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CancerBum21
Posts: 29
Joined: Fri Feb 26, 2021 6:27 am

New to the Club

Postby CancerBum21 » Mon Mar 01, 2021 3:23 pm

Hi Y'all! I'm new to the club. I'm 34 and a father of 2 and found out 2 weeks ago that I have rectal cancer. So far, I've been working with my doctors to try to determine what stage cancer I have. After I got the pathology report back from my gastroenterologist I was referred to a Medical Oncologist and Surgeon. My gastroenterologist ordered a CT scan and my surgeon ordered a MRI. The CT scan showed mild wall thickening and the MRI didn't show anything. I guess the next step is an ultrasound of the tumor to stage it since it didn't show up on the MRI.

I just feel like the process is moving so slowly! I'm try to be as proactive as I can, but the process just seems so disorganized. Is it common for it to take over a month to go from initial diagnosis to staging and treatment? It just seems like this process is taking forever. I want to take some action or at least know how bad it is. From my understanding the tests I've done basically rule out stage III and IV. I've called around to other providers and I guess I can't just go get an ultrasound at other place, I would have to have an initial appointment first which would probably put me at around 2 weeks... has this been anyone else's experience too?

Nor Cal
Posts: 89
Joined: Sun Dec 06, 2020 8:18 pm

Re: New to the Club

Postby Nor Cal » Mon Mar 01, 2021 9:34 pm

Sorry you've joined the club. It took me about 1 month exactly to go from finding a colon tumor to chemo. The wait is awful, just keep being your own best advocate.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. CEA 120.
BRAF+ TMB 5% MSS TDL1-1%
July 2020 - Present: 55 cycles chemo (All the various 5-FU regimens)
December 2020 - February 2021 Y90 Radioembolization, Chemoembolization x2

NoVA21
Posts: 13
Joined: Thu Feb 25, 2021 7:15 pm

Re: New to the Club

Postby NoVA21 » Mon Mar 01, 2021 11:11 pm

I am sorry to hear about your diagnosis.
I had colon cancer and not rectal. The biggest difference in treatment that I know of is that colon cancer usually starts with surgery and then treatment, while rectal is treatment first and then surgery.

In my experience, I was in surgery about exactly 1 month after my diagnosis. Then about a week to find out about the staging. 3 weeks after that I was in treatment. So 2 months give or take. But within those two months I lost count how many times I went back and forth to do different tests at the hospital. If my guess above is correct, I would think you would get treatment sooner than my timeline since you would not have the surgery until after.

The anxiety can be overwhelming which makes the wait unbearable. Hang in there. Never get discouraged.
Dx Jan 2015
Colon Resection Feb 2015 stage 3B
Folfox started Mar 2015
Could only finish 11 out of 12 rounds
Mar 2016 dx mets on both lungs - officially stage 4
Apr 2016 double lung resection
By the grace of God, am still clear today.

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horizon
Posts: 1669
Joined: Tue Apr 12, 2011 10:10 pm

Re: New to the Club

Postby horizon » Tue Mar 02, 2021 12:26 pm

Sorry that you joined our club. That sounds pretty similar to what I remember happening. Waiting for tests and appointments at the beginning is completely nerve wracking. Hang in there. You'll get a lot of support here.
I'm just a dude who still can't believe he had a resection and went through chemo (currently 13 years NED). Is this real life?

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Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

Rectal Cancer Diagnosis Scenarios

Postby Green Tea » Wed Mar 03, 2021 3:35 pm

Code: Select all

DISCLAIMER: This post concerns only M-Stage=MØ patients, that is, Stage I, Stage II, or Stage III rectal cancer patients who have no evidence of remote metastasis to the liver, lungs, peritoneum or other remote sites.

CancerBum21 wrote:...I just feel like the process is moving so slowly! I'm try to be as proactive as I can, but the process just seems so disorganized. Is it common for it to take over a month to go from initial diagnosis to staging and treatment? It just seems like this process is taking forever. I want to take some action or at least know how bad it is...

Welcome to the Club!

I'm sorry to hear that things are moving so slowly. Sometimes it just takes a long time for them to get all of the relevant data together.

First of all, the treatment for rectal cancer is somewhat different from the treatment for colon cancer because rectal cancer (nonmetastatic) usually involves three phases, not just two.

