aam7.00 wrote:... I am worried about distant metastasis and I am wondering if I may have given cancer the chance to spread. ...
aam7.00 wrote:... I have been reading a lot of literature on this subject and it seems that there are very few doctors who consider rectosigmoid cancer as rectal instead of the colon...
boxhill wrote:... I also think that it would be important to discuss with your surgeon in advance the issue of preserving the rectum and avoiding LARS if at all possible, if that is your preference. I think it is important to establish your priorities and come to an understanding in advance with your surgeon how various contingencies will be addressed. Nothing is 100%, of course, and ultimately you have to rely on your surgeon's professional opinion, but you needn't be passive, either.
chrisca wrote:... My GI doc mentioned that with the increasing popularity of laparoscopic procedures for rectal resection, very high ligation of the IMA is usually done. This is the worst possible scenario for LAR syndrome risk...
Reference: https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=59120&p=467267#p467267
JJH wrote:aam7.00 wrote:... I am worried about distant metastasis and I am wondering if I may have given cancer the chance to spread. ...
Here are my thoughts: If the cancer did in fact spread during the 5-week CRT, it would be in the form of a circulating tumor cell or a micro-metastasis and would not show up on a scan anytime soon. In addition, there is the possibility that the reduced-dose Capecitabine used during CRT may have served to stabilize or kill off the emerging distant mets. In any event, by April or so they will be putting you on a regimen of adjuvant chemotherapy (probably FOLFOX or Capeox), and that regimen should serve to mop up whatever small distant mets might still be around.
If they do another CT scan next month and find something suspicious in the liver or lungs, they then might decide to use a stronger form of adjuvant therapy (e.g., FOLFOX + Avastin) starting in April.
In my opinion, there is not much point in worrying right now because they have no way of confirming/disconfirming the presence of small remote metastases at this point in time.
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P.S. It would help to know your tumor's "T" value in the TNM staging system. Also, your tumor's MSI status from the colonoscopy pathology report.
CF_69 wrote:My tumour was also rectosigmoid. I was about 15 cm from anal verge, depending on who measured.
I was also treated as rectal.
If you had suspicious nodes, that could be why they wanted to hit you with chemoradiation before surgery.
There’s a saying I like. I used to use it when it came to beers, but it’s applicable in many areas.
It’s better to have too many than not enough.
JJH wrote:aam7.00 wrote:... I have been reading a lot of literature on this subject and it seems that there are very few doctors who consider rectosigmoid cancer as rectal instead of the colon...
Just a few more thoughts ... Although your tumor is technically in the colon area, to remove it they may need to make the lower cut in the upper or middle rectum in order to insure clear margins. If this is the case, then your surgery might be more like a rectal cancer surgery than like a simple colon cancer surgery, and it might mean that a temporary ileostomy will be necessary and that you may later experience some LAR Syndrome symptoms due to missing rectal functions.
What you might want to do now is to talk to the surgeon and see what his current plans are for type of surgery, e.g., Low Anterior Resection vs. Left Hemicolectomy; and Open Surgery vs. Laparoscopic Surgery, etc. The type of surgery chosen could make a big difference in long-term recovery and quality-of-life considerations.
boxhill wrote:I think JJH makes excellent points about the type of surgery being very important for future quality of life.
I just want to throw one thing out there: laparoscopic surgery can sound awfully appealing in terms of quicker recovery and so on, but there is a lot to be said for open surgery with a good, experienced surgeon who is thus afforded the opportunity to take a good look around. When I had an emergency hemicolectomy, my surgeon found and removed a subcapsular liver met that was too small to show on the ct scan. He *felt* it when thoroughly examining my liver. Would not have happened with laparascopic surgery.
I also think that it would be important to discuss with your surgeon in advance the issue of preserving the rectum and avoiding LARS if at all possible, if that is your preference. I think it is important to establish your priorities and come to an understanding in advance with your surgeon how various contingencies will be addressed. Nothing is 100%, of course, and ultimately you have to rely on your surgeon's professional opinion, but you needn't be passive, either.
aam7.00 wrote:CF_69 wrote:My tumour was also rectosigmoid. I was about 15 cm from anal verge, depending on who measured.
I was also treated as rectal.
If you had suspicious nodes, that could be why they wanted to hit you with chemoradiation before surgery.
There’s a saying I like. I used to use it when it came to beers, but it’s applicable in many areas.
It’s better to have too many than not enough.
I spoke to the surgeon today and he says the chemo during radiation is like a catalyst /activator that assists radiation, and that's it. He didnt say if it will prevent any metastasis if that were to happen. He isn't too happy with the chemo-radiation. Just so you know, I am having at a different hospital
galee wrote:My adenocarcinoma was about 12cm from the anal verge. It was not recommended that I have treatment prior to LAR. I consulted with two surgeons. I chose a surgeon who specializes in colorectal procedures - That is all he does day in and day out. He did a flexible sigmoid procedure three days prior to my resection to make a personal determination of location, decide on laparoscopic surgery and to tattoo parameters. He stated there was about a 10% chance of temporary ileostomy. He did document as rectal cancer in my records. Resection was successful. No ileostomy was needed. He removed about 8 inches of colon. Leaving me with 6-7cm of rectum. Post surgery my bowels are a real challenge, but I’ve been told it’s still early. I have numerous symptoms of LARS but I am hopeful I will find a new normal.
I know it’s almost impossible, but try not to look back. Move forward with hope and positivity. I wish you all of the best in the days to come! If you are able to do so, meet with a couple of surgeons. Ask all your questions. When I met with the surgeon I chose, I felt the first sense of peace since my diagnosis. Prayerfully, surgery will be soon to remove your cancer. At that point your pathology will be thorough and you will gain a better understanding of the beast.
CF_69 wrote:aam7.00 wrote:CF_69 wrote:My tumour was also rectosigmoid. I was about 15 cm from anal verge, depending on who measured.
I was also treated as rectal.
If you had suspicious nodes, that could be why they wanted to hit you with chemoradiation before surgery.
There’s a saying I like. I used to use it when it came to beers, but it’s applicable in many areas.
It’s better to have too many than not enough.
I spoke to the surgeon today and he says the chemo during radiation is like a catalyst /activator that assists radiation, and that's it. He didnt say if it will prevent any metastasis if that were to happen. He isn't too happy with the chemo-radiation. Just so you know, I am having at a different hospital
My medical oncologist, radiation oncologist and surgeon were all on the same page.
They did say the intent was to shrink the tumor and I only took the chemo pills on radiation days.
I may be wrong but I would guess that while the chemo is to assist with the radiation, that it is still chemo and would attack any other rapidly dividing cells that it finds, ie: potential mets, even though that was not the primary intention.
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