MistyBlu wrote:Thank Jacques...
So Robster had me thinking that maybe I missed something. I'm going to stop back in the ONC office again tomorrow and ask the questions on staging and treatment. I went through the results with my husband and he said the only thing I didn't have in the notes above was that the ONC said the cancer did go through the walls yet I have his handwritten notes where he checked off perforation negative. Is this two different things. I know he mentioned the peritoneal cavity and said there was no penetration. So if it ent through the walls could this make me a stage 3?
Is Folfox a combination of drugs, one of which os oxaliplatin, such that one can be given just the oxaliplatin in some cases? Like what's being offered to me?
I’m sorry MistyBlu I may have caused some confusion.#1:
We need to distinguish between tumour stage and overall disease stage. Tumour stage is assessed as T1-T4, based on the depth of progression through the bowel wall. Your tumour has grown through the muscularis propria and into the outer lining of the bowel wall, but not through it. This is considered a “T3” tumour.
The combination of a T3 tumour, with no lymph nodes involved (N0) and no distant metatases (M0), gives an overall assessment of T3N0M0. This is considered “stage 2a” overall disease (info on disease staging here: https://www.cancer.net/cancer-types/col ... cer/stages
Note this is very different to a perforation, which is where the bowel wall actually fails and leaks as as a result of the tumour. This is a serious emergency, and you did not have this (thankfully)!
According to NCCN guidelines, stage 2a cancer without high risk factors would normally either get no chemotherapy, or a course of Xeloda (capecitabine) only. Oxaliplatin would only be on the table for stage 2a if other high risk factors were present.
Poorly differentiated cancer cells (also known as ‘high grade’ or ‘grade 3’ cells) is considered a high risk factor, which may explain why oxaliplatin is being offered as an option in your case.#2:
You’re quite right - FOLFOX is a combination of FOLinic acid (aka leucovorin), Fluorouracil (aka 5FU) and OXaliplatin.
It would be unusual just to give oxaliplatin alone - it is almost always either combined with flourouracil or its oral form, Xeloda (capecitabine) to maximise its effectiveness. If doing a “lighter” chemo, usually only fluorouracil or Xeloda would be given.
The only real difference between Xeloda (capecitabine) and fluorouracil (5FU) is that the former is in tablet form, and the latter is given via IV infusion over several days. They both end up metabolised to the same drug by the liver.
The reason I was confused here is that he said he is “not offering FOLFOX”, but then goes on to include Xeloda+Oxaliplatin (XELOX) in your list of options, which is effectively the same thing - if not slightly tougher. I’m also not sure where he gets his recurrence rate (35%) from, which seems very high for stage 2a disease.In summary from me:
The presence of one high risk factor (poorly differentiated cells) in purely my personal
opinion would warrant the use of some adjuvant chemotherapy (eg Xeloda). Whether you want to take this further and do oxaliplatin as well would depend on how much additional risk reduction it would give you, and your personal willingness to accept the risks of short and long-term side effects from oxaliplatin treatment.
I hope this clarifies!