New here: Question, re: Chemo after Stage II resection

[Fred.R]

Hey there;

I'm glad I found this place. I hope as time goes on I can answer as often as I ask.

here's where I'm at:

Just finished a Sigmoid Collectomy. Am currently sporting a stoma and healing.

My status is T3N0M0

1) I have read that starting chemo four weeks after the surgery is better than 8 and 12.
2) I have seen a few studies that suggest chemo helps survival rates, regardless, but there hasn't been focus on Stage II and chemo.
3) I feel I have to make the chemo decision soon, the doctor is on the fence as there are no hard studies.
4) Are there better chemo agents that FOLFOX? It seems like most of the stage II studies I find online refer mostly to them.

Has anyone read anything that speaks to this? In talking survival rates, I want to be aggressive. But if it's literally ZERO, I'm thinking of a swifter reverse ileostomy as that would return my day and date to normalcy faster. But obviously, long term survival is the goal, not short term comfort.

Any advice/links/thoughts would be appreciated.

- F

[cashmere]

Hi Fred,

Welcome to the club I am sure you do not want to belong to!!

IMO, I would opt to keep the ostomy and do chemo. The chemo after surgery is to mop up any cancer cells that go undetected.

In the grand scheme of things, the time frame, side effects, etc are well worth it.

Good luck with your decision, Pearl

[O Stoma Mia]

...here's where I'm at:
Just finished a Sigmoid Collectomy. Am currently sporting a stoma and healing.
My status is T3N0M0...

Hi Fred - Here is how I interpret your current situation and the near future, given the information you have provided so far.

1. Sigmoid colon resection - T3N0M0
2. One month to recover from surgery
3. Six months of first-line FOLFOX adjuvant chemotherapy
4. One month to recover from chemotherapy
5. Ileostomy reversal surgery
6. One month to recover from reversal surgery
7. Five years or more of surveillance (periodic scans for recurrence)

In Step 2 you will need at last one month before starting chemo. More time may be needed if scans show that there are leaks at the join between the two parts of the sigmoid colon. Step 3 is a minimum of 6 months, but could extend longer if interruptions are required to boost up immunity and/or electrolyte balance between cycles. After Step 6, there will be a long period of re-training the colon to reach a new "normal". At Step 7, re-staging and new therapies are instituted if scans confirm a recurrence and the need for additional treatment.

Is this the way it looks to you?

[BrownBagger]

I was originally staged the same as you, and I had four rounds of Xelox, which is identical to Folfox except that you take Xeloda pills instead of 5-FU infusions with the pump. Most people find it easier to swallow the pills twice a day. I still needed four infusions of Oxiliplatin--once every three weeks. I'd do it again and given the way it worked out for me, I'd do a lot more.

But just so you know, that Oxi is some nasty stuff. No getting around that. Oddly enough, I found great relief in regular, vigorous exercise.

[Voxx66]

This is complicated. I had stage IIa, did no chemo, and got liver mets. Still - given the evidence at the time I would make the same choice. (Knowing the hand that was dealt of course would suggest a different choice.) My doc is on the board that sets the chemo treatment standards nationally and he went over the odds in great detail including materials not yet published. The problem is that there are many unique factors in each case which will influence individual odds in every specific case. In my case he felt a full 12 round FOLFOX regimen would increase my 5 year survival rate by around 2% and 5 year disease free chances by 4%. Given the risks of chemo - he told me honestly if it was him he wouldn't do it but it was a close call.

Yes - you have to start asap or you get even fewer benefits. And chemo while great at knocking down large numbers of tumor cells isn't great at rooting out every last one of them. You can do chemo and it can still come back. The choice will in the end be yours but getting the most info possible is going to be key to that. I am not going to suggest what you should do. I can only tell you what I know and you can take what you will ha.

I have btw lots of info including some not yet published that goes into stage II risk factors. I can share more if you wish when I have a bit more time late today.

[orcasres]

I was staged 2a after resection. The onc said that chemo gave me a 5% advantage in disease free survival and I did not hesitate to do it. My onc was relieved, but he very much made it my decision. I knew that if I did have a recurrence I would be very upset with myself for not pursuing all of the options. With stage 2, the decision is more of a personal one than for other stages because the research results are so mixed.

Good luck with your decision making.

Lois

[teacher49]

Fred,

I was Stage 2a, RC at diagnosis. My surgeon was iffy about doing chemo....said the jury was still out on chemo for Stage 2. The ONC told me the stats for Stage 2 were @ 25% chance of recurrance and the addition of chemo would halve that...... to 12.5% recurrance risk.

