Father recently diagnosed - Surgeons seem too eager?

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monkeypork
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Father recently diagnosed - Surgeons seem too eager?

Postby monkeypork » Sat Oct 31, 2015 2:39 am

Hello,

I'm writing on behalf of my Father who is in his late 60's that just got diagnosed this past week with Colon Cancer. During a Colonoscopy they found about a 1 inch diameter polyp on his colon and took 3 biopsies at the top, middle, and bottom. The top was 'pre cancerous'. The middle was 'cancer', the bottom was 'benign'.

This particular Dr. was not comfortable using the 'lasso' approach to remove the polyp because he said it's form was atypical. So he recommended a surgeon.

The surgeon suggested removing 10 inches of the colon, associated lymph nodes and blood vessels. But he is also overweight so the surgeon said he could not do the surgery right away.

This seems like such a shocking difference in approach.

Any advice? He lives in Burlington, NC which is close to Durham and the Duke medical community.

Any recommendations for other Colon doctors who might be able to remove the polyp as a first resort?

So thankful in advance for any/all responses.

Thanks,
-Willie

weisssoccermom
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby weisssoccermom » Sat Oct 31, 2015 9:55 am

Welcome Willie to our club. I'm sure you'll find many helpful people here.
I understand your questions/concerns but honestly, because the polyp does contain cancerous cells, the operation that is being suggested is standard of care. Here's one of the reasons. You know that there are cancerous cells in that polyp which means that it is possible, depending on the location of the tumor and your father's particular anatomy, for even one cancerous cell to have gotten into either (or both) the lymphatic or vascular system in his body. I realize that it doesn't seem likely as the polyp isn't overly large, only a small portion of it contains cancer, etc. but believe me, cancer is so unpredictable that it is best to have the operation that the surgeon is recommending. If the GI doc wasn't comfortable trying to get the polyp out because of its shape, my first inclination is to believe it is flat polyp.....and those are much more 'dangerous' than the typical polyps with a well defined stalk. Just an FYI....had the GI been able to remove the polyp in its entirety, your father would likely be looking at the same surgery. No doctor wants to run the risk that there are cancerous cells remaining in the surrounding tissue....even if it appears that the polyp was completely removed.

There is a reason that the surgeons do this particular surgery....studies have shown that it is beneficial, in the long run, to the patient. Better to remove the surrounding, potentially affected area NOW, rather than wait to see if even one cancerous cell had remained and then be dealing with a bigger problem.

Did the surgeon say when they would be able to operate on your father? Here is a link where you can go to find a board certified colon and rectal surgeon in your area. A general surgeon can also perform this surgery, however, if there are other mitigating factors, such as your father's weight, you may want to consider a specialist who could best handle the case.

Good luck. Please let us know how your dad is doing and what another surgeon says.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
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Jacques
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby Jacques » Sat Oct 31, 2015 11:45 am

weisssoccermom wrote:... Here is a link where you can go to find a board certified colon and rectal surgeon in your area...

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=52349#p410280
DX(2012): RC
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LAR
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sadysue
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby sadysue » Sat Oct 31, 2015 11:51 am

I don't think the surgeon seems eager if there is any evidence of cancer, which you say there is. I would definitely make an appt with a board certified colorectal surgeon asap for a second opinion. Duke is a good place to start, if it's not too far from you. Best of luck to you dad.
Rectal dx 4/2011 (Stage 3B - T3N1M0)
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mmblz
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby mmblz » Sat Oct 31, 2015 1:24 pm

Fwiw, don't think of 10 inches as a lot, that's just what they need to take to get the polyp. The actual section removed will all depend on the blood supply, which dictates where they can cut.
38yo married 14 years. 4 kids 10, 8, 5, 3
2015-09-21 colonoscopy finds tumor in sigmoid, partial obstruction
2015-09-22 CT no mets, path G2 adenocarcinoma, CEA 1.2
2015-09-29 lap hemicolectomy at MSKCC
2015-10-06 pT3 N1a M0 stage IIIB
2015-10-22 folfox started - 12 rounds, last 4 no oxaliplatin
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Nik Colon
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby Nik Colon » Sat Oct 31, 2015 8:09 pm

weisssoccermom wrote:Welcome Willie to our club. I'm sure you'll find many helpful people here.
I understand your questions/concerns but honestly, because the polyp does contain cancerous cells, the operation that is being suggested is standard of care. Here's one of the reasons. You know that there are cancerous cells in that polyp which means that it is possible, depending on the location of the tumor and your father's particular anatomy, for even one cancerous cell to have gotten into either (or both) the lymphatic or vascular system in his body. I realize that it doesn't seem likely as the polyp isn't overly large, only a small portion of it contains cancer, etc. but believe me, cancer is so unpredictable that it is best to have the operation that the surgeon is recommending. If the GI doc wasn't comfortable trying to get the polyp out because of its shape, my first inclination is to believe it is flat polyp.....and those are much more 'dangerous' than the typical polyps with a well defined stalk. Just an FYI....had the GI been able to remove the polyp in its entirety, your father would likely be looking at the same surgery. No doctor wants to run the risk that there are cancerous cells remaining in the surrounding tissue....even if it appears that the polyp was completely removed.

