Which way ?????.

[llupp]

What's the answer????????
Today we visit the surgeon once again hubby is doing much better and is adjusting to the bag. He has started timing his self so he knows how fast he can change it. I believe boredom must be setting in. The surgeon told us we need to have a long talk with the onco doc because he believes no chemo is needed now because of the pathology report. We believe since we went this far what's another 4 months of chemo to be sure.
Pathology report
No residual viable tumor after neoadjuvant chemo
The prior tumor bed is identified and measures 1.9x1.5 cm.
The entire tumor bed is submitted and no viable tumor is identified consistent with a complete pathological response.
Margins clear
Tumor per formation absent
Tumor grade no viable tumor for grading
Angiolymphatic invasion absent
Perineural invasion absent
Lymph nodes 24 benign
Surgical stage after neoadjuvantbchemon:ypTOypNO

Kidney
Renal cell carcinoma
Tumor focality unifocal
Tumor size 4.6x4.3x3.5
Tumor appears limited to kidney
Sarcomatoid absent
Fuhrman nuclear grade II
Surgical margins clearbrenalnvein,ureteraln all free of involvement
Surgical staging pT1b,pix

The kidney surgeon said with taking the whole kidney and chemo does not response well to rcc he recommends c-scan every 6 months.

The rectal surgeon saids he could not have ask for a better report and if it was him he would not do chemo. We see the onco on the 30th. So I am asking for alittle help here in questions to ask the onco doc. And with understanding of this report. The surgeons are telling us to question more chemo it could do more harm than good. I am very confused up to surgery everyone was on the same page about chemo after surgery. Any help will be greatly appreciated.
Caregiver
Husband rectum cancer 04/13
Pets can
C-scan 04/13
Port put in
Left kidney tumor found
6 weeks chemo f5 and radiation
Surgery schedule for 8/19
Removed left kidney
Removed tumor from rectal
Temp ilestomy
Release from hospital 8/23
Return to hospital 8/29
Dehydration and partial block stoma
Release 09/03

[O Stoma Mia]

... Today [Sept. 12] we visit the surgeon once again ...We believe since we went this far what's another 4 months of chemo to be sure...The rectal surgeon saids he could not have ask for a better report and if it was him he would not do chemo.

We see the onco on the 30th. So I am asking for a little help here in questions to ask the onco doc. And with understanding of this report. The surgeons are telling us to question more chemo it could do more harm than good. I am very confused up to surgery everyone was on the same page about chemo after surgery. Any help will be greatly appreciated.

Hi llupp - Thanks very much for the update and for including all the details from the various reports. If you are asking for a list of questions for the oncologist by September 30th, then I'm sure that some Forum members will be able to provide some input or opinions by then.

About your appointment with the rectal surgeon today, I'm not sure people here will have enough time to respond to you before you go to your meeting. Since rectal cancer surgery is usually very difficult due to the location of the tumor in the pelvic cavity, I would have a few questions for the surgeon:

• Exact location of the rectal tumor: How far down was the rectal tumor, i.e., how many centimeters from the anal verge?
• Proximity of tumor to other organs: Was the tumor close to the reproductive or urinary organs?
• Difficulty of surgery: How difficult did the surgeon consider this particular surgery to be?
• Likelihood of having dropped live cancerous cells during the surgery

The reason for these question is the following: If the surgery was considered difficult and 'dirty', then perhaps some cancer cells or micro-tumors were dropped deep in the pelvic region during surgery. These cells/micro-tumors might still be there but not big enough to show up on any of the scans right now, but if they were alive when dropped, they might be able to be killed by future treatments (either chemo or radiation). But the reports seem to suggest that all live cancer cells/ micro-tumors might already have been destroyed by the neo-adjuvant therapy, so I think that this is where the issue is. (This is just my personal opinion; it is not a medical opinion)

[-Sophie-]

I had a complete response to neo adjunctive chemo. No tumour or viable cancer found. I thought that might mean no more.chemo. Due to original.staging the onc wanted to be completely sure and highly recommended the extra chemo. I would suggest doing it but maybe just the 5fu instead of folfox.

[weisssoccermom]

Welcome. Here's my very first impressions based on your post.