Stats are stats ....just averages not individuals. I leaned towards chemo because before my current teaching job I had read too many cancer cases in my years as a cancer registrar (the person who collects all the data on cancer cases) so I chose to do the adj. chemo, just in case a few stray micro-cells were left.

If I had to do it again, I would still do the chemo....but maybe stop the Oxy at Round 8. Round 10 really socked me with loss of nerves in the bottoms of my feet. They kept asking me for my symptoms and to describe any pain in my limbs up until then....but until you have peripheral neuropathy, you don't really know what it feels like. Numbness & tingling in the soles of your feet.

I'm one year out from the end of chemo and I feel good otherwise.....work full-time....play golf....just can't go barefoot or wear sandals....because I wouldn't feel it if I gashed my feet.

[Fred.R]

Interesting. So from those of you show chose Chemo, even if you didn't finish the whole treatment, you feel there was merit.

I am leaning toward this. Right now I'm in my third day out of the hospital from the tear in my colon which put me under for ten days. I have another five days of antibiotics which bring me up to "week three" of when I should have been done with the surgery part, although I know my body is still on the mend.

My gut tells me to go for the Chemo. Let it do whatever it can do - let my body handle whatever it can handle - if I make it all the way through, so be it, if I don't, then I stop, take whatever time I need to get better and for the ileostomy reversal and then fight.

I'll pop in after I discuss with my Onc but in your past, did you believe that any chemo was better than no chemo? I fear the two surgeries in five days has made me weak, but I also know the longer I wait for chemo the less effective it is post surgery.

Thanks everybody.

[Choijk]

Hi Fred, someone posted a video link, an interview with dr John Marshall regarding stage 2 and chemo or no chemo. I found it helpful but can't seem to find the link. I found something similar to the interview online.

http://www.cancernetwork.com/colorectal ... 65/1513860

I will try to look for the video link.

Best of luck with your decision, it is a very tough decision which my mom thought about over and over again. However, in the end, because she didn't have any prognostic factors, she decided against chemotherapy. Also two oncologists didn't recommend it either. However, my mom is older and just turned 74 this August 26. I don't know if her age had any bearing on the doctors recommendations regarding no chemotherapy.

[Choijk]

Fred here is the link to the video re stage 2

http://vimeo.com/15157338

Best wishes on your decision!

[WorriedWife]

My hubby was stage 2b and decided against chemo also. No matter what happens he is happy with his decision. We had 2 onc opinions, the first one said he suggested chemo, the 2nd one who spent a whole hour with us explaining everything in great detail said it's up to my hubby - he did not suggest one way or the other but gave us all the info to make the decision ourselves. We've seen way too many cases where people do chemo and the cancer came back anyway. My hubby felt at the time (last summer) that if it does come back then maybe they'd have some new and better treatments out. Good luck to you and just go with your instincts and all your knowledge....everyone thinks differently and just do whatever you think is right for you. Bless you and I wish you the very best moving forward. It's a tough decision.

[justin case]

I was stage2a, had chemo 9 rounds, FOLFOX and radiation, surgery with illiostomy, got the illiostomy reversed after 3 weeks, and then did 12 rounds of 5FU only. You do not have to go through chemo with an ostomy, that is often the choice as chemo can cause diarrhea and or constipation.
Regards,
Michael

[dewife]

My hubby had a rt side resection, followed by Folfox, & went into remisssion for 20 mos after 6 tmts. Unfortunately, the oxylaplatin left him w/ neuropathy in his feet-3yrs later. You'll Learn that everything with this disease is a trade off!

[CrazyHarry]

I started my adventure with Rectal Cancer. Then chemo/rad with Xeloda until my kidneys stopped functioning.

Resection

Adjuvant FOLFOX and made it through 3 before neuropathy took over and we stopped the Oxiplatin. Fans hung up with just the 5FU. No nasty oxi side effects but my GI tract gets very mad at me after chemo. Only two more and I'm doing my best to see it to the end.

The reasoning is that I'm in the wrong end of the gene pool as well as a family history that didn't end well for the patients. My parents who died at 41 and 56 from metastatic breast and renal cancer.

So I plan for a week of misery and maybe a good day or two before my next chemo.

Best wishes on whatever decision you make.

[Voxx66]

Crazyharry - may I ask how well your kidneys have recovered? My father had issues with chemo and kidneys and I have been a bit concerned about it. Hopefully yours have bounced back.