5 fu

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natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

5 fu

Postby natelaugh » Wed Apr 03, 2019 11:58 pm

Hi,

My dad is 79 with colon cancer stage 3b with T3N2AM0. He had right colon remove, partial colectomy on 2/19/19. Pre surgery, his CEA was 68. He saw his oncologist this week and the doc suggested to do a 5 fu only for 6 months. My dad post surgery, CEA is 2.8, below the range of 0.0-5.0 ng/mL.

Should my dad do the chemotherapy? Any advise or question I should ask my dad oncologist?

Thanks,
Last edited by natelaugh on Thu Apr 04, 2019 3:27 pm, edited 1 time in total.
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

Eleda
Posts: 328
Joined: Thu Dec 28, 2017 2:28 am
Facebook Username: adele Morgan
Location: Ireland

Re: 5 fu

Postby Eleda » Thu Apr 04, 2019 3:49 am

Because Ur father is stage 3 the protocol is chemotherapy after surgery because it has traveled into his bloodstream and could possibly be waiting there to grow again,,,,, of course it's always a personal choice and only you or he can make that,
If it's any consolation I had to stop the folfox for 2 weeks because of a reaction to oxaliplatin but continued 5fu pump alone for 2 weeks and I felt no reaction or side effects to it on its own
Good luck with Ur decision

ADELE X
SWF, 47
Mom to 3 sons 6/8/12
Dec4th 2017 colonoscopy for minor intermittent rectal bleeding during Summer
CEA 4.4
DX T3 L3C M0 2.5/3 cm above AV.
JAN 3RD started 1650mg Zelda 2xday, with 28 radiation
Did tagamet 800mg daily and 75mg IV VIT C WEEKLY UNTIL SURGERY and
Tumor reduce by 80% 1 LN still remaining
TATME May10th, temp illeostomy
10/07/2018 CEA 3
MMR INTACT
Began FOLFOX July 10th
24/08/2018 Allergic reaction so next infusion lucovorin and 5fu
CEA 4
Second attempt with oxi aug 12th

Punky44
Posts: 475
Joined: Mon Oct 01, 2018 4:29 pm

Re: 5 fu

Postby Punky44 » Thu Apr 04, 2019 8:09 am

Yes mop up chemo is strongly advised for stage 3.

It affects everyone differently and for what it’s worth, my mom has a pretty uneventful time on it. Will thy just be doing 5fu and not FolFox?
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4; 3.0; 3.4
Latest update: 3/22/21: CEA 3.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

User avatar
O Stoma Mia
Posts: 1603
Joined: Sat Jun 22, 2013 6:29 am

Re: 5 fu

Postby O Stoma Mia » Thu Apr 04, 2019 8:46 am

natelaugh wrote:Hi,
My dad is 79 with colon cancer stage 3b with T3N2M0. He had right colon remove, partial colectomy on 2/19/19. Pre surgery, his CEA was 68. He saw his oncologist this week and the doc suggested to do a 5 fu only for 6 months. My dad post surgery, CEA is 2.8, below the range of 0.0-5.0 ng/mL.

Should my dad do the chemotherapy? Any advise or question I should ask my dad oncologist?

Thanks,


Before deciding about chemotherapy, the doctor or oncologist must look at all seven of the primary pathology risk factors:
According to the NCCN guidelines, the pathology high-risk features include the following:
  1. T4 primary tumors,
  2. poorly differentiated histology,
  3. presence of lymphovascular invasion (LVI) ◄◄◄,
  4. presence of perineural invasion (PNI),
  5. bowel obstruction,
  6. less than 12 lymph nodes evaluated in the pathology report, or
  7. close or indeterminate margins.


Since your father was staged as Stage III-B (T3N2M0), this means that he has at least one of the seven high risk factors above (i.e., lymphovascular invasion, because of the cancerous lymph nodes that were found). This is a high-risk factor because the cancerous lymph nodes already provide evidence that the tumor has found a way to send circulating tumor cells and micrometastases through the lymphatic system. There is then a good chance that there are other circulating cancer cells or micrometastases still circulating around in the lymphovascular system. That is why some kind of first-line chemotherapy is recommended in this case. This is sometime called "mop up" chemo, and it usually has a a fixed length of 6 months.

Also, your father might have more than just one high-risk factor. In his pathology report, there might be evidence of some of the other six risk factors listed above.

For this situation, the recommended course of treatment in the U.S. is to choose one of the first-line chemotherapy options listed by NCCN. 5FU is one of the recommended first-line treatment options, so your doctor is indeed suggesting one of the standard first-line therapies for a Stage III-B patient. There are other first-line therapies available, such as FOLFOX or XELOX(CAPEOX), but the doctor did not recommend these, perhaps because they are rather difficult regimens that older patients often have difficulty completing.

natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

Re: 5 fu

Postby natelaugh » Thu Apr 04, 2019 3:53 pm

Punky44 wrote:Yes mop up chemo is strongly advised for stage 3.

It affects everyone differently and for what it’s worth, my mom has a pretty uneventful time on it. Will thy just be doing 5fu and not FolFox?


My dad oncologist think 2 drugs FolFox for 6 months might be too much for my dad. He said that Oxaliplatin is very toxic and only add a few 2-3% to overall "Disease-Free Probability Following Surgery".

