Need thoughts

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Jen43
Posts: 12
Joined: Sat Mar 23, 2019 9:52 pm

Need thoughts

Postby Jen43 » Wed Jun 05, 2019 11:00 am

I received my pathology report from my surgeon I have stage 2 pT3N0M0

With G2, 0/17 lymph nodes but I did have positive for intramural large vessel invasion and perineural invasion both sound very scary and from what I read means high risk of spreading or recurrence.

I will see the oncologist soon and he will talk to me about chemo. I seen a lot saying chemo may not make a difference in stage 2.

If anyone can share some light on this I be very grateful.

retiredteacher
Posts: 102
Joined: Sat Oct 21, 2017 1:34 pm

Re: Need thoughts

Postby retiredteacher » Wed Jun 05, 2019 11:42 am

Sorry to hear about your diagnosis. While I did not get a decent initial staging, guessing I was close to yours, about 20 months ago, except rectal. Wondered to my oncologist if he could make a case for "wait and watch." He said the yes, he probably could if he wanted to. But, he added, when someone hands you a chance for a cure, you might want to take it. So that was my reasoning. This far out, clear scans and colonoscopy - some neuropathy damage in feet and radiation damage in bones. I would have made the same decision if I had to do it again - then again, many folks have gone the wait and watch route. At any rate, it's good that you are here for good information as well as differing perspectives.
RC, F, 63 at diagnosis, Sept. 2017
Adeno 6.3 - 7 cm tumor (PET) MSS, G2,
Est. T3N0M0 PET
2500 Cap/RT Oct/Nov18; 25 treatments
"Near complete metabolic response" PET Jan 2018
CEA 0.5 Oct. 2017, Jan. 2018, 0.6 Oct. 2018
MRI Feb. 2018 Presurg yT2 N0 12 cm from AV 3 cm
LAR Feb 20 yT1N0M0 0/21 G1 0.3 cm
CAPEOX March 2018, oxi and cap reduced to 80% at cycle 3
Completed 4 cycles CAPEOX; stopped due to gut issues, liver enzymes
Clear CT and colonoscopy November 2018. NED. :-)

Beckster
Posts: 367
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Need thoughts

Postby Beckster » Wed Jun 05, 2019 12:50 pm

Jen43 wrote:I received my pathology report from my surgeon I have stage 2 pT3N0M0

With G2, 0/17 lymph nodes but I did have positive for intramural large vessel invasion and perineural invasion both sound very scary and from what I read means high risk of spreading or recurrence.

I will see the oncologist soon and he will talk to me about chemo. I seen a lot saying chemo may not make a difference in stage 2.

If anyone can share some light on this I be very grateful.


Welcome... T3NOMO means that your are Stage 2A. You have 2 high risk factors..LVI and PNI. I too am stage 2A with a G3 and LVI. Stage II is a grey area. Some do chemo and some do not. You could get a second eye for pathology if you want to make sure that doctors agree on your report because some high risk factors are subjective. As you can see from my signature, I did 6 months of Xeloda. You should also make sure that they test for MSI-H. If you have this, you might not do chemo. Bring someone in with you when you meet with your oncologist, so you have a second set of ears. If you have any questions, please feel free to message me.

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 (path) 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
1/2/17 to 6/9/17- Xeloda monotherapy
6/17, 12/17, 6/18, 12/18, 6/19 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
Clear Colonoscopy 10/17 :D

Green Tea
Posts: 187
Joined: Mon Oct 24, 2016 10:48 am

Re: Need thoughts

Postby Green Tea » Wed Jun 05, 2019 11:40 pm

Beckster wrote:... You should also make sure that they test for MSI-H. If you have this, you might not do chemo..

Jen43 - When you meet with the oncologist, you could ask how your tumor could be tested for 'microsatellite instability' (MSI). For this type of test, the hospital may need to send the specimen to a special lab in another city or another province. Specialized tests like this are not always available in small, local hospitals.

This test is needed in order to make sure they don't give you the wrong kind of chemo.

It might also help to put your country name in the Location field in your profile. This way other members from Canada might notice your post and have some comments for you on how to successfully navigate the Canadian health care system.

If you want to do that, a link for updating your profile is here. The Location field is just below the AOL field:

https://coloncancersupport.colonclub.com/ucp.php?i=164

Rock_Robster
Posts: 100
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Need thoughts

Postby Rock_Robster » Thu Jun 06, 2019 1:07 am

Indeed, there appears on average to only be a survival benefit from adjuvant chemo in a small number of Stage II patients; the challenge is in identifying which patients are most likely to benefit, given the risks and costs of doing chemotherapy.

