Risk/Benefit analysis of radiation for Women with Rectal Cancer?

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boxhill
Posts: 220
Joined: Fri Apr 06, 2018 11:40 am

Risk/Benefit analysis of radiation for Women with Rectal Cancer?

Postby boxhill » Tue Mar 12, 2019 1:00 pm

The more I read about the side effects suffered by many women after radiation for rectal cancer, the more I see them downplayed in places such as the ACA website, the more women say that their doctors never informed them of the risks or how to best address them, the more I wonder whether the largely male onco/radiology world is giving any seriously thought to whether some women should not receive radiation before surgery, when it seems to be routinely dispensed.

The primary reason for pre-surgical radiation and chemo appears to be to "make the tumor easier to remove." In fact, it would appear to be close to the sole reason, since situations where radiation of tissues in the area to prevent spread seem warranted can be addressed during or post surgery.

I have recently read the stories of several women who report that their tumor shrank significantly (50% was cited) after 4 cycles or so of pre-surgical Folfox, but then the plan is to go ahead and irradiate them anyway.

It is the norm, as my neurosurgeon would say, to undergo a risk/benefit analysis before undertaking any medical procedure . I am wondering whether the doctors involved in these cases, largely male, are taking a woman's sexual health and quality of life into consideration AT ALL. Let us not forget that a couple of decades ago the hysterectomy was the most frequently performed surgery and the one most likely to be deemed unnecessary. Let us also not forget that surgeons exerted themselves to develop nerve-sparing surgical techniques in prostate surgery, the sole point of which is to help a man preserve his sexual function and continence, not to make surgery easier or save his life. Why don't they do routine irradiation of the prostate bed after surgery to maximize progression-free survival? They only do it if a rising PSA indicates need.

I would love to see some discussion of this, especially with colorectal surgeons. I wonder if anyone has had or read about such a discussion.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemicolectomy
11 of 25 nodes,5 of 5 mesentery nodes
0.5 cm sub-capsular liver met removed
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28/18
7/9/18 CT no masses or enlarged nodes, 2mm indeterminate lung nodule
11/20/18 CT same, Lung nodule likely calcified granuloma. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met and 2 lymph nodes in porta hepatis, CT review shows progression of nodes on FOLFOX
12/31/18 Keytruda

teachpdx
Posts: 621
Joined: Wed Jan 16, 2013 12:29 am
Location: Portland, OR

Re: Risk/Benefit analysis of radiation for Women with Rectal Cancer?

Postby teachpdx » Wed Mar 13, 2019 12:59 pm

Boxhill,

I totally concur with you. My sex life is pretty much over (not that I have one anyway). It would be way too painful and the tissue is so compromised that with the slightest amount of friction I can have tears. I went to a gynecologist (female) after my treatments to see if she could help me find some relief to the dryness, pain, etc. When I asked her about why my vagina was now white instead of pink, assuming radiation damage, she suggested that she could do a biopsy to see what the problem was. I was incredulous. I knew what the problem was.

It's a huge problem and I'm on disability due to the side effects. I gave birth to 12 pound child 25 years ago and I think part of my problem is the lack of stability the rectum provides and in women having wider pelvises means less stability.

Each treatment comes with it's own side effects. I didn't take any oxyalitplatin post because as a Lynch patient with have less chances of metastices. I also didn't want to have neuropathy for the rest of my life. If I had to choose between loosing my sex life or loosing my tactile senses I'd probably choose loosing my sex life.

Peace,

Kristi
4/24/12 RC T3N1M0 age 53
5/23-7/2 - 26 chemorad - Xeloda
7/16 Lynch- MSH2
8/28 LAR w/ temp ileo, CR, 0/11,M0, hysterectomy
10/13 6 cycles Xeloda - completed only 1 1/2 due to HFS
3/12/13 - reversal
8/13 NED
6/15 - HFS gone!


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