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.
Beckster wrote:... You should also make sure that they test for MSI-H. If you have this, you might not do chemo..
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....
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.
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
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.
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.
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.
One thing that he stated was of most importance is correct pathology staging.
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
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
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