boxhill wrote:Did they mention distance from the anal verge? That seems to be the most critical factor.
I don't have rectal cancer, but I've observed that people almost always report their doctors saying "they won't know until they re in there" and it seems as if an awful lot of them have permanent colostomies. Then there is the matter of ability to predict quality of life with colostomy vs Jpouch or whatever.
Maybe if you can get the cm from the anal verge figure you can do some research/poll treatment veterans based on that.
Punky44 wrote:One potential benefit to short course is not dealing with any side effects. My mom still says her 5 days of short course were the easiest part of her whole journey. (Btw, she did not need a permanent colostomy with short course—did they say why that would be the case in your situation?)
Gravelyguy wrote:I had 4 rounds of Folfox with Vectibix then short course. My tumor was less than 1 cm from the anal verge. I got the same message as your husband. very likely APR but would see when they got in there. I am convinced that it all depends on the surgeon. I had THE guy at Mayo Rochester who works on low tumors do the surgery.
I agree with Punky, no problem with radiation. I did have proton beam radiation and I think Punky's mom did too. This is the latest and greatest I am told!
Dave
Rock_Robster wrote:This is a tough call, and there isn’t really a “wrong” answer.
I believe the evidence suggests long-term oncological outcomes are similar between the two.
I ended up deciding on long-course radiation for a few reasons:
- I had a fairly “bulky” primary - a T3b tumour, about 3.5cm. My rad onc believed I had better chance of down-staging with long-course.
- With lymph node involvement, I believe (check this) that the long-course spends more time sterilising the nodal field around the tumour - reducing risk of recurrence
- The short and long term side effects potentially seem to be fewer
- It does allow the possibility of “watch and wait” in the case of a complete response - not that I would consider that as a stage IV patient
The biggest downside is the time taken - the 5 weeks of treatment plus 8-10 weeks to recover and have full effect. In my case I had a very good response (complete metabolic response), so that was encouraging. However I had a small liver met grow when off full-dose systemic chemo - of course I’ll never know if that would have happened anyway.
Big advantage I see from short-course is it gets you done and back to your ‘normal’ life sooner, minimising time for cancer cells to spread.
My tumour was about 10-12cm high, so the risk of a colostomy was never really on the table. I do have a temporarily ileostomy however (min. 3 months).
If your husband is young and capable, I see no harm in trying for the no-colostomy option. If he ends up having one then you’re no further behind; but if he ends up avoiding it then all the better. Yes it’s true - people do struggle with adapting after the surgery/reversal, but there are also many people who are able to get on and have a very normal life (in some cases with modest adaptations). In the absolute worst case, they can always convert to a colostomy later (not a major operation like the original resection).
If he doesn’t need the colostomy, do you know if they will do a temporary ileostomy instead? This is fairly common in rectal surgery after chemo and radiation to allow the anastomosis (join) to heal and minimise risk from leaks.
Good luck,
Rob
Marie25 wrote:Gravelyguy wrote:I had 4 rounds of Folfox with Vectibix then short course. My tumor was less than 1 cm from the anal verge. I got the same message as your husband. very likely APR but would see when they got in there. I am convinced that it all depends on the surgeon. I had THE guy at Mayo Rochester who works on low tumors do the surgery.
I agree with Punky, no problem with radiation. I did have proton beam radiation and I think Punky's mom did too. This is the latest and greatest I am told!
Dave
We went to mayo as well! May I ask your surgeon's name?
CF_69 wrote:I would go for the option to not have a permanent colostomy if the success rate is the same.
Also I think the radiation dose is the same total amount with both options. Someone will correct me if I’m wrong about that.
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