adenocarcinoma
TNM code: T3N0M0
Stage II
Positive lymph nodes: 0 positive out of 26 sampled.
Baseline CEA value: 2.6
Lymphovascular invasion (LVI): Area suggestive but not definite for peritumoral lymphovascular permeation are noted
Perineural invasion (PNI): absent
Surgical margins: clear
MSI status : negative
BMI
Primary surgery type: right colon, laparoscopic right hemicolectomy

esuperbaby
Posts: 21
Joined: Thu Jan 03, 2019 1:55 am

Re: Stage II but puzzle with the chemo.. : (

Postby esuperbaby » Thu Jan 03, 2019 8:07 pm

Beckster wrote:Welcome! I am a Stage 2a just like you...ascending colon with 0/24 lymph nodes, but LVI. Even though LVI is subjective,but because of my age, my onc suggested 6 months of Xeloda as an "insurance policy." I go to MD Anderson, which is a major cancer center. I have no regrets and am 26 months out and no recurrence. Stage II is a grey area, but I felt that I wanted to do anything possible to make sure this cancer did not recur. You can get all my information below and if you have any questions, please feel free to reach out to me. Surgeons are not oncologists....I am sure that you will get a better picture after you see the onc.



Beckster


Thanks for your reply. Our background looks quite similar.

May I ask if your Oncologist mentioned how much % would help if chemo would be used as “insurance policy” in your case?

I’m convinced chemo can somehow help to reduce the recurrence, but with the side effect , I’m not sure if I should go for it ...

Hope I will have a better direction after consulting the Oncologist.

Thanks again !
Diagnosised on 12Dec18, surgery done on 17Dec18.
40 Years old/ Male
Ascending colon cancer, 5cm
Moderately differentiated adenocarcinoma
TNM code: T3N0M0
Stage II
Positive lymph nodes: 0 positive out of 26 sampled.
Baseline CEA value: 2.6
Lymphovascular invasion (LVI): Area suggestive but not definite for peritumoral lymphovascular permeation are noted
Perineural invasion (PNI): absent
Surgical margins: clear
MSI status : negative
BMI
Primary surgery type: right colon, laparoscopic right hemicolectomy

weisssoccermom
Posts: 5892
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Stage II but puzzle with the chemo.. : (

Postby weisssoccermom » Thu Jan 03, 2019 8:47 pm

Stage IIa....rectal cancer.
When your oncologist is mentioning chemo, ask WHAT protocol he/she is talking about. Here are the most common:

FOLFOX: 5FU + oxaliplatin (infusion.....generally with the 5FU you would wear a pump home for 48 hours)
XELOX: Xeloda + oxaliplatin (oxi is infused....Xeloda is a pill....in simplistic terms....Xeloda is the 'oral' form of 5FU)

Both of the above generally require a port to be placed

5FU: infusion.....likely would require a port and a pump
Xeloda: oral form only


What I was told was that the OXI only adds a 2-3% benefit to the 5FU or Xeloda. IF you have no negative prognostic factors (besides LVI, those may include signet cell, mucinous and/or a poorly differentiated tumor) then you should consider talking to your oncologist about XELODA only (you could do 5FU only as well but that would require infusions) and skip the oxi. That would be a decision between you and your oncologist.

My onc was adamant that oxi was NOT indicated for my case but I insisted. I only had ONE infusion of it and stopped because of a horrible reaction. I first tried the 5FU but switched to Xeloda (I didn't like the pump and my reactions on 5FU were much more severe than on Xeloda) and have been fine for the past 11+ years. Personally, I wouldn't skip chemo entirely and if I had to go it again, I would still do the Xeloda and skip the oxi.

I know that you are worried about the side effects but those are not bad on just the Xeloda or even the 5FU. The more severe side effects are generally due to the oxi.
At the very least, talk to your oncologist about options.