The three phases are:
1. Pre-surgery (also called "neoadjuvant therapy")
2. Surgery
3. Post-surgery (also called "adjuvant therapy")

The difference is that for rectal cancer it is very important to reduce the size of the tumor before surgery if at all possible. Then after surgery has taken place it may be advisable to invoke one or more more treatment protocols to "mop up" any stray tumor cells or micro-metastases that may still be present.

So, when a patient is diagnosed with rectal cancer, at least two doctors must be assigned -- a Colorectal Surgeon and a Medical Oncologist.  But there is also the possibility that a third doctor may need to be on the team -- a Radiation Oncologist -- in case it is decided that pelvic radiation is advisable either before or after surgery.  Thus, a rectal cancer treatment plan requires that all three of the above phases be addressed up front in the planning phase before the doctors can start any kind of treatment, because the doctors need to look at the big picture to assess the best way to guarantee overall treatment success while maintaining good quality of life.

Before a treatment plan can be launched, the team must agree specifically on what (if anything) should be done in each of the three phases above. (It should be mentioned here that in some cases it is not necessary to have all three phases.  For example, a Stage I diagnosis may require only surgery and nothing more.)

The interventions applied in the three phases above must be tailored to the specific rectal cancer diagnosis at hand, which means that the very first part of the planning sequence is to determine a detailed diagnosis as completely as possible and as early as possible. This means that a number of diagnostic tests (e.g., CT scans,  x-rays, MRIs, ultrasounds, lab tests, genetic tests, etc.) will need to be done. This may take some time, especially if the diagnosis turns out to be a difficult, complex one.

The NCCN gives a list of about a dozen recommended items to address when finalizing a rectal cancer diagnosis. In addition, the College of American Pathologists has a list of required pathology data elements that must be captured for a complete colorectal cancer diagnosis. Altogether there are about a dozen or a dozen and a half important data items that must be captured and incorporated in the initial diagnosis.

Eight of the most important data elements to be captured initially are:

1.  T-stage of primary mass:   The initial T-stage of the tumor before any intervention, i.e., T1, T2, T3, T4a, or T4b  -- the degree to which the tumor has grown into or through the rectum wall.

2. N-stage: The initial N-stage of the regional (mesorectal) lymph nodes. i.e., N0, N1a, N1b, N1c, N2a, or N2b  according to  the number of suspicious local lymph nodes appearing on the scans.

3.Orientation of tumor within the rectum: Dorsal-wall/ventral-wall/left-wall/right-wall.

4. Distance between the lower aspect of the tumor and the ano-rectal ring (sphincter muscle). Degree of sphincter involvement.

5. Tumor length (mm)

6. Radial Margin -  Amounted of cancer-free space between the tumor and other important organs/structures. The smallest distance (mm) between the tumor and the Mesorectal Fascia (MRF)

7. MSI or dMMR status - Whether the tumor is Microsatellite-High (MSI-H), or Microsatellite-Stable (MSS)

8. Baseline CEA - Initial CEA level prior to any treatment intervention.

Armed with good data in the critical areas of the diagnosis, the doctors can then proceed, in a coordinated way, to plan their respective interventions.

For most (but not all) cases, it is assumed that surgery will need to be performed at some point in time.  Given the data received from the initial diagnosis, the surgeon will determine the various approaches that could be taken to remove the tumor, and which approach would be the best one to use in this case.

For rectal cancer, there are a number of surgical possibilities, including AR (anterior resection) LAR (low anterior resection), ULAR (ultra low anterior resection), APR (abdomino-perineal resection), PE (pelvic extenteration), TE (trans-anal excision), TME (total mesorectal excision) TAMIS (trans anal minimally invasive surgery), TEM  (trans-anal endoscopic microsurgery), ESD (endoscopic submucosal dissection), TASER (trans anal submucosal endoscopic resection). The surgeon must determine the best approach to take given the constraints and circumstances.  In addition, the surgeon must assess whether a temporary ileostomy or a permanent colostomy will be required. And in some cases the surgeon may recommend an additional J-pouch surgery

The type of surgery envisioned may then dictate what kind of pre-surgery treatment would be required, such as TNT (total neoadjuvant therapy), LCCRT (long course chemo-radiation therapy), SCRT (short course radiation therapy), NCT (neoadjuvant chemotherapy) --  or possibly no pre-surgery treatment at all. If radiation is deemed necessary then a Radiation Oncologist must be added to the team.

For the post-surgery phase -- which is normally a phase of fixed length (usually from 4 to 8 months) -- there are about half a dozen options commonly available, such as FOLFOX, XELOX(CAPOX), 5FU/Leucovorin, FOLFIRI, FOLFIