Removal of Benign Mass in Colon

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ffl0203t8
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Removal of Benign Mass in Colon

Postby ffl0203t8 » Wed Nov 20, 2019 9:53 am

Hi, I'm new to this forum and I'm looking for some advice. I went in early November for a colonoscopy and my doctor found a medium sized infiltrative mass (not a polyp) in my cecum. I was obviously concerned to learn this and waited two weeks for the biopsy results. Thank God the mass was considered benign. The doctor told me that if I had waited another 6-12 months to do my colonoscopy that the mass would have more than likely become cancerous. His first reaction to remove the mass was for a surgeon to cut out approx 2 inches of my cecum and reconnect. After he thought it over he asked me if I would be ok going through another colonoscopy and having him remove it from inside my cecum. He said there is a slight risk of him going through the wall of my colon which would require me to get the reconnect surgery at the hospital. Apparently he has done dozens of infiltrative mass removals in the past like this, and he says it's less invasive than the surgery of going in laparoscopic. I'm a little nervous about this, can anyone share with me their thoughts and/or experiences with this? Thank you in advance! :)

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Jacques
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Re: Removal of Benign Mass in Colon

Postby Jacques » Thu Nov 21, 2019 7:31 am


ffl0203t8
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Re: Removal of Benign Mass in Colon

Postby ffl0203t8 » Thu Nov 21, 2019 1:34 pm

Thank you very much Jacques, this helps a bunch! The doctor gave me the option to remove the sections through surgery or to do this Endoscopic submucosal dissection (ESD). Has anyone here had the ESD, and if so what has been your experience with it? He mentioned that there is a possibility of going through the wall of the colon? Has anyone had any long term issues with an ESD? Long term success? Thank you in advance!

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Jacques
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Re: Removal of Benign Mass in Cecum

Postby Jacques » Sat Nov 23, 2019 2:41 pm

So far you haven't had any replies to your recent request for experience reports. When is your deadline for deciding on the type of surgery for removing the cecal mass? Is there any other type of input that you would like to have and that would help you decide which option would be best for you?

There are a number of members here who were diagnosed with cecal cancers, but I think most of them had their tumors removed by surgery, usually by laparoscopic right hemicolectomy. I'm not sure if any of them were given the option of having their tumors removed by endoscopy. Some of them have done quite a lot of background research into cecal masses and how they differ from tumors in other parts of the colon.

After you have posted more messages and have been promoted to Regular Member status, you will have PM privileges and can send private messages to some of these members to ask about the surgery options they were given and to ask about what they know about how cecal masses arise and how they can develop into tumors.

ffl0203t8
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Re: Removal of Benign Mass in Colon

Postby ffl0203t8 » Sat Nov 23, 2019 8:20 pm

Thank you again Jacques. I was looking for more input from others that have gone through the same thing.

I'm scheduled for a ESD two weeks from today. I don't want to wait too long as you can imagine. I have read that doing a ESD in the cecum is very difficult due to the cecum being the thinnest wall of the colon. This does concern me, but I guess I am hoping that my doctor is confident enough to not perforate my colon. If he does perforate my colon what would happen next? He said he has performed dozens of these procedures and that I'm a perfect patient for a ESD.

I am very lucky and Blessed that the mass is benign according to the biopsy. I hope my luck continues two weeks from today.

Utwo
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Re: Removal of Benign Mass in Colon

Postby Utwo » Sat Nov 23, 2019 10:53 pm

ffl0203t8, after colonoscopic removal of my cecum polyp, I was back to office the next day.

As a result of subsequent "prophylactic" laparoscopic right hemicolectomy I lost about half of my blood, got a leak and an infection.
I was back to office in a little bit more than four weeks.

If you have a chance of removing this through colonoscopy by a person who already did this procedure quite a few times - it's the best possible option.
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

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Jacques
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Re: Removal of Benign Mass in Cecum

Postby Jacques » Sun Nov 24, 2019 12:32 am

ffl0203t8 wrote:.... I'm a perfect patient for a ESD...

It's good to hear that your doctor considers you to be a "perfect patient" for this procedure, because not all patients qualify for procedures like this, mainly because of other co-existing health problems.

If you have time in the next 2 weeks you could post a few more messages so that you reach regular Registered Member status by the time you go in for the procedure. You could give more information from your colonoscopy report, and more of the details from the pathology report describing the histologic features of the cecal mass.

You could also mention whether your colonoscopy was a routine scheduled screening colonoscopy, or a special one designed to check on troublesome symptoms that needed explanation.

ffl0203t8
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Re: Removal of Benign Mass in Colon

Postby ffl0203t8 » Sun Nov 24, 2019 7:21 pm

Thank you Utwo and Jacques! I went in for a routine colonoscopy with no symptoms. It was my second colonoscopy in my life, 10 years apart.

I have to say that what Utwo wrote helped me with their experience, I just want to know that what I'm doing should be what's best for me. The other question I have is what happens if there is a perforation of my colon during the procedure? Can they try to fix it during the colonoscopy, or would I need to be sent directly to a hospital?

If anyone could help share their experiences with what I have in front of me I would really appreciate it!

Utwo
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Re: Removal of Benign Mass in Colon

Postby Utwo » Mon Nov 25, 2019 10:38 pm

ffl0203t8 wrote: The other question I have is what happens if there is a perforation of my colon during the procedure? Can they try to fix it during the colonoscopy, or would I need to be sent directly to a hospital?
In my case this procedure was done in a major hospital.
In a worst case scenario they would have switched it to an open surgery.

However it depends on a size of a hole/perforation.
In more than 50% of all cases a leak is closed on its own without any additional surgery.