The NCCN guidelines suggest you might consider no chemo or a ‘lighter’ chemo (ie just Xeloda / capecitabine) for a ‘low risk’ stage II. For a ‘high risk’ stage II, treatment with FOLFOX may be indicated.

The ‘high risk’ factors identified are:
- Close or positive surgical margins
- Grade 3 or 4 cancer cells
- Lymphatic or vascular invasion
- Perineural invasion
- Fewer than 12 lymph nodes sampled
- Bowel obstruction or perforation

From your post, it seems you have 2 of these risk factors (EMVI and PNI), suggesting adjuvant FOLFOX may be appropriate.

There is an odd paradox where sometimes Stage II outcomes seem to be worse than Stage III; potentially because Stage II is not treated as aggressively. If I were in your shoes I would be giving serious thought to doing the adjuvant chemo. This may also depend on your age and overall health status. There also are things you can do minimise the long-term risks - for example I believe there are recent recommendations that 6 cycles of FOLFOX is sufficient for Stage II adjuvant treatment, which significantly reduces the risk of permanent neuropathy (vs 12 cycles).

As others have said too, your MSI status should be a consideration in this, along with any other mutations (RAS/BRAF).

If you’d like to be really cutting edge, you might inquire about ctDNA testing after surgery. There is recent research showing this can be a strong predictor of residual recurrence risk after curative surgery. You might have to pay for this yourself but it could be a game-changer in terms of insight:
https://jamanetwork.com/journals/jamaon ... le/2733132

Not an easy call, but best of luck.

Rob
Last edited by Rock_Robster on Thu Jun 06, 2019 6:46 am, edited 1 time in total.
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 cycles neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)
07/19 - Planned restaging scans and ULAR w temp ileo

Jen43
Posts: 12
Joined: Sat Mar 23, 2019 9:52 pm

Re: Need thoughts

Postby Jen43 » Thu Jun 06, 2019 5:57 am

Thank you all for your reply’s it’s all be very helpful.

A few things for me to add is I am 39, I also have cirrhosis of the liver caused by fatty liver which just makes me so unsure what chemos if ant would I be able to have.

There was a comment on my pathology report saying that it have been sent for MSI testing which I am happy they took that step.

I will also be having genetic testing done.

Green Tea
Posts: 187
Joined: Mon Oct 24, 2016 10:48 am

Re: Need thoughts

Postby Green Tea » Thu Jun 06, 2019 6:33 am

Jen43 wrote: I also have cirrhosis of the liver caused by fatty liver which just makes me so unsure what chemos if any would I be able to have....

Chemotherapy Dosing in the Setting of Liver Dysfunction
https://www.cancernetwork.com/oncology-journal/chemotherapy-dosing-setting-liver-dysfunction
.
Hepatotoxicity Secondary to Chemotherapy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521265/

boxhill
Posts: 242
Joined: Fri Apr 06, 2018 11:40 am

Re: Need thoughts

Postby boxhill » Thu Jun 06, 2019 9:25 am

Welcome to the ongoing state of uncertainty that is CRC, alas! I'm happy to hear that you are "only" stage II, but sympathize with the dilemma posed by your risk factors and pre-existing liver disease.

You've gotten excellent advice already. It's great that your doctors have already sent your samples for MSI testing: they are clearly on the ball. The results will have a lot to do with your further course of action, since at this point it is agreed that those of us who are MSI-H are less likely to respond to 5FU-based chemo (FOLFOX, FOLFIRI, Xeloda, etc). I do not know what the actual percentages of responders/nonresponders are. If you have a KRAS mutation--KRAS and BRAF testing should be done and may be part of your pathology report--another group of drugs that address the EGFR pathway are out (Erbitux, Vectibix).

Despite this, virtually all of us who are MSI-H have had to "fail" one of the standard 5FU chemos in order to be allowed to try an immunotherapy such as Keytruda or Opdivo/Yervoy, unless we were able to get into a trial. So the fact that so many MSI-H people have done that kind of chemo doesn't mean it is ideal. Of course, if you are MSS, this is all irrelevant. :) No matter what, I'd advise looking into whether any trials are available.

