What surgery should I have?

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CF_69
Posts: 18
Joined: Sat Dec 22, 2018 9:44 pm

What surgery should I have?

Postby CF_69 » Thu Jan 10, 2019 1:32 pm

Hey all,

I will have this discussion with my surgeon, but I don’t see him for another couple of weeks.

I have a T3 N1 adenocarcenoma in the distal sigmoid colon.
Currently doing 25 Xeloda / radiation sessions. 6 more to go.

So I’ve been reading about LARS a lot and it scares the shit out of me (sorry).

I’ve had 2 colonoscopies as I was being diagnosed.

1st one said the tumor was in Sigmoid near the rectosigmoid junction 15 cm from verge.

2nd said 12 cm from verge.

MRI said “about 16 cm craniad to the anal verge adjacent to the rectum above the anterior peritoneal reflection...”

Two nodes seen in the fat of the sigmoid mesocolon, one 5mm the other 3.7 mm.

Will I get a LAR?

Obviously getting the cancer out is the priority but I would like to keep as much rectum as possible.

Has anyone had a similar tumor?
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N1M0
CEA 1.9
Xeloda / radiation x 25

rtcasper
Posts: 48
Joined: Sat Aug 04, 2018 12:12 pm
Location: Ohio

Re: What surgery should I have?

Postby rtcasper » Fri Jan 11, 2019 8:58 pm

Hi, as you can see by my signature, mine was 12-13.5 cm from anal verge, difference between imaging and surgeon's sigmoidoscopy. I'm about 99% certain you're going to have a LAR. I did, had illeostomy,and had reversal surgery this past Tuesday actually. There's nothing about this journey that is pleasant, except for maybe the amazing and wonderful people you're going to meet and the support you will receive from family and friends. Good luck to you and if you have any questions, don't hesitate to ask.
By the glory, by the grace, by the strength of God, I will be made whole.

43-M
Aug 3, 18-colonoscopy, 5cm mass 12cm from AV rectal cancer
Aug 16-MRI
Aug 17-CT,chest and pelvis
CEA-.99-likely not a good marker
Clinical DX-T2/T3n1 -3cm mass, 13.5 from AV-might be colon? - let surgeon make determination
Sept 10-14 radiation
Sept 25-CR lap surgery, temp loop ileostomy
Oct 2-path stage pT1N0M0-no chemo recommended
Jan 8-stoma takedown

CF_69
Posts: 18
Joined: Sat Dec 22, 2018 9:44 pm

Re: What surgery should I have?

Postby CF_69 » Sun Jan 13, 2019 3:21 pm

Thanks for the reply.

I just hope the surgeon can leave me as much rectum as possible.

It seems as though my tumor is on the colon side of the bend, and I know they need to take tissue on either side. Just hoping for the best case scenario going forward.

Of course these are all things I will bring up when I do see my surgeon next. Just wondering if there is an operation that removes the rectosigmoid and leaves the rectum more or less intact, or if they’ll just take everything out.

I know beating this cancer is the number one thing, and I feel a bit silly worrying about “quality of life” down the road before I even get there.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N1M0
CEA 1.9
Xeloda / radiation x 25

User avatar
LPL
Posts: 559
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: What surgery should I have?

Postby LPL » Sun Jan 13, 2019 4:33 pm

Hi CF_69,
I really dont understand why some with the tumor ’in/at’ the sigmoid junction are labelled/treated as Colon cancer (like my husband) and others are treated as Rectal cancer.
My husband’s surgeon wrote in the surgery report: ”resection of the recto-sigmoid junction and the upper rectum”.
He did not have any radiation since that is not the protocol for colon cancer. Maybe your doctor can explain this?
Last edited by LPL on Sun Jan 13, 2019 5:21 pm, edited 1 time in total.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

CF_69
Posts: 18
Joined: Sat Dec 22, 2018 9:44 pm

Re: What surgery should I have?

Postby CF_69 » Sun Jan 13, 2019 4:50 pm

I don’t know why either. That’s the treatment plan my doctors came up with, so I trust their judgement.

I have two suspicious nodes so maybe they wanted to carpet bomb the whole area, so to speak.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N1M0
CEA 1.9
Xeloda / radiation x 25

rtcasper
Posts: 48
Joined: Sat Aug 04, 2018 12:12 pm
Location: Ohio

Re: What surgery should I have?

Postby rtcasper » Sun Jan 13, 2019 6:22 pm

I'm not 100% sure either, as I only received 5 days of radiation prior to surgery. ..that seemed to be a compromise treatment between the rectum vs.colon typical plans. My rectum was removed down to the "..." line, I forget what it's called, plus approx 18 inches of colon. As far as the possibility of leaving more rectum attached, there seems to be evidence to support that it may help in the eventual reversal, so definitely worth asking about. I think it's probably as simple as what the surgeon is comfortable doing. Either way, I've got what I've got and I'm trying to deal with it. Hopefully things work out well for you, keep us informed.
By the glory, by the grace, by the strength of God, I will be made whole.

43-M
Aug 3, 18-colonoscopy, 5cm mass 12cm from AV rectal cancer
Aug 16-MRI
Aug 17-CT,chest and pelvis
CEA-.99-likely not a good marker
Clinical DX-T2/T3n1 -3cm mass, 13.5 from AV-might be colon? - let surgeon make determination
Sept 10-14 radiation
Sept 25-CR lap surgery, temp loop ileostomy
Oct 2-path stage pT1N0M0-no chemo recommended
Jan 8-stoma takedown

User avatar
O Stoma Mia
Posts: 1539
Joined: Sat Jun 22, 2013 6:29 am

Re: What surgery should I have?

Postby O Stoma Mia » Wed Jan 16, 2019 2:44 am

CF_69 wrote:... I will have this discussion with my surgeon, but I don’t see him for another couple of weeks....

So, are you ready for your meeting with your surgeon?

Do you know if your surgeon is a Board Certified Colorectal Surgeon?

Do you know what surgery options are generally available for tumors/ lymph nodes in this location?

If you still have time, you might want to do some research on your own to better prepare yourself for this meeting.

CF_69
Posts: 18
Joined: Sat Dec 22, 2018 9:44 pm

Re: What surgery should I have?

Postby CF_69 » Thu Jan 17, 2019 5:15 pm

Well I’m ready in the sense that I will voice my concerns and ask a few questions that I do have.

My surgeon is a general surgeon / oncology surgeon.

I’ve met him a few times. He dropped in on my colonoscopy, he’s run a few scenarios by me but no final plan yet.

I’ve been reading these boards daily for weeks now so getting a feel for what others have gone through.

Honestly the thought of having no bowel control or ED sucks real bad. I’m also unsure about my future employment. I am / was a seafarer so I’m not sure if I’ll ever be able to go back to living at sea for months at a time, or flying long distances as I have been for the last several years.

Hopefully I can. If not that’s one more obstacle to deal with.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N1M0
CEA 1.9
Xeloda / radiation x 25


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