Newbie trying to get up to speed...

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Rock_Robster
Posts: 399
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Newbie trying to get up to speed...

Postby Rock_Robster » Sat Aug 03, 2019 11:42 pm

The NCCN guidelines for colon cancer say that chemo can be considered but not required for stage 2A without higher risk factors, but a ‘lighter’ chemo such as 5FU or capecitabine (Xeloda) only.

The heavier chemos (FOLFOX/CAPEOX) would be considered if you had one or more of the following higher risk factors:
- close or positive surgical margins
- EMVI, PNI or LVI
- grade 3 or 4 tumour cells
- bowel obstruction or perforation
- less than 12 lymph nodes sampled

Based on a quick scan of your thread, I don’t think any of these apply?

Good luck,
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & (01/20) stoma reversal

jmn
Posts: 48
Joined: Sat Aug 11, 2018 8:20 pm
Location: New York/Philadelphia

Re: Newbie trying to get up to speed...

Postby jmn » Sun Aug 04, 2019 8:28 am

Beckster wrote:The only thing that I can suggest is getting a second pathology on your tumor. Was your pathology done at a Designated Cancer Center https://www.cancer.gov/research/nci-role/cancer-centers? These centers are usually at major cancer centers. I would seriously consider getting a second opinion. You can always request one. The reason being is that Grade, LVI, and PNI is subjective. Having a second set of eyes would be beneficial. I know people, Stage II, that had a second pathology done on their tumor and the results changed, especially with grade and LVI. By doing these two things, you would have a piece of mind. I did not have a second pathology, butt it was done at a major cancer center. It would give me more information needed for recurrence.

Can’t agree more—get a second pathology on your tumor.

Like Beckster, I was diagnosed with Stage IIA colon cancer of the cecum following a successful resection. Based on the pathology report, my oncologist recommended surveillance and no further treatment. However, I decided to get a second opinion at Memorial Sloan Kettering—and I am so happy I did! Their pathologists identified several high-risk features, including LVI and PNI. Given my new Stage IIB diagnosis and the recommendation of my MSK oncologist, I took Xeloda (capecitabine) for six months. The good news is that I finished chemo in April, had my NED status confirmed in May, and had a clear colonoscopy three weeks ago.

I’ll never really know whether chemo will prevent a recurrence in the future, but I have peace of mind knowing that I am doing everything possible to keep the cancer from coming back.

All the best to you as you confirm your diagnosis, consider the risks and benefits of treatment options, and choose a treatment plan that you believe is best for you. PM me if I can be helpful in any way.
DX: CC, 7-9-18 @ age 61, male
Severe anemia (4.5 g/dl), 5-11-18; colonoscopy, 6-29-18
Lap-assisted right hemicolectomy, 7-16-18
G2, moderately differentiated adenocarcinoma in cecum, 4.2 x 3.7 x 0.7 cm
Stage IIB, pT4aN0 (first pathology DX: pT3N0)
0/24 lymph nodes, LVI present, PNI present, surgical margins clear, MSS
CEA: 3.0 (pre-op, 7-10-18); 0.7 (post-op, 8-8-18)
TX: Xeloda (capecitabine) monotherapy, 10-16-18 to 4-21-19
CEA: 4-19, 3.4; 5-19, 3.0; 7-19, 3.0
NED: 5-28-19 :D
Clear colonoscopy, 7-15-19 :D

68r5cwd6me
Posts: 6
Joined: Mon Jul 08, 2019 8:36 pm

Re: Newbie trying to get up to speed...

Postby 68r5cwd6me » Thu Aug 08, 2019 9:01 pm

Thank you for all the replies.

Met with surgeon who, as predicted, suggested the observation route BUT referred me to an oncologist for a more detailed risk/benefit discussion on other alternatives. When I mentioned I was prepared to speak to an oncologist at a major cancer center, he fully encouraged the broader exploration of opinions.

Remaining questions and actions:
1. although the pathology report has been "2nd-opinioned" (from the lab and "verified" by the hospital's pathology dept), my intention is to have the major cancer center runs another histopathology analysis

2. Surgeon's follow up schedule was a bit less aggressive than I was expecting. He suggested 1 year follow up and have both CT scan and colonoscopy done prior. Once I have a chance to discuss with oncologists, will most likely have a more aggressive CT scan (and bloodwork) frequency than a year from now.