As to lingering/permanent chemo side effects, mostly people worry about neuropathy, and that is caused by Oxaliplatin. Reducing the dose of oxi and/or eliminating it completely after a number of chemo cycles reduces the likelihood of developing the problem by limiting the cumulative dose. Especially as a Stage II patient, you could be very conservative with it.

As a Stage II person, you will want to take all this into account when deciding on chemo, depending on what they offer you, and ask a lot of questions.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemicolectomy
11 of 25 nodes,5 of 5 mesentery nodes
5mm liver met removed
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED, 2mm indeterminate lung nodule
11/20/18 CT NED, Lung nodule calcified granuloma. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met and 2 lymph nodes in porta hepatis, CT review shows progression on FOLFOX
12/31/18 Keytruda
6/5/19 Triphasic CT LNs shrunk to normal, Liver node stable

rp1954
Posts: 1518
Joined: Mon Jun 13, 2011 1:13 am

Re: Need thoughts

Postby rp1954 » Thu Jun 06, 2019 3:13 pm

Rock_Robster wrote:Indeed, there appears on average to only be a survival benefit from adjuvant chemo in a small number of Stage II patients; the challenge is in identifying which patients are most likely to benefit, given the risks and costs of doing chemotherapy.

In principle, if targetable, different chemo formulations should favor different biologies. Our review found a low pain alternative for a high risk CA199 group rather than skipping chemo. (CA199+CSLEX1 is much less common in stage 2)

The ‘high risk’ factors identified are:
- Close or positive surgical margins
- Grade 3 or 4 cancer cells
- Lymphatic or vascular invasion
- Perineural invasion
- Fewer than 12 lymph nodes sampled
- Bowel obstruction or perforation

Some outside the US would add those with high density stains of CA199 and CSLEX1.

There is an odd paradox where sometimes Stage II outcomes seem to be worse than Stage III; potentially because Stage II is not treated as aggressively.

There is/was discussion that those undiscovered stage 2's with more metastatic biology graduate much faster to stage 4, whereas some of the less aggressive CRC lines accumulate in stage 3, shifting the statistical risks to create the perceived paradox.
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 to almost nothing mid 2018, mostly IV C

Beckster
Posts: 367
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Need thoughts

Postby Beckster » Thu Jun 06, 2019 3:30 pm

rp1954 wrote:
Rock_Robster wrote:Indeed, there appears on average to only be a survival benefit from adjuvant chemo in a small number of Stage II patients; the challenge is in identifying which patients are most likely to benefit, given the risks and costs of doing chemotherapy.

In principle, if targetable, different chemo formulations should favor different biologies. Our review found a low pain alternative for a high risk CA199 group rather than skipping chemo. (CA199+CSLEX1 is much less common in stage 2)

The ‘high risk’ factors identified are:
- Close or positive surgical margins
- Grade 3 or 4 cancer cells
- Lymphatic or vascular invasion
- Perineural invasion
- Fewer than 12 lymph nodes sampled
- Bowel obstruction or perforation

Some outside the US would add those with high density stains of CA199 and CSLEX1.

There is an odd paradox where sometimes Stage II outcomes seem to be worse than Stage III; potentially because Stage II is not treated as aggressively.

There is/was discussion that those undiscovered stage 2's with more metastatic biology graduate much faster to stage 4, whereas some of the less aggressive CRC lines accumulate in stage 3, shifting the statistical risks to create the perceived paradox.


When I first met my oncologist, he stated that with stage 2, there are 3 scenerios. Surgery removed all cancer and chemo would not do anything, microsopic cells were left and chemo would erraticate the cancer, or microsopic cell were left and chemo did not work. One thing that he stated was of most importance is correct pathology staging.
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 (path) 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
1/2/17 to 6/9/17- Xeloda monotherapy
6/17, 12/17, 6/18, 12/18, 6/19 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
Clear Colonoscopy 10/17 :D

rp1954
Posts: 1518
Joined: Mon Jun 13, 2011 1:13 am

Re: Need thoughts

Postby rp1954 » Fri Jun 07, 2019 3:43 pm

Beckster wrote: When I first met my oncologist, he stated that with stage 2, there are 3 scenerios. Surgery removed all cancer and chemo would not do anything, microsopic cells were left and chemo would erraticate the cancer, or microsopic cell were left and chemo did not work.

Changes in chemo chemistry can change the identities of beneficiarees and degree of benefits and complications, depending on the biology of the patient and the cancer cells. Oxi- benefits are much argued for various stage 2s. I've mentioned Japan's works on CA199+CSLEX1 with mild, daily 5FU with targeted cimetidine when specifically matched, otherwise shorter, high dose 5FU based burnout strategies sound pretty optimal.