He used this tool to get probability https://www.mskcc.org/nomograms

Do you think or anyone know that using only 5FU for mop up work/effective??
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

Re: 5 fu

Postby natelaugh » Thu Apr 04, 2019 4:09 pm

O Stoma Mia wrote:
natelaugh wrote:Hi,
My dad is 79 with colon cancer stage 3b with T3N2M0. He had right colon remove, partial colectomy on 2/19/19. Pre surgery, his CEA was 68. He saw his oncologist this week and the doc suggested to do a 5 fu only for 6 months. My dad post surgery, CEA is 2.8, below the range of 0.0-5.0 ng/mL.

Should my dad do the chemotherapy? Any advise or question I should ask my dad oncologist?

Thanks,


Before deciding about chemotherapy, the doctor or oncologist must look at all seven of the primary pathology risk factors:
According to the NCCN guidelines, the pathology high-risk features include the following:
  1. T4 primary tumors,
  2. poorly differentiated histology,
  3. presence of lymphovascular invasion (LVI) ◄◄◄,
  4. presence of perineural invasion (PNI),
  5. bowel obstruction,
  6. less than 12 lymph nodes evaluated in the pathology report, or
  7. close or indeterminate margins.


Since your father was staged as Stage III-B (T3N2M0), this means that he has at least one of the seven high risk factors above (i.e., lymphovascular invasion, because of the cancerous lymph nodes that were found). This is a high-risk factor because the cancerous lymph nodes already provide evidence that the tumor has found a way to send circulating tumor cells and micrometastases through the lymphatic system. There is then a good chance that there are other circulating cancer cells or micrometastases still circulating around in the lymphovascular system. That is why some kind of first-line chemotherapy is recommended in this case. This is sometime called "mop up" chemo, and it usually has a a fixed length of 6 months.

Also, your father might have more than just one high-risk factor. In his pathology report, there might be evidence of some of the other six risk factors listed above.

For this situation, the recommended course of treatment in the U.S. is to choose one of the first-line chemotherapy options listed by NCCN. 5FU is one of the recommended first-line treatment options, so your doctor is indeed suggesting one of the standard first-line therapies for a Stage III-B patient. There are other first-line therapies available, such as FOLFOX or XELOX(CAPEOX), but the doctor did not recommend these, perhaps because they are rather difficult regimens that older patients often have difficulty completing.


Do you know if 5FU mop up is effective/work, since it is only using 1 drugs and not FOLFOX? Thanks you for providing these information!
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

Punky44
Posts: 475
Joined: Mon Oct 01, 2018 4:29 pm

Re: 5 fu

Postby Punky44 » Thu Apr 04, 2019 6:32 pm

There might be some on this board who can chime in? That does make sense though given his age.
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4; 3.0; 3.4
Latest update: 3/22/21: CEA 3.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

jpb571111
Posts: 1
Joined: Fri Apr 05, 2019 2:33 pm

Re: 5 fu

Postby jpb571111 » Fri Apr 05, 2019 2:41 pm

I saw and read some posts here.

I am T3N1. Started folfox in Feb 2019 4/12 cycles complete. My CEA level is .07( very low).
The f5u is very strong and alotta side effects. My onc recommended Folfox ( which sounds like the norm)

The side effects are horrible..nausea, fatigue, cold sensitivity, throat issues, constipation. This list goes on..

The f5u is a small portion that I get at the end and take home. Folfox is 3 parts.. not sure you can do just one..

My mouth issues are from the folfox..

Pyro
Posts: 305
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: 5 fu

Postby Pyro » Sat Apr 06, 2019 7:13 pm

If his health is poorish anyway, no. I’ll say it, chemo is hell.
Aug 2015- Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail
Jun 2019 - FOLFURI
Aug 2019 - No more, quality time!

rp1954
Posts: 1540
Joined: Mon Jun 13, 2011 1:13 am

Re: 5 fu

Postby rp1954 » Sat Apr 06, 2019 10:36 pm

5FU works best when it is sensitized or aided by something else. In the literature, in other places, depending on the markers, these could be as mild as PSK correlated with the CEA marker, maybe IV vitamin C for both cancer inhibition and reduced side effects if his cancer is KRAS/BRAF mutant, and if his CA199 (cancer tissue, or pre-op blood samples) was not too low, added cimetidine would have a good chance of having better stats than Folfox killing off escapees.

When these things hit their targets, they do better with fewer side effects. Also be sure and eliminate all sources of folic acid, specifically, the 5FU toxic, inferior vitamin B9 source for true folate, which we replaced with liver foods, like Liverwurst, pate' and plain liver dishes. We skipped out on high dose leucovorin and used low dose leucovorin tablets, like 5 - 20 mg per day, and it still improved our oral 5FU drug (UFT).

There are other naturopathic or nutraceutical items that can reduce side effects and/or improve the cancer situation. We used advice from the Riordan Clinic for IV vitamin C and some of the nutraceuticals and the Life Extension articles on cancer.

WhiteSwan's mom did ok with PSK and cimetidine alone but that has more recur risk if there are tumor cell clusters, but they have very few side effects.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C


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