Postby afaust » Sun Jan 28, 2018 11:13 pm
Hi everyone!
I’m new to the forum - and so thankful to have stumbled across it! Wow - it’s given me a ton of knowledge and support that I couldn’t fine elsewhere! Incredibly helpful to hear everyone’s experiences.
So, my question to the group is as follows. I THOUGHT I knew my treatment path but upon seeking a second opinion, I now find myself with another option and both paths present equal risks/downsides. To fill in the blanks - I am a 45yr old female, diagnosed w/ rectal cancer - T3 N0 - this past Nov 2017. My oncologists support the standard of care - CRT/illeostomy surgery/8 cycles of folfox/reversal surgery. I have just completed CRT Jan 2018 and my tumor has responded favorably. Prior to CRT, my tumor was 4cm from the anal verge but upon completion of CRT the mass is now 5-6cm from the AV - yeah!
The next step of the standard of care - surgery - always seemed to be the step where I really needed to make sure that I had the best surgeon around and hence, needed to meet with multiple surgeons. I’m sure I’m not alone when you first got the news that you’re diagnosed with rectal cancer, the “bag” news was always something I just couldn’t wrap my mind around (beyond the obvious elephant in the room). I wanted to find the surgeon that was absolutely going to “fight” for my sphincter muscles during that surgery such that i wouldn’t end up with a permanent “bag”. So, I met with the surgeon that my oncologists work with - great bedside manner, experienced, great in all aspects. He indicated that based on my response he’s relatively certain that he can preserve my muscles. Fantastic! The I head off to my meeting with another surgeon…at MSK in NYC.
During this meeting, this surgeon indicated that MSK is taking a different approach to rectal cancer treatment - neoadjuvant chemotherapy. This approach starts with 8 cycles of FOLFOX, then CRT and lastly surgery. Lastly surgery because there is a SMALL percentage of patients that after completing steps 1 & 2, they show a complete response and surgery is not needed. WOW I’m thinking (but very, very cautiously thinking WOW). My husband & I left that meeting thinking - “what’s the downside to this approach?” Granted, I’m already somewhat out-of-order to this approach in that I’m already through CRT but….so?
I reached out to my medical oncologist to find out what COULD the downside of this approach be to me? Valid downside as it turns out. My oncologist explained that my tumor has shown great response to CRT so now is the time to remove it. If I were to go through the 8 cycles of FOLFOX now, there’s a chance that the tumor could prove unresponsive to the FOLFOX regime and, in fact, start to grow again. Hmmmm.
So what I’m weighing - follow the standard of care, go through surgery, deal with the “bag” for in excess of 6 months and also wrap my mind around the difficulties that reversal can bring OR jump on the neoadjuvant train, start my 8 cycles of FOLFOX now, risk the tumor growing and creating more problems but also have the slight (very slight) chance of having a CCR and forgoing surgery altogether (oh & “bag time” would be shorter - 6-8 weeks). Thoughts/opinions/advice/experience welcomed! Thx much
45 yr old female, married & mother of 2 boys - 4yrs & 10yrs old
diagnosed w/ rectal cancer Nov 2017
T3 N0
completed CRT Jan 2018 (28 rad treatments/ 5FU chemo 6 weeks)
figuring out my next move - surgery or neoadjuvant chemotherapy