Postby roadrunner » Fri Sep 11, 2020 11:49 pm
Some general background that may be of use to you:
There are a lot of things to figure out, but there’s time; I was told “nothing will happen for 10 weeks” — these are indeed slow growing, and while risk of metastasis is never zero, you generally have time to assess, pick doctors, etc.
With respect to any possible metastasis, you will likely receive scans (CT/MRI/ and/or PET) which will investigate that. There is a good chance that has not occurred, but even if it has (which would be stage 4), there are many treatments and success stories described on this forum and elsewhere. But stage 4 is a different treatment approach altogether. If your cancer is stage 3 like mine, the treatment course will be more predictable, though there are options. Your rectal tumor is likely to present certain challenges due to its location. Rectal cancer is complicated by the nature and functionality of the structures involved, so you will need the best surgeon you have access to. Also, there are different treatment methods. The main two are (1) chemoradiation (usually the chemo is Xeloda) followed by surgery and (2) TNT, or “Total Neoadjuvant Therapy,” in which chemo (often FOLFOX) is delivered first, then chemoradiation, then surgery. TNT tends to be done more commonly at major cancer centers and research hospitals. TNT can, in approximately 30% of cases, achieve a “complete clinical response,” which is sometimes approached with a “watch and wait” strategy (no surgery). (This can happen with chemoradiation only, but it is less common.) There is a thread on this board about that. It may be of interest to you because of the location of your tumor will likely create surgical challenges which may increase morbidity and complicate your recovery. TNT does also appear to reduce the risk of metastasis if none is detected initially. Generally, chemoradiation will be used to shrink the tumor to provide better surgical options.
Treatment of rectal cancer is a bit of a long haul, and I at least favor learning more about it so you can best identify the right cancer center, oncologists (radiation and medical), and surgeon (very important for you in particular). I should add that I have done lots of chemo and radiation, and neither was a blast but they were doable. Radiation in particular was relatively easy to tolerate (technology has indeed advanced; but again, you need to be informed about methods, machines, and oncologists).
Stage 2, which also seems possible in your case, is usually a bit simpler and sometimes involves less chemo.
That’s super general stuff, and obviously I at least do strongly favor learning about your disease and its treatment options, including whether you need (and want to) at least talk to major cancer centers to understand your options better. Also, while I totally respect the “Google is not your friend” advice, if you can keep in mind that scary stats and possibilities are (1) based on old data (and things have improved a lot) and (2) generally applicable only, and your outcome will be determined by your specific situation, your biology, your care, etc., I think education is a great thing. This is a complicated disease, and there are many options as to treatment.
For context, I had TNT, and have been told I have a complete response, but am still pending final surgical assessment to see if I need surgery.
Hope this helps!
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23