Colon cancer diagnosed July 2019

[helenef]

Hello,

I'm glad I found this forum to share my journey and exchange with other CRC fighters.
I have a locally advanced sigmoid adenocarcinoma diagnosed in July, most likely stage 3 cancer. I had a loop colostomy done in August to avoid any blockage during neoadjuvant chemotherapy. I'm about to start round 3 of 6 cycles of FOLFOXIRI + Avastin. The plan if all goes well is to have the tumour removed by the new year and colostomy reversed.

I have a couple of questions, mainly to understand the oncologist report and the type of treatment I'm given.
- Histology report says the cells are poorly differentiated and this does not look like a good prognosis to me. Are there any statistics published about survival taking into account both stage and grade of the cancer?
Questions about pre-op staging (T3dN1Mx):
- there's no spread visible on the scans, so it's more likely T3dN1M0?
- What's the difference between T3a and T3d?
- N1 does it mean 1 lymph node involved? I supposed they see that on the scans but the real staging will be confirmed after the op.
Questions about neoadjuvant chemo
- FOLFOXIRI with Avastin is a tough treatment. I see they usually give it to stage 4 patients. However this is a neoadjuvant treatment with the aim to shrink the tumour before op because it is bulky at the moment, and kill any micro-metastases not visible on scans in the process. Anyone had the same treatment? It seems a bit unusual to me but seems like a good treatment plan.

Overall, while I want to get the best chances at getting rid of the cancer, I can't stop getting worried about my staging, grading, and maybe the possibility of this being worst than what it is already?
Lost my dad to brain cancer 3 years ago, he was gone in 5 months while I was pregnant now I have another baby, 9 months old. I have all the good reasons to fight. I feel I can go through anything, like I'm not scared of side effects, surgeries, etc. but I have a hard time not worrying about the cancer coming back at some point. I know it's stupid in a way, I'm having treatment to be able to remove the tumour, so why worry about that now?

Thank you for reading, I'm going to try to update my signature now.

[claudine]

Welcome helenef, hopefully this forum will be able to bring you as much comfort and useful information as it has others! I can't really answer your questions, but I read that Folforixi gives better results than Folfiri. Hopefully it'll shrink your tumor nicely and you can get surgery soon! Good luck with treatment.

[MeAndMine]

My treatment is different for rectal cancer and I started out with radiation and chemo which I'm doing right now. It's also with the idea of shrinking the tumor. I don't really have the answers as I'm still new at all of this and on the first leg of my treatment but hopefully you'll get some good advice from others on the forum. I'm glad you found us!

[NHMike]

N1 means 1-3 lymph nodes involved. N1a is 1 lymph node. N1b is 2-3 lymph nodes. N1c has some other features involved.

I use this webpage for staging definitions:

https://cancerstaging.org/references-to ... Medium.pdf

[NHMike]

URMC / Encyclopedia / Grading and Staging of Cancer
Search Encyclopedia
Grading and Staging of Cancer

After cancer is diagnosed, healthcare provides need to learn as much as they can about it. This helps them to plan the best treatment and look at overall outcomes and goals. For many types of cancer, part of this process includes figuring out the cancer grade and stage.
What does the grade of a cancer mean?

Histologic "grade" is used to describe what the cancer cells look like using a microscope. Most cancers are graded by how much they look like normal cells. Low grade or grade I tumors are well-differentiated. This means that the tumor cells are organized and look more like normal tissue. High grade or grade III tumor cells are poorly differentiated. This means that the tumor cells don't look like normal cells. They're disorganized under the microscope and tend to grow and spread faster than grade I tumors. Cancer cells that do not look well-differentiated or poorly differentiated are called moderately differentiated, or grade II. In general, cancer cells are graded using this scale. (Be aware that some may use grade 3 as the highest grade):

Grade X: grade isn't known
Grade 1: Well differentiated, low grade
Grade 2: Moderayely differentiated, intermediate grade
Grade 3: Poorly differentiated, high grade
Grade 4: Undifferentiated, high grade

https://www.urmc.rochester.edu/encyclop ... tid=p00554

[NHMike]

Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398112/

I was curious about the results of the research too:

The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).
---------------------

Hmmm. I think that I had cT3 - maybe that's what the c is for - I have wondered about that for a while.

[helenef]

Welcome helenef, hopefully this forum will be able to bring you as much comfort and useful information as it has others! I can't really answer your questions, but I read that Folforixi gives better results than Folfiri. Hopefully it'll shrink your tumor nicely and you can get surgery soon! Good luck with treatment.

Thank you Claudine

[helenef]

My treatment is different for rectal cancer and I started out with radiation and chemo which I'm doing right now. It's also with the idea of shrinking the tumor. I don't really have the answers as I'm still new at all of this and on the first leg of my treatment but hopefully you'll get some good advice from others on the forum. I'm glad you found us!

Thank you MeAndMine. I understand rectal cancer treatment involve radiotherapy and chemotherapy. I recognise a lot of rectal cancer treatment and diagnosis features in mine while it is a colon cancer. My oncologist said we could not do radiotherapy because of the localisation of the tumour.
All the best with your treatment!

[helenef]

Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398112/

I was curious about the results of the research too:

The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).
---------------------

Hmmm. I think that I had cT3 - maybe that's what the c is for - I have wondered about that for a while.

Thank you for the links NHMike. This is an interesting study.

I think c before TNM means clinical (from the scans and biopsies, before surgery). see here:

http://oncolex.org/Colorectal-cancer/Background/Staging
cTNM is based on all available information from:
Clinical examination
Endoscopy
Radiology
The final stage is given after the evaluation of the pathology specimen, and is given prefix “p”. Pathological TNM (pTNM) is based on pT, pN and the apprehension of M (operation/ radiology).

[NHMike]

I think c before TNM means clinical (from the scans and biopsies, before surgery). see here:

http://oncolex.org/Colorectal-cancer/Background/Staging
cTNM is based on all available information from:
Clinical examination
Endoscopy
Radiology
The final stage is given after the evaluation of the pathology specimen, and is given prefix “p”. Pathological TNM (pTNM) is based on pT, pN and the apprehension of M (operation/ radiology).

Thank-you for that note. So I guess I don't know what sub T3 designation I had. Or maybe it's somewhere else in an MRI report. I will go digging for it one of these days.

That T number certainly shows why so much has to be removed.

[boxhill]

helenef, very glad to hear that you will not be having radiation. The side effects for women can be nasty and permanent. I hope folfoxiri does the trick for you.

Did they biopsy the tumor? If so, they may have done the tests required to determine BRAF, KRAS, and MSS/MSI status.