There is a reason that the surgeons do this particular surgery....studies have shown that it is beneficial, in the long run, to the patient. Better to remove the surrounding, potentially affected area NOW, rather than wait to see if even one cancerous cell had remained and then be dealing with a bigger problem.

Did the surgeon say when they would be able to operate on your father? Here is a link where you can go to find a board certified colon and rectal surgeon in your area. A general surgeon can also perform this surgery, however, if there are other mitigating factors, such as your father's weight, you may want to consider a specialist who could best handle the case.

Good luck. Please let us know how your dad is doing and what another surgeon says.

The OP did say there was cancer found.
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weisssoccermom
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby weisssoccermom » Sat Oct 31, 2015 8:34 pm

That's not the link that I had intended to post but thank you. Here is the link to the actual board that does the certification. Sorry, I forgot to post it.

http://www.abcrs.org/verify-a-physician-2/
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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ozziej
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby ozziej » Sun Nov 01, 2015 4:25 am

Given my own experience I would suggest obtaining more information and then seeking a second opinion. I had a flat 1.5 cm polyp identified during colonoscopy. My GI biopsied the polyp and thought it was benign. He referred me to a GI skilled in endoscopic mucosal resection (dye injected during colonoscopy, lifts the polyp, snare removal). Had the EMR done, polyp removed completely in one piece. However, histology came back as adenocarcinoma and showed part of the polyp had invaded the rectal wall. Was referred to a colorectal surgeon. He offered two options: "watch and wait" or ultra low anterior resection. He said that if I was 45 and in otherwise good health he would recommend surgery. If I was 75 and had other health issues then watch and wait. I was 56 and I chose the surgery. One of the hardest decisions of my life. No regrets, but there are consequences (avoided permanent colostomy but ongoing bowel issues). The location of the polyp can make a difference, is it in the colon or the rectum, and if in the rectum, how low? This can have implications for post resection bowel issues. Is the surgeon able to tell you the depth of any penetration into the bowel wall? Any penetration increases risk of lymph/vascular invasion. This is not an easy decision, you and your father need to be armed with all the information available in order to choose how to proceed.
Best wishes
Jan
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radnyc
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby radnyc » Sun Nov 01, 2015 8:43 am

I would do the surgery, don't wait too long. He has colon cancer. Find a reputable surgeon in your area.
DX Jan '10, at 47
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby Carolinabluetec » Sun Nov 01, 2015 12:58 pm

I am a similar age and had 9 inches of my sigmoid colon removed. I had no lasting ill effects of the surgery due to the fact that I was in excellent health otherwise and not a surgical risk. If he is significantly overweight and has other issues that make him a surgical risk these need to be discussed with the surgeon you choose.
03/14 DX Adenocarcinoma Sigmoid Polyp
05/14 Da Vinci Sigmoid Colectomy
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weisssoccermom
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby weisssoccermom » Sun Nov 01, 2015 5:12 pm

Honestly, even if the polyp had been able to have been removed in its entirety AND the biopsy came back with a history of cancer in any part of the polyp, the 'standard of care' would be to have the surgery done. While just looking at a few facts it seems as though removal of the polyp should suffice, without the surgery and removal of the surrounding lymph nodes, there is no way to know if the cancer has/hasn't spread. Even the smallest of polyps/tumor have the ability to spread into the vascular and/or lymphatic system. I very much doubt, with a confirmed diagnosis of a cancer, that you will find a doctor who wouldn't recommend the surgery.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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dianetavegia
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Re: Father recently diagnosed - Surgeons seem too eager?

Postby dianetavegia » Mon Nov 02, 2015 5:54 pm

12 to 15 lymph nodes has been shown to have a higher success rate. I had a 2.5 cm tumor and 18 inches of my colon removed.

Not too eager at all! I'm assuming since your father is large that he can't have a LAP and probably the timing of a full abdominal surgery is based on the surgeon's schedule instead of anything else.

Get that out as soon as possible and read up on longer healing times, etc. for larger patients. ALSO, if and when your Dad needs chemo, make sure his onc doses him based on weight. A study showed that most oncs dosed their patients based on the norm and not by weight and overweight women in the study were not receiving proper doses of chemo. And, larger people have much lower CEA's (blood test that shows levels of a protein for circulating tumor cells) so if Dad's is super low, don't just assume he's righter than rain. Be aggressive and save a life!
Stage IIIB cc surgery 1/7/09. 5/17 nodes. 12 tx FOLFOX
Stage IVa 2/15/12. CEA 6.4 PET = 1.5cm liver met. HR 4/11/12 No chemo

Nine years 10 months since dx and 6 1/2 years post liver resection.
NED Oct. 2018

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