3. Rock_Robster, yes I was fortunate not to have those high risk factors. Some studies have included an elevated CEA (mine was 11 pre-op) as a risk factor while at least one study even listed MSS as a risk factor. What is the usual time to revisit the CEA post-ops? A month after surgery? 3-4 months for things to "settle"?
DX: Colon Cancer (Sigmoid) July 2019
Tumor type: Tubular Adenocarcinoma
Tumor grade: G2
T3N0M0 Stage IIa
Lymph Nodes: 0/19
Margin: clear (1.4cm)
LVI PNI: Not identified
MSS
KRAS: Wild
Pre-op CEA: 11 (07/19)
Post-op CEA: 1.9 (08/19)
Oncotype DX: 15 (Lowest Recurrence Risk bracket)

Rock_Robster
Posts: 399
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Newbie trying to get up to speed...

Postby Rock_Robster » Thu Aug 08, 2019 9:24 pm

68r5cwd6me wrote:3. Rock_Robster, yes I was fortunate not to have those high risk factors. Some studies have included an elevated CEA (mine was 11 pre-op) as a risk factor while at least one study even listed MSS as a risk factor. What is the usual time to revisit the CEA post-ops? A month after surgery? 3-4 months for things to "settle"?

That’s great news 68r5cwd6me!

Indeed some studies have used CEA; eg. >200 at diagnosis is a risk factor in the Fong Clinical Risk Score for liver mets, but it didn’t make it into the NCCN guidelines. I suppose MSS could be risk factor, but if so it’s one that 95% of patients have so I’m not sure how useful that is for differentiation...

For Stage II follow-up, the NCCN guidelines recommend CEA testing every 3-6 months for 2 years, CT scans every 6-12 months for 5 years, and annual colonoscopies (provided you had a complete colonoscopy at diagnosis). My onc has usually tested CEA about a month after surgery - I gather you want quite a prompt reading, but too close to surgery could cause false positives with inflammation etc.
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & (01/20) stoma reversal

jmn
Posts: 48
Joined: Sat Aug 11, 2018 8:20 pm
Location: New York/Philadelphia

Re: Newbie trying to get up to speed...

Postby jmn » Thu Aug 08, 2019 9:31 pm

See quick responses below …

Remaining questions and actions:
1. although the pathology report has been "2nd-opinioned" (from the lab and "verified" by the hospital's pathology dept), my intention is to have the major cancer center runs another histopathology analysis Great! I had mine done at Memorial Sloan Kettering.

2. Surgeon's follow up schedule was a bit less aggressive than I was expecting. He suggested 1 year follow up and have both CT scan and colonoscopy done prior. Once I have a chance to discuss with oncologists, will most likely have a more aggressive CT scan (and bloodwork) frequency than a year from now. You may be right. Your oncologist will recommend an appropriate surveillance strategy.

3. Rock_Robster, yes I was fortunate not to have those high risk factors. Some studies have included an elevated CEA (mine was 11 pre-op) as a risk factor while at least one study even listed MSS as a risk factor. What is the usual time to revisit the CEA post-ops? A month after surgery? 3-4 months for things to "settle"? Not sure of the usual time, but my first post-op CEA was done about month after my CEA pre-op was done—a little better than three weeks after my resection.
DX: CC, 7-9-18 @ age 61, male
Severe anemia (4.5 g/dl), 5-11-18; colonoscopy, 6-29-18
Lap-assisted right hemicolectomy, 7-16-18
G2, moderately differentiated adenocarcinoma in cecum, 4.2 x 3.7 x 0.7 cm
Stage IIB, pT4aN0 (first pathology DX: pT3N0)
0/24 lymph nodes, LVI present, PNI present, surgical margins clear, MSS
CEA: 3.0 (pre-op, 7-10-18); 0.7 (post-op, 8-8-18)
TX: Xeloda (capecitabine) monotherapy, 10-16-18 to 4-21-19
CEA: 4-19, 3.4; 5-19, 3.0; 7-19, 3.0
NED: 5-28-19 :D
Clear colonoscopy, 7-15-19 :D


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