Biggest question is this. What was your husband's original staging - the clinical stage? You don't say that and a rectal cancer patient is always treated by the clinical staging and NOT the staging after neoadjuvant chemoradiation. If you think about it it totally makes sense. One undergoes chemoradiation in hopes of: either shrinking or obliterating the original tumor and to sterilize the nodal field. Since staging is based on three factors - the "T" aspect - or the depth of the tumor in the rectal wall, the "N" component - the number of local nodes affected and the "M" component - distant metasteses, when you affect one or more of these areas, you can see how it can easily change the staging. This is precisely why cancer patients who receive any type of neoadjvuant treatment (be in chemo, radiation, RFA, etc and/or any combination) are always treated based on the initial staging. My point is - it is great that the tumor was totally eliminated but.........you should be treated based on the clinical staging and nothing else. Since you didn't mention what the clinical staging was, it is difficult to even give an opinion. Doctors are also very familiar with the terminology. For example, the yp in the surgical pathology report is very important. The "P" simply means that it is from a pathology report and the 'y' designation means that the report is based on AFTER treatment - a HUGE factor.

Now my second point. I truly wish surgeon's would stop advising patients about chemo. IT IS NOT THEIR FIELD OF EXPERTISE!!! Chemotherapy is the specialty of the oncologist - not the surgeon. Sure, just like a surgeon tends to recommend surgery (that's their field of expertise), an oncologist might very well recommend chemotherapy over another doctor but isn't that the reason why you're seeing an oncologist? After 7 years of this cancer journey, I get so angry when patients, particularly the newbies, get all these conflicting answers from their surgeons and oncologists. Don't get me wrong - the same types of situations hold true for oncologists as well - they oftentimes have a tendency to recommend a particular surgical procedure when that's not their field either. PLEASE - listen to what the oncologist says....he/she is the expert in the field. Cancer is truly a journey when you do want some very specific experts on your team. The radiation oncologist should be giving advice on radiation treatments and if he/she has a concern say about chemo - then he/she needs to bring it up to the oncologist. Same thing applies for the oncologist with the surgeon, the surgeon with the radiation oncologist, etc.

Since it is not routine or recommended for a clinically staged 1 patient to have chemoradiation, my guess is that your husband was at least clinically a stage IIA or above - meaning that he either had a fairly deep tumor and/or had some local lymph nodes that appeared to be affected. In either case, it is great that the chemoradiation did its job but......keep in mind that the radiation treatments ONLY had an effect on the pelvic area. The chemo that your husband received during those six weeks is NOT the same strength that a patient receives in the adjuvant setting. My point is simply this. Cancer is a sneaky little disease that can easily fool a patient. All it takes is ONE - a measly ONE microscopic cell to have found a pathway in the lymphatic or vascular system of a patient and that ONE tiny cell can set up residence somewhere else - a distant lymph node, another part of the pelvis that wasn't radiated, a lung, liver, etc. - and all of a sudden that ONE cell turns into hundreds and millions and now that same patient is dealing with a big problem! I'm not saying this scenario is going to happen - just that it is a possibility. PLEASE listen to the oncologist and NOT the surgeon

Jaynee

[O Stoma Mia]

Husband
rectum cancer 04/13 T? N? M?
Pets can
C-scan 04/13
Port put in
Left kidney tumor found
6 weeks chemo f5 and radiation
Surgery schedule for 8/19
Removed left kidney
Removed tumor from rectal
Temp ilestomy
Release from hospital 8/23
Return to hospital 8/29
Dehydration and partial block stoma
Release 09/03

Hi llupp - As Jaynee has mentioned, what is needed is your husband's TNM staging code at the time of diagnosis, i.e., in the April time frame. Is there a way that you can get this information? Here is a description of the TNM staging system for colorectal cancer:

TNM Staging - Colorectal Cancer
.
.

[llupp]

My husband and I were talking last night and I asked him why we are walking on eggs and not jumping up and down over the good pathology report. Why are we so scared still? When do we get celebrate and not be afraid of shadow around the corner? I guess it's because we are too informed and know that cancer is always going to be the elephant in the room. Sorry this is so down usually I am the one who is so positive. I just want that happy ending.
We decide we will listen and ask questions to our onco on the 30 th and go with the chemo if he decides that's wise.

[llupp]

So today we saw our oncologist and had a long discussion. My hubby red blood count was alittle low so he decided in 2 weeks we will start 6 treatment of 5--fu and Oxilplatin for 48 hrs. Every 2 weeks. We talked about what the surgeon said and he said he was right in a way . But until the standard of care is such he does not feel comfortable. He said they are doing a lot of trials to see if the chemo is needed. It is a this point very debatable and he rather error on caution. So any tips or help I would love. My biggest concern at this point is my poor hubby is still recovering from the surgery he is so tired and just doesn't have his pep back. The oncologist did agree with the kidney surgeon no need for any chemo just scans every 6 months.

[llupp]

Original staging IIb or IIIa. According to oncologist they just didn't know for sure.