Staging and treatment options.

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camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Fri Aug 02, 2019 8:44 am

Rock_Robster wrote:
camicom wrote:
kaloy85 wrote:isn't it T3N1 is stage 3B, not 3A (T1-T2/N1, T1/N2a)?

pT3pn1a is on the report.

For this one I would agree with Kaloy; I believe T3 with any lymph node involvement would be stage 3b.


https://www.cancer.gov/images/cdr/live/ ... 29-750.jpg
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Fri Aug 02, 2019 8:50 am

Rock_Robster wrote:
camicom wrote:
kaloy85 wrote:isn't it T3N1 is stage 3B, not 3A (T1-T2/N1, T1/N2a)?

pT3pn1a is on the report.

For this one I would agree with Kaloy; I believe T3 with any lymph node involvement would be stage 3b.


https://www.cancercenter.com/cancer-typ ... cer/stages

Stage III (stage 3 colorectal cancer): Stage III colorectal cancer is divided into three categories:

Stage IIIA: The cancer has grown into the intestine wall, through the mucosa (the inner lining) and into the submucosa and may have entered the muscle. The cancer has spread to up to three lymph nodes near the site of the primary tumor.

Stage IIIB: The cancer has grown into or through the outermost layer of the colon or rectum and may have spread into nearby organs or tissues. The cancer has spread to up to three lymph nodes near the primary site, but has not spread to distant organs.

Stage IIIC:The cancer has grown into or through the outermost layer of the colon or rectum and may have spread to four or more lymph nodes near the primary site. The cancer has also spread to nearby organs.
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

Rock_Robster
Posts: 184
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Staging and treatment options.

Postby Rock_Robster » Fri Aug 02, 2019 8:55 am

camicom wrote:
Rock_Robster wrote:
camicom wrote:pT3pn1a is on the report.

For this one I would agree with Kaloy; I believe T3 with any lymph node involvement would be stage 3b.


https://www.cancer.gov/images/cdr/live/ ... 29-750.jpg

I think what’s shown there is a T2 tumour, as it has not reached the subserosa. I believe a T3 tumour with 1 LN would be Stage 3b according to the AJCC system:
https://www.cancer.org/cancer/colon-rec ... taged.html
Male 37 yr; Melbourne, Australia. BMI 24
10/2018 Dx 3.5 cm RC adenocarcinoma, 12cm from AV
Mod diff (G2), EMVI+, LVI+, PNI-
3 local LN; 4 liver mets, resectable
pT3 pN1a pM1a; 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
12/18 - DVT
3/19 - Liver resection (open); R0
4-5/19 - 25 x pelvic radiation w Xeloda; complete metabolic response (TRG 3)
07/19 - ULAR (robotic), temp ileo. R0; 1/27 LN positive
08/19 - FOLFOX x 2-4

camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Fri Aug 02, 2019 9:02 am

Rock_Robster wrote:Fascinating article camicom, thanks for sharing. I note that the overall survival being better for the non-chemo group failed to achieve statistical significance; but nonetheless it still doesn’t appear to demonstrate superiority of chemo in this trial design.


Normally this time a year I would be handicapping football to wager on it. My priorities have changes quite a bit:) I have spent numerous hour scanning the web for anything that pertains to my specific situation, which is a bit unusual with only the 1 node, and amount of nodes taken and cancer free 48. If it was a matter of 20-30% better survival rate with chemo, I would be all over it. Even some of the onco company calulators(that make their money selling the chemo) put the chemo benefit amount at just about 10%.

One other big thing I take into consideration. We all know that diet plays a huge part in not getting cancer. What you don't here much of is people changing their eating/lifestyle after their disagnosis. We all know sugar and inflammation is a huge factor in cancer, and I was shocked when I went to a cancer center to get a chest CT, was in the chemo room getting the canula for the contrast, and they were giving a first time chemo recipient cookies.(I also almost had an anxiety attack being in the room with other people getting treatment, at that point it still really hadn't sunk in what I have):)

I wonder what % of people in the above report actually changed their lifestyle after the cancer disagnosis. I'm sure that would bump the survival rates even higher.

I'm confidant a change in diet(that I've been on since 5/13) will keep my body in a place that gives it a better chance to be DF.

Thank you again for your reponses.
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

Rock_Robster
Posts: 184
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Staging and treatment options.

