Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

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roadrunner
Posts: 347
Joined: Sun Jan 12, 2020 8:46 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby roadrunner » Mon Jan 16, 2023 12:55 pm

It may depend on where your polyps are. If they are rectal, and in the CRT “zone of death,” you should consider whether any accelerated process in that area might be due to the radiation therapy.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)

Suelee20
Posts: 10
Joined: Sat Dec 31, 2022 1:44 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Suelee20 » Tue Jan 17, 2023 2:53 pm

Roadrunner,

What is CRT zone of death? I’m trying to get a handle on the viability of surgery or some procedure of my husband’s tumor in the rectum. Granted, his cancer is not under control which is also one of the reasons why Dr doesn’t recommend surgery due to being off chemo for so long.

Thanks
Sue
Wife of DH (52); DX 9/27/18; CEA 22.9
10/31/18 LAR; Rectosig;6.2x4.5x1.1cm; Inv adenocarc; LowGr; pT4bN2b;tumor inv through muscularis propria into pericolorectal soft tissue;tumor inv peritoneal memb, ext to the serosal surf,inv the pelv sidewall;LN - 8/27;neg margins;WT-KRAS,NRAS,BRAF; MSS
Surg2/21(liv)
Ablat3/19(liv)
AdjChemoRT+Cap8/19(pelv)
Cykniferad1/20(liv)
SBRT12/21(lungs)
Stent6/22(rect)
CAPOX+Bev(4x);Folfiri+Bev(5x);Cap+Cetux(5x);Capiri+Cetux(14x);Oxali+Cetux(7x)
1/23Capiri+cetux totrytoslowprog

roadrunner
Posts: 347
Joined: Sun Jan 12, 2020 8:46 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby roadrunner » Tue Jan 17, 2023 4:31 pm

I was just using a colorful term for the area in the rectum that’s in the radiation field when rectal cancer is treated. Even with current technology, healthy rectal tissue is irradiated, which causes permanent damage. In some cases, this can lead to an accelerated polyp process in that area.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)

Jolene
Posts: 178
Joined: Wed Jan 23, 2019 10:17 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby Jolene » Fri Jan 27, 2023 1:12 pm

roadrunner wrote:I was just using a colorful term for the area in the rectum that’s in the radiation field when rectal cancer is treated. Even with current technology, healthy rectal tissue is irradiated, which causes permanent damage. In some cases, this can lead to an accelerated polyp process in that area.


Gosh ! I never thought about this. A lot of the polys are in the rectal area as I do the sigmoid flex every 4 months , 6 months in the last couple of years.

This could potentially mean I should be doing a scope every other year forever to keep removing polyps. :|

I will ask the doctor about this possibility the next time ! He couldn't answer me when I asked why does he keep finding new polyps to remove !
Dx @ 39 F on WW managmeent
Nov 18 - Dx of a mid-rectal tumour at T3N1M0 (2cm) 7cm from AV
Dec 18 - CRT, 28 sessions + Capecitabine at 3000mg daily
Jan - Mar - WW in place (12 weeks)
Mar'19 - MRI, PET, sig flex and biopsy ordered to determine being a WW candidate.
Apr - CCR, surgery on hold. 6 cycles of Xelox.
Aug - 6 cycles of Xelox completed
Oct'19 - Flex sig, biopsy, PET/MRI
20-21 - Every 6 months - Full scope, Flex sig, biopsy, PET / MRI / CT
Jan 22 - NED - Flex sig, PET/CT
Jan 23 - NED - Flex sig, MRI

roadrunner
Posts: 347
Joined: Sun Jan 12, 2020 8:46 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby roadrunner » Fri Jan 27, 2023 2:42 pm

I have the same concern. My colorectal surgeon is a leading edge, world-class guy, and he feels this is likely at least part of the picture. I had a TAE done last time, he did another previously by lift-and-snare. My situation is quite complicated given the risk-based approach I took, so YMMV, but yeah, it’s something to watch.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)


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