I like telling people a story how I was on "sugar with rat poison" diet for a week. :)
I was fasting to facilitate self-healing of a leak.
Because my weight was rather low and was going down, they started a glucose I/V.
As typical to any hospital patient I was also getting warfarin shots.
Warfarin is an anticoagulant (blood thinner) and used in hospitals to prevent formation of blood clots and also is used as a rat poison.

If I were you I would have preferred to have this procedure in a large hospital rather than in a small office.
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

ffl0203t8
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Re: Removal of Benign Mass in Colon

Postby ffl0203t8 » Mon Nov 25, 2019 11:21 pm

Thanks for your thoughts. I'm now a little more worried. I have my appointment already, I hope and pray he can do this with no complications. Any other suggestions?

Utwo
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Re: Removal of Benign Mass in Colon

Postby Utwo » Tue Nov 26, 2019 7:20 am

ffl0203t8 wrote:Thanks for your thoughts. I'm now a little more worried. I have my appointment already, I hope and pray he can do this with no complications. Any other suggestions?
I was told that statistically speaking a chance of perforation is rather small.

In an ideal world we should be able to choose a hospital and a doctor to deal with.
However we do not live in an ideal world and sometimes have very limited options (especially in Canada).

I do not believe that this risk is high enough to warrant being worried.
In a worst case scenario they would transport you to a better equipped hospital.
So this is not a safety critical issue unless you live e.g. on Baffin Island etc.
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

ffl0203t8
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Joined: Wed Nov 20, 2019 9:39 am

Re: Removal of Benign Mass in Colon

Postby ffl0203t8 » Tue Nov 26, 2019 7:39 am

Ok, thank you again. I am in an area with several hospitals near by in Michigan, so that helps ease my mind. I really appreciate your help and advice. :)

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Jacques
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Removal of Benign Mass in the Cecum

Postby Jacques » Tue Nov 26, 2019 3:35 pm

ffl0203t8 wrote:...The other question I have is what happens if there is a perforation of my colon during the procedure? Can they try to fix it during the colonoscopy, or would I need to be sent directly to a hospital?


You have already received some very good experience-related comments from Utwo. I also have some thoughts, but mine are second-hand reflections derived mainly from various articles and web-sites I have seen in the past few days. I have no direct experience with colonoscopic or endoscopic therapeutic procedures. You would have to check with you doctor to see if any of the comments below apply to you.

One of the things that I found in my reading is that there are three main ways that an endoscopist can deal with small perforations that occur during the procedure. These are: 1. To use a heated colonoscope attachment to cauterize and close the wound; 2. To use a different colonoscope attachment to squirt a special kind of biological "super glue" on the perforation; and, 3. To close the wound with a clamp or series of clips.

I also found that there are different kinds of perforations that can happen. They can be grouped into two groups: 1. Blunt-object injuries and 2. Sharp-object injuries.

In the first category are the colonoscopy surveillance cases where the colonoscope, with its light and camera out in front, gets stuck in a diverticula pocket or in a sharp hair-pin curve like the recto-sigmoid junction and the doctor exerts too much pressure and causes a big perforation in the weak colon wall. This doesn't happen very often and is said to have a perforation risk around 1/1000.

In the second category are the therapeutic colonoscopic procedures where sharp colonoscope attachments are used to perform polyp removal operations or to grab biopsy samples for analysis. For this type of procedure, the risk of perforation is said to be around 1/500. In cases where the mass to be removed is a very large flat polyp that spans several folds in the colon wall and that requires the polyp to be removed in several successive sections, the risk is even higher.

In the case of Endoscopic Submucosal Dissection (ESD) the situation is a bit different. This procedure apparently requires the use of two different sharp attachments: 1. A needle attachment is first used to inject a colored saline solution underneath the mass in order to elevate the whole mass above the cecum wall so that it will be easier to excise it; 2. A heated scalpel attachment is then used to cut around the circumference of the mass and to then lift it off the cecum wall in one piece; and 3. A needle attachment is then used to tattoo the cecum wall at the location of the original mass. Any of these operations can cause an unintended puncture of the cecum wall if the doctor is not extremely careful.

And there is another distinction I ran across in my reading. This is the distinction between: 1. Recognized Perforations, and 2. Unrecognized Perforations.

In the first case, the doctor realizes that a perforation has in fact occurred and he then takes whatever measures he has available to deal with it, including some of the ones mentioned above. The second case is considered by some to be the more serious, however. In this case, the doctor has unwittingly made a small pinhole perforation in the cecum wall but doesn't realize it. He then finishes the procedure, tells the patient that everything is OK, but he doesn't arrange for any special preventive measures. Then, in a week or two the patient finds himself in the hospital with sepsis or septicemia, which could have been prevented if the doctor had implemented an aggressive antibiotic cocktail regimen and told the patient to be extremely careful to eat only small snacks of mostly bland, non-spicy, low-residue foods, and no carbonated beverages or other foods that produce gas. This is so that the cecum can rest in peace for a couple of weeks while any presumed pinhole injuries are given time to heal naturally.

ffl0203t8
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Re: Removal of Benign Mass in Colon

Postby ffl0203t8 » Tue Nov 26, 2019 9:16 pm

Very interesting info Jacques, especially the last paragraph you wrote. I am going to ask the doctor to put me on antibiotics after the surgery. I will also take your advice to watch what I eat for at least two weeks after the procedure. Better to be safe than sorry. I really appreciate you looking into this for me, it means a lot!

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Jacques
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Re: Removal of Benign Mass in Colon

Postby Jacques » Fri Dec 06, 2019 1:39 pm

ffl0203t8 wrote:...I'm scheduled for a ESD two weeks from today...

Good luck on your upcoming cecum surgery. When you get a chance, let us know how it went.


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