Good luck
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

esuperbaby
Posts: 21
Joined: Thu Jan 03, 2019 1:55 am

Re: Stage II but puzzle with the chemo.. : (

Postby esuperbaby » Fri Jan 04, 2019 1:29 am

weisssoccermom wrote:Stage IIa....rectal cancer.
When your oncologist is mentioning chemo, ask WHAT protocol he/she is talking about. Here are the most common:

FOLFOX: 5FU + oxaliplatin (infusion.....generally with the 5FU you would wear a pump home for 48 hours)
XELOX: Xeloda + oxaliplatin (oxi is infused....Xeloda is a pill....in simplistic terms....Xeloda is the 'oral' form of 5FU)

Both of the above generally require a port to be placed

5FU: infusion.....likely would require a port and a pump
Xeloda: oral form only


What I was told was that the OXI only adds a 2-3% benefit to the 5FU or Xeloda. IF you have no negative prognostic factors (besides LVI, those may include signet cell, mucinous and/or a poorly differentiated tumor) then you should consider talking to your oncologist about XELODA only (you could do 5FU only as well but that would require infusions) and skip the oxi. That would be a decision between you and your oncologist.

My onc was adamant that oxi was NOT indicated for my case but I insisted. I only had ONE infusion of it and stopped because of a horrible reaction. I first tried the 5FU but switched to Xeloda (I didn't like the pump and my reactions on 5FU were much more severe than on Xeloda) and have been fine for the past 11+ years. Personally, I wouldn't skip chemo entirely and if I had to go it again, I would still do the Xeloda and skip the oxi.

I know that you are worried about the side effects but those are not bad on just the Xeloda or even the 5FU. The more severe side effects are generally due to the oxi.
At the very least, talk to your oncologist about options.

Good luck


Really appreciate your kind reply , it’s very informative !

I will bring along with me and discuss with the oncologist Tmr!

Thanks again!
Diagnosised on 12Dec18, surgery done on 17Dec18.
40 Years old/ Male
Ascending colon cancer, 5cm
Moderately differentiated adenocarcinoma
TNM code: T3N0M0
Stage II
Positive lymph nodes: 0 positive out of 26 sampled.
Baseline CEA value: 2.6
Lymphovascular invasion (LVI): Area suggestive but not definite for peritumoral lymphovascular permeation are noted
Perineural invasion (PNI): absent
Surgical margins: clear
MSI status : negative
BMI
Primary surgery type: right colon, laparoscopic right hemicolectomy

Beckster
Posts: 301
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Stage II but puzzle with the chemo.. : (

Postby Beckster » Fri Jan 04, 2019 7:00 am

esuperbaby wrote:
Beckster wrote:Welcome! I am a Stage 2a just like you...ascending colon with 0/24 lymph nodes, but LVI. Even though LVI is subjective,but because of my age, my onc suggested 6 months of Xeloda as an "insurance policy." I go to MD Anderson, which is a major cancer center. I have no regrets and am 26 months out and no recurrence. Stage II is a grey area, but I felt that I wanted to do anything possible to make sure this cancer did not recur. You can get all my information below and if you have any questions, please feel free to reach out to me. Surgeons are not oncologists....I am sure that you will get a better picture after you see the onc.



Beckster


Thanks for your reply. Our background looks quite similar.

May I ask if your Oncologist mentioned how much % would help if chemo would be used as “insurance policy” in your case?

I’m convinced chemo can somehow help to reduce the recurrence, but with the side effect , I’m not sure if I should go for it ...

Hope I will have a better direction after consulting the Oncologist.

Thanks again !


My onc did not give percentge. He stated that as Stage II...there are 3 scenerios.
1.they either got all the cancer at surgery and chemo would do nothing,
2. some microscopic cells excaped and chemo would take care of it or
3.some microscopic cells excaped and it would recur even with chemo.

