Green Tea wrote:SilverWedding wrote:...
Again, the plan is
Monday - bloodwork surgeon Dr Vaid ordered
Wednesday - almost full body CT scans with dye
Thursday - see surgeon Dr. Vaid
Friday - see colonoscopy dr again for some reason
I’m looking at Colonoscopy Report. It says
1) Terminal ileum was normal
2) internal and External Hemorrhoids
3) Diverticulosis of Sigmoid Colon
4) Large, more than 5cm, firm friable mass starting at [dentate] line extending into rectal vau. The mass occupies 2/3 circumference of dentate line.
...
Thank you for posting this information. I will reply with some tentative thoughts so that you will at least have some basis for your meeting with the surgeon on Thursday. Between now and next Thursday you will have to do some homework so that you can understand the technical terms that the surgeon may be using in his explanation of your options.
The main issue, in my opinion, is that the tumor is judged to be very, very low and is resting on the dentate line itself. This makes it very difficult to do a clean surgery because both the internal and external anal sphincter muscles are located there, just outside the rectum/anal-canal wall. Furthermore, there may be even other problems once the results of the pelvic scan are in: The scans may show cancer involvement in adjacent areas, such as the bladder, the pelvic lymph nodes or in the sphincter muscles themselves.
First, before next Thursday you should learn more about the anatomy of the rectum and the anal canal. Here is an image showing the area where the pectinate or dentate line is located. It is very close to where the sphincter muscles are located:
Anal canal imageFor dealing with cancers in this location, I think that there are two (or maybe three) main surgical options available. The first of these is called ULAR (Ultra Low Anterior Resection), and the second is called APR (Abdomino-Perineal Resection). You should familiarize yourself with these two terms before next Thursday.
Here is a prior thread on this forum with 16 posts concerning ULAR vs APR. You can read through the responses to see what the main issues are.
Difficult decision: ULAR or APR?https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=53956And another, more recent, thread:
APR surgery for low rectal tumorhttps://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=62441Here are two scientific articles that deal with this area:
A retrospective analysis of ultralow anterior resection vs. abdomino-perineal resection for lower rectal cancer.https://www.ncbi.nlm.nih.gov/pubmed/22246189Abdominoperineal Resection: How Is It Done and What Are the Results?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789508/In addition, you can look at what some of the cancer center websites say about the options for rectal cancer surgery:
Surgery options for rectal cancerhttps://www.cancersa.org.au/information/a-z-index/surgery-for-bowel-cancerhttps://www.texasoncology.com/types-of-cancer/rectal-cancer/surgery-for-rectal-cancer/From the plan for next week that you posted above, it looks like your scan results and lab results will be done at the last minute and probably not be available to you until you meet with the surgeon. If that is the case, you will have to be prepared for a barrage of technical terms that you have not yet encountered. You may have to ask the surgeon to slow down and to explain each of the unknown terms that show up in the scan reports and the lab report. It is important that you understand all of the technical details before you are asked to make a decision.
Before next Thursday, try to do as much research as you can about low rectal tumors so that you can follow the surgeon's discussion. Try not to be pressured into making any decision on the spot. Ask for more time to study the issue or to solicit a second opinion if you think you need to.
Here is a sample of an Informed Consent Form for an Abdominal-Perineal Resection. It will give you an idea of what is involved in that type of operation:
https://www.health.qld.gov.au/__data/assets/pdf_file/0034/149695/colorectal_01.pdfAnother resource you can study this week is the NCCN Quick Guide to Rectal Cancer. It gives a good, easy-to-read, summary of the different tests involved and the available treatments for the different stages of Rectal Cancer. You should make yourself familiar with the different stages in the TNM staging system, because tentative staging is the primary objective of the different tests being done this week:
https://www.nccn.org/patients/guidelines/rectal/index.htmlAbout the NCI designation for the Graham Center, it is classified as an NCI Community Cancer Center, not as an NCI Comrehensive Cancer Center. NCI has two levels of cancer center certification. The top level is Comprehensive Cancer Center, of which there are now 70 in the country. Below that are the NCI Community Cancer Centers. The Christiana Hospital has been a Community Cancer Center for over 10 years. This is different from a Comprehensive Cancer Center.