Postby Rock_Robster » Fri Aug 02, 2019 9:08 am

I know what you mean about the diet! I have changed mine considerably since diagnosis with help of an integrative oncologist and dietician, but the cafeteria at my cancer centre still sells salami sandwiches... Group 1 carcinogen. They may as well sell cigarettes too :(
Male 37 yr; Melbourne, Australia. BMI 24
10/2018 Dx 3.5 cm RC adenocarcinoma, 12cm from AV
Mod diff (G2), EMVI+, LVI+, PNI-
3 local LN; 4 liver mets, resectable
pT3 pN1a pM1a; 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
12/18 - DVT
3/19 - Liver resection (open); R0
4-5/19 - 25 x pelvic radiation w Xeloda; complete metabolic response (TRG 3)
07/19 - ULAR (robotic), temp ileo. R0; 1/27 LN positive
08/19 - FOLFOX x 2-4

camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Fri Aug 02, 2019 9:46 am

Rock_Robster wrote:I know what you mean about the diet! I have changed mine considerably since diagnosis with help of an integrative oncologist and dietician, but the cafeteria at my cancer centre still sells salami sandwiches... Group 1 carcinogen. They may as well sell cigarettes too :(


Before this I was a bit overweight, but healthy as a horse. 49, hasn't eaten red meat in 20 years, excercise 4-5 a week, no HBP, no diabetes, Calcuim CT score was a 1. I did drink too many beers and diet cokes during football season, and jobs have always been high stress. Sincethe diagnosis its been kale and tofu, nothing reallhy inflammatory. Salmon maybe twice a week. I will probably go full plant based once I fully heal.

Diet is a matter of like and death now, no more fooling around:)
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

Pyro
Posts: 274
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Staging and treatment options.

Postby Pyro » Sat Aug 03, 2019 10:27 am

If you want your best chance, do the chemo. If you do not, don’t do it, it’s up to you, chemo sucks but it works. On a side note, how do you do research? Medical journals at the library or are you a doctor?
Aug 2015- Diag Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail, CEA @36
Jun 2019 - FOLFURI until I can’t stand it

camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Sat Aug 03, 2019 1:12 pm

Pyro wrote:If you want your best chance, do the chemo. If you do not, don’t do it, it’s up to you, chemo sucks but it works. On a side note, how do you do research? Medical journals at the library or are you a doctor?


Hours and hours online. From Cancer survival calculators, to Stage 3 colon cancer with single lymph node invasion, to Stage 3 colon cancer chemo or no chemo. Not to mention metabolic pathways that feed cancer, and blocking them. Glucose, Glutamine etc.

From what I've read chemo is the default option for all Stage 3 cancers, but in my case since its only the primary node affected and the fact they took 48 nodes, changes the % quite a bit, even in relation to other Stage 3 cancers. Stage 3 with only 1 node affected actually had a better prognosis that Stage 2B, 2C beiieve it or not.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944507/

Its amazing what you can find.

Like I said earlier, normally this time of year would be spent handicapping football. Now all that time is directed at fighting this thing.
Last edited by camicom on Sat Aug 03, 2019 3:30 pm, edited 1 time in total.
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Sat Aug 03, 2019 3:21 pm

kaloy85 wrote:isn't it T3N1 is stage 3B, not 3A (T1-T2/N1, T1/N2a)?


I stand corrected. You are correct. It is Stage 3B. Thats what I get for taking my surgeon's word for it. The good news is, most of the info I have looked at doesn't really differentiate between A,B, or C for survival rates with only one node and many nodes taken.
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

CF_69
Posts: 65
Joined: Sat Dec 22, 2018 9:44 pm

Re: Staging and treatment options.

Postby CF_69 » Sat Aug 03, 2019 5:26 pm

My oncologist originally said no chemo, but we gave it a few weeks and at my choice, I did 3 months of Xeloda.

He told me about a study that showed that at my stage (2A) there was no benefit to adding the oxiplatin and also that 3 months was shown to be as effective as 6.

I’m going by memory here.

I understand that this is a personal decision, as I have already made mine, but I will say that 3 months of Xeloda wasn’t fun, but it wasn’t terrible either.

Even if a calculator says you have a 1% better chance of survival by foregoing adjuvant chemo...to me potentially giving ANY cancer cells a chance to survive and set up shop somewhere else was too much of a risk.

Of course there is no guarantee that my 3 months of Xeloda will save me from recurrence down the road, but then again, maybe it will.

I wouldn’t make such a big decision because of decades old info an online calculator provided.

You have the beast on the ground. Step on its neck.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0 after pathology
CEA 1.9
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.

User avatar
mslaurie
Posts: 18
Joined: Sun May 19, 2019 7:04 pm

Re: Staging and treatment options.

Postby mslaurie » Sat Aug 03, 2019 5:34 pm

Husband was stage IIB in 2009. Choose not to do chemo.
NED from 2009 until April 2019 - recurrence spread to peritoneum and liver (none in colon) now Stage4c.