I took the pill form, which was quite doable. It is better being safe than sorry, but it is up to you to make the best decision that works for you
57/Female
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 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/17, 12/17, 6/18, 12/18 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
Clear Colonoscopy 10/17 :D

esuperbaby
Posts: 21
Joined: Thu Jan 03, 2019 1:55 am

Re: Stage II but puzzle with the chemo.. : (

Postby esuperbaby » Fri Jan 04, 2019 8:34 am

Beckster wrote:
esuperbaby wrote:
Beckster wrote:Welcome! I am a Stage 2a just like you...ascending colon with 0/24 lymph nodes, but LVI. Even though LVI is subjective,but because of my age, my onc suggested 6 months of Xeloda as an "insurance policy." I go to MD Anderson, which is a major cancer center. I have no regrets and am 26 months out and no recurrence. Stage II is a grey area, but I felt that I wanted to do anything possible to make sure this cancer did not recur. You can get all my information below and if you have any questions, please feel free to reach out to me. Surgeons are not oncologists....I am sure that you will get a better picture after you see the onc.



Beckster


Thanks for your reply. Our background looks quite similar.

May I ask if your Oncologist mentioned how much % would help if chemo would be used as “insurance policy” in your case?

I’m convinced chemo can somehow help to reduce the recurrence, but with the side effect , I’m not sure if I should go for it ...

Hope I will have a better direction after consulting the Oncologist.

Thanks again !


My onc did not give percentge. He stated that as Stage II...there are 3 scenerios.
1.they either got all the cancer at surgery and chemo would do nothing,
2. some microscopic cells excaped and chemo would take care of it or
3.some microscopic cells excaped and it would recur even with chemo.

I took the pill form, which was quite doable. It is better being safe than sorry, but it is up to you to make the best decision that works for you


Thanks and understand !

May I ask if you take the Xelonda alone?

Thanks again
Diagnosised on 12Dec18, surgery done on 17Dec18.
40 Years old/ Male
Ascending colon cancer, 5cm
Moderately differentiated adenocarcinoma
TNM code: T3N0M0
Stage II
Positive lymph nodes: 0 positive out of 26 sampled.
Baseline CEA value: 2.6
Lymphovascular invasion (LVI): Area suggestive but not definite for peritumoral lymphovascular permeation are noted
Perineural invasion (PNI): absent
Surgical margins: clear
MSI status : negative
BMI
Primary surgery type: right colon, laparoscopic right hemicolectomy

User avatar
susie0915
Posts: 891
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Stage II but puzzle with the chemo.. : (

Postby susie0915 » Fri Jan 04, 2019 9:11 am

I was also 2a rectal cancer. I did do 6 rounds of Xelox after surgery. I had chemo/radiation before chemo and a sigmoidoscopy showed only scar tissue left and pet scan showed no cancer before surgery. My surgeon suggested depending on pathology after surgery may not have to do chemo. The pathology did show minimal residual cancer cells, clear margins, and 0/24 lymph nodes. My oncologist recommended chemo, as she said even though chance of recurrence was low she could not guarantee no cancer cells got into the blood stream. Disappointed I went ahead and did the oxi infusions with xeloda(pill). Infusions were every 3 weeks, and pills were taken for two weeks starting on day of infusion, then one week off. I did have my doses reduced a couple times due to diarrhea. I had my chemo during the winter so there was some cold sensitivity from the oxi. Overall not horrible, I do still have some minor neuropathy in my feet, it is annoying but does not prevent me from doing anything. I would say I am glad I did as I wouldn't want to wonder "what if" if I did have a recurrence and did not do. It is a really tough decision at stage 2 and I know with rectal cancer chemo is recommended more often than with colon cancer.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/only scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change
11/18 CEA .6

Deb m
Posts: 453
Joined: Tue Jan 14, 2014 10:08 am

Re: Stage II but puzzle with the chemo.. : (

Postby Deb m » Fri Jan 04, 2019 1:34 pm

Hello,

were another stage II, ascending colon cancer. We also got our treatment at MDA cancer center in Houston Texas and we were highly advised to do the chemo because my husband was also positive for LVI and he was also a t4. Even if he wasn't a t4, they still would of highly recommended chemo just because of the LVI. We were told that with stage two, if you had any of the high risk features, chemo is needed. These high risk features are:

1. LVI
2. poorly differentiated cells/high grade
3. T4 ( tumor grew thru all layers of colon)
4. less than 12 nodes removed

We did 12 hits of folfox. Were eight years out now and have no regrets. He's been NED since surgery! My advise to you is to get a opinion from a Major cancer center before you make up your mind.