One thing that he stated was of most importance is correct pathology staging.

DIscrepancies in various blood tests have more potential to pick up errors or unknowns in staging that are really stage 4s (e.g. T3N0M1). Misses like this screw more nominal 3s but it happens to nominal 2s also. This is one reason why better, broader initial labs before and after surgery can make a difference.
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 to almost nothing mid 2018, mostly IV C

Jen43
Posts: 12
Joined: Sat Mar 23, 2019 9:52 pm

Re: Need thoughts

Postby Jen43 » Fri Jun 07, 2019 6:09 pm

I feel so confused by all this. I haven’t had any of those blood test or how I get them or about tissue on the slides

Pyro70
Posts: 101
Joined: Mon Jan 21, 2019 4:25 pm

Re: Need thoughts

Postby Pyro70 » Sat Jun 08, 2019 9:11 am

Jen43 wrote:I feel so confused by all this. I haven’t had any of those blood test or how I get them or about tissue on the slides


Jen don’t let RP stress you out. The advice he pushes on people is not accepted by the medical community and you won’t find it in any national guidelines (in the US or elsewhere). That’s why you haven’t heard about it. If you look into the evidence to support his claims it is very weak. He has been pushing this stuff for years, but never seems to provide advice on actual new developments in cancer care that are really revolutionizing how we treat patients (immunotherapy, targeted therapies, etc).


My advice to you is first, first consider yourself lucky. You caught it earlier than many of us. You have a good chance at a complete cure! Discuss with your oncologist if chemo makes sense. Currently there is a trend to doing more chemo in high risk stage 2 patients, but maybe skipping it in lower risk stage 3 patients. I’m not sure how high your risk level is.

In addition to MSI testing I would insist on getting NGS molecular profiling of your cancer (this will likely include MSI). Getting NGS at diagnosis is really SOC now. In your case i might also consider getting a circulation tumor DNA blood test. The science on ctDNA isn’t settled. But if it comes back negative, it’s unclear what it means. But if you get a positive, I would definitely do chemo. Now if you’re going to do chemo anyways, probably no need for a test.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

Green Tea
Posts: 187
Joined: Mon Oct 24, 2016 10:48 am

Re: Need thoughts

Postby Green Tea » Sat Jun 08, 2019 10:41 am

What I would suggest for your first meeting with the oncologist is for you to review the results of any standard blood tests that you have already had and ask the oncologist if these results indicate if you are healthy enough to endure a course of chemotherapy or not.

By now, you should have had the standard blood tests that are usually done for any annual check-up, namely, (1) Complete Blood Count (CBC) with differential , and (2) a Comprehensive Metabolic Panel.

Look specifically for any tests that are borderline abnormal or out-of-range. Of particular interest would be the tests in the liver panel, because you have a compromised liver.

Also ask the oncologist if you have any borderline results in immune-system deficiency that would make it difficult for you to have successful chemo.

Here are some test descriptions quoted from labtestsonline.org :

    "Complete Blood Count (CBC)
      What is being tested?
      The complete blood count (CBC) is a test that evaluates the cells that circulate in blood. Blood consists of three types of cells suspended in fluid called plasma: white blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs). They are produced and mature primarily in the bone marrow and, under normal circumstances, are released into the bloodstream as needed...

      A standard CBC includes the following:

    1. Evaluation of white blood cells: WBC count;
        The five different types of WBCs include:

      1. Neutrophils (neu) normally make up the largest number of circulating WBCs. They move into an area of damaged or infected tissue, where they engulf and destroy bacteria or sometimes fungi.
      2. Eosinophils (eos) respond to infections caused by parasites, play a role in allergic reactions (hypersensitivities), and control the extent of immune responses and inflammation.
      3. Basophils (baso) usually make up the fewest number of circulating WBCs and are thought to be involved in allergic reactions.
      4. Lymphocytes (lymphs) exist in both the blood and the lymphatic system. They are divided into three types, but the differential does not distinguish among them.
        • B lymphocytes (B cells) are antibody-producing cells that are essential for acquired, antigen-specific immune responses. Plasma cells are fully differentiated B-cells that produce antibodies, immune proteins that target and destroy bacteria, viruses and other "non-self" foreign antigens.
        • T lymphocytes (T cells) finish maturing in the thymus and consist of a few different types. Some T cells help the body distinguish between "self" and "non-self" antigens. Others initiate and control the extent of an immune response, boosting it as needed and then slowing it as the condition resolves. Other types of T cells directly attack and neutralize virus-infected or cancerous cells.
        • Natural killer cells (NK cells) directly attack and kill abnormal cells such as cancer cells or those infected with a virus.
      5. Monocytes (mono), similar to neutrophils, move to an area of infection and engulf and destroy bacteria. They are associated more often with chronic rather than acute infections. They are also involved in tissue repair and other functions involving the immune system.
    2. Evaluation of red blood cells: RBC count, hemoglobin (Hb), hematocrit (Hct) and RBC indices, which includes mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW). The RBC evaluation may or may not include reticulocyte count.