In Hindsight Husband said if he had to do it over again he would have chosen in 2009 to do the chemo just in case that would have helped in his cancer not coming back almost 10 years later. We will never know now if it would have or not.
I am Caregiver to my Husband
Oct 2009 stage IIb
Sept 2009 - Ifoot colon removed
NED since 2009 until April 2019
Clear Scan Dec 2018 = NED -Clear colonoscopy March 2019
Routine annual chest xray April 2019 (lungs fine liver show as abnormal)
May 2019 Ultrasound, CT scans confirm recurrence Peri and liver mets with ascites. Stage 4C
May, June, July 2019 OXI and Xeloda (1st cycle, 2nd and 3rd cycle)
July met with surgeon (Candidate for cytoreduction surgery and HIPEC) - 4 months till surgery.

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

Re: Staging and treatment options.

Postby jmn » Sat Aug 03, 2019 9:12 pm

mslaurie wrote:Husband was stage IIB in 2009. Choose not to do chemo.
NED from 2009 until April 2019 - recurrence spread to peritoneum and liver (none in colon) now Stage4c.

In Hindsight Husband said if he had to do it over again he would have chosen in 2009 to do the chemo just in case that would have helped in his cancer not coming back almost 10 years later. We will never know now if it would have or not.

I know what he means—that’s partly why I decided to have chemo.

I’m also Stage IIB. My MSK oncologist recommended six months of adjuvant chemotherapy. I did it for two reasons: (1) I wanted to kill any undetected cancer cells that might be lurking somewhere in my body and (2) I didn’t want to find myself regretting having turned down chemo should the cancer come back.

The chemo was manageable and I’m glad I did it. Only time will tell what the future holds.
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

camicom
Posts: 22
Joined: Thu Jun 27, 2019 1:39 pm
Facebook Username: david galloway

Re: Staging and treatment options.

Postby camicom » Mon Aug 05, 2019 7:16 am

CF_69 wrote:My oncologist originally said no chemo, but we gave it a few weeks and at my choice, I did 3 months of Xeloda.

He told me about a study that showed that at my stage (2A) there was no benefit to adding the oxiplatin and also that 3 months was shown to be as effective as 6.

I’m going by memory here.

I understand that this is a personal decision, as I have already made mine, but I will say that 3 months of Xeloda wasn’t fun, but it wasn’t terrible either.

Even if a calculator says you have a 1% better chance of survival by foregoing adjuvant chemo...to me potentially giving ANY cancer cells a chance to survive and set up shop somewhere else was too much of a risk.

Of course there is no guarantee that my 3 months of Xeloda will save me from recurrence down the road, but then again, maybe it will.

I wouldn’t make such a big decision because of decades old info an online calculator provided.

You have the beast on the ground. Step on its neck.


How well did you tolerate the Xeloda? You are I are close to the same age.
5/13 Blood in stool CT and Bloodwork Clean
6/17 Colonoscopy 5cm Malignant Neoplasm in Transverse Colon
CEA 1.2 Lung CT clear
6/19 Confirmed Adenocarcinoma Mod Diff
7/19 Extended Right Hemicolectomy
Stage 3A with only Primary node affected 48 total nodes taken
BRAF Neg
Recommended 3 month Folfax
Decided no chemo
5 year DF ration is 81% w/o chemo 80% with

CF_69
Posts: 65
Joined: Sat Dec 22, 2018 9:44 pm

Re: Staging and treatment options.

Postby CF_69 » Mon Aug 05, 2019 10:20 am

I had some mild nausea at the beginning of each cycle and softer stools, possibly more frequent. Hard to know as I’m about 4 months post surgery so my body is still adjusting to that.

I was taking 5000 mg a day. 5 pills in the morning and 5 in the evening. 2 weeks on, 1 week off.

I haven’t done the heavy duty chemo, so I can only imagine the side effects or read about them. I didn’t have any of the typical side effects from the Xeloda that others have.

Everyone reacts differently.

It wasn’t fun but like I said, it wasn’t terrible either. I think it’s about as “low impact” as you can get in terms of chemo drugs.

I was tempted not to do it, so I know where you’re coming from. I also have a family friend that had prostate cancer and did not do adjuvant chemo and he’s around 7 years NED right now.

I asked my oncologist what he would do in my situation, after assuring him that my decision was already made, and he said that he was on the fence.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0 after pathology
CEA 1.9
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.

Beckster
Posts: 374
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Staging and treatment options.

Postby Beckster » Mon Aug 05, 2019 12:55 pm

I was on Xeloda for 6 months and it was doable. It did not interfere with my lifestyle. I worked, went out and had my martinis on the week off. I was a little more tired, but people did not even know I was on chemo...plus I did not need a port!
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


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