Debbie

peanut_8
Posts: 2299
Joined: Sun May 25, 2014 1:31 pm

Re: Stage II but puzzle with the chemo.. : (

Postby peanut_8 » Fri Jan 04, 2019 3:45 pm

Hi esuperbaby, Welcome to Colon Talk.

I'm a 5 year survivor of stage 2a rectal cancer. Like you, I also had suspected LVI. My oncologist initially recommended I go with FOLFOX for adjuvant treatment. My preference was Xeloda. For a couple reasons, one being that it's a pill, so you eliminate the need for IV's, In my opinion that was to invasive for the added benefit. Like weissoccermom mentioned above, something around 2-3% survival improvement. Secondly it seems that some people who go with FOLFOX end up with permanent neuropathy, from the oxaliplatin in the combo. I discussed the issue with my oncologist, and he agreed that the Xeloda plan was perfectly acceptable.

I understand that you're concerned about side effects during treatment. I can only speak about those associated with Xeloda. The main one is hand/foot syndrome, a condition where your hands and feet become irritated and sometimes even blister. There are ways to mitigate this. One being drinking a lot of fluids. I was going through 2-3 liters of water per day. This helps with flushing out the toxins from treatment. Occasionally I'd add a NUUN tablet for added electrolytes and variety of taste. Using lotion on your feet and hands also helps.

There were other issues with nausea and occasional diarrhea, butt they were manageable. There are meds for these conditions so it's wise to keep your medical team aware of any issue you may encounter.

Can't think of anything else right now, butt good for you that you're doing research before you decide. There are lots of knowledgable and caring folks here on CT, not to mention very helpful.

Best Wishes,
peanut
Terri aka peanut
diagnosed Jan 14, RC stage 2a, age 56
permanent colostomy
MSS
April 14, 28 chemo/rad with Xeloda
June 14 adjuvant Xeloda 6 rounds
currently NED

Beckster
Posts: 301
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Stage II but puzzle with the chemo.. : (

Postby Beckster » Fri Jan 04, 2019 7:12 pm

esuperbaby...

Yes I took 6 months of just Xeloda...we started with Capeox(Oxi and Xeloda) but I was allergic to the oxi. So I just took the pill. Let us know your decision and than, if you decide to take chemo, we can guide you through side effects. The people on this forum are quite knowledgable. They helped me through chemo and its side effects and the 6 months flew by!
57/Female
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 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/17, 12/17, 6/18, 12/18 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
Clear Colonoscopy 10/17 :D

erins
Posts: 35
Joined: Sun May 27, 2018 12:41 pm

Re: Stage II but puzzle with the chemo.. : (

Postby erins » Sat Jan 05, 2019 10:31 am

My oncologist used some of the same numbers for me, but I was negative for LVI (T3N0M0, G1-well-differentiated) tumor, sigmoid colon). He said that it was an even choice, but I have serious underlying kidney issues, so the reduction in recurrence risk wasn’t worth the risk of renal failure. Side effects from chemo didn’t really enter the calculations, and without the kidney issues I’d have likely chosen to do some adjuvant chemo.

Folks here have lots of suggestions either way you go—it’s a hard decision to make, especially if you’re otherwise healthy.
38 yr old female
Rectal bleeding for 1 month—>
5/4/18 colonoscopy found mass in sigmoid colon
5/21/18 LAR
stage 2a, 0/17 lymph, clean margins
T3N0M0 G1
LVI neg, PNI neg, MSS
9/21/18 CEA 0.8
11/16/18 CEA 0.8 & CT clear
12/7/18 iron infusion

DarknessEmbraced
Posts: 3210
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Stage II but puzzle with the chemo.. : (

Postby DarknessEmbraced » Sat Jan 05, 2019 11:56 am

Welcome to to the group! I was diagnosed as stage 2a in 2014. T3N0M0. My pathology report said lymph vascular invasion undetermined so I was referred to an oncologist. The oncologist said chemo would only give me another 3% to 5% reduction in risk. Chemo wasn't recommended. I didn't have chemo and have been in remission since surgery.
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18


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