    3. Evaluation of platelets: platelet count; may or may not include mean platelet volume (MPV) and/or platelet distribution width (PDW)"

    "Comprehensive Metabolic Panel (CMP-14)
      What is being tested?
      The comprehensive metabolic panel (CMP) is a frequently ordered panel of 14 tests that gives a healthcare provider important information about the current status of a person's metabolism, including the health of the kidneys and liver, electrolyte and acid/base balance as well as levels of blood glucose and blood proteins. Abnormal results, and especially combinations of abnormal results, can indicate a problem that needs to be addressed.

      The CMP includes the following tests:

    1. Glucose - energy source for the body; a steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood.
    2. Calcium - one of the most important minerals in the body; it is essential for the proper functioning of muscles, nerves, and the heart and is required in blood clotting and in the formation of bones.
      Proteins
    3. Albumin - a small protein produced in the liver; the major protein in serum
    4. Total Protein - measures albumin as well as all other proteins in serum
      Electrolytes
    5. Sodium - vital to normal body processes, including nerve and muscle function
    6. Potassium - vital to cell metabolism and muscle function
    7. CO2 (carbon dioxide, bicarbonate) - helps to maintain the body's acid-base balance (pH)
    8. Chloride - helps to regulate the amount of fluid in the body and maintain the acid-base balance
      Kidney Tests
    9. BUN (blood urea nitrogen) - waste product filtered out of the blood by the kidneys; conditions that affect the kidney have the potential to affect the amount of urea in the blood.
    10. Creatinine - waste product produced in the muscles; it is filtered out of the blood by the kidneys so blood levels are a good indication of how well the kidneys are working.
      Liver Tests◄◄◄
    11. ALP (alkaline phosphatase) - enzyme found in the liver and other tissues, bone; elevated levels of ALP in the blood are most commonly caused by liver disease or bone disorders.
    12. ALT (alanine amino transferase, also called SGPT) - enzyme found mostly in the cells of the liver and kidney; a useful test for detecting liver damage
    13. AST (aspartate amino transferase, also called SGOT) - enzyme found especially in cells in the heart and liver; also a useful test for detecting liver damage
    14. Bilirubin - waste product produced by the liver as it breaks down and recycles aged red blood cells"

      Reference for Comprehensive Metabolic Panel (CMP-14) https://labtestsonline.org/tests/comprehensive-metabolic-panel-cmp

Also, be sure to tell the oncologist about any treatments you have already had for your fatty liver diagnosis. In addition, the oncologist will also want to take note of whether you are a smoker and whether you are obese, because these two factors are risk factors for successful chemo.

Just try to ask enough questions now so that you can understand if your overall heath condition at this point in time will make it difficult for you to have any chemo at all.

Wishing you a successful meeting with your new oncologist!

User avatar
CRguy
Posts: 9899
Joined: Sun Feb 10, 2008 6:00 pm

Re: Need thoughts

Postby CRguy » Sat Jun 08, 2019 1:09 pm

Jen43 wrote:I feel so confused by all this. I haven’t had any of those blood test or how I get them or about tissue on the slides


It is easy to get overwhelmed with all this. Many of us have been here and dealing with doctors / tests and treatments for many years
BUTT ... if it is overwhelming to you ... we apologize
Just trying to help give you the benefit of our combined experiences.

Having a talk with your docs and asking some of these questions is a good start.
Get a binder, write notes and maybe even take someone with you as a second set of ears.
Sometimes Doctors get overwhelming too ! :shock:

Don't be afraid to ask questions here on forum or send PMs to individual members.

We are here as a support forum, BUTT only you know how much "support" might be too much.

Cheers and best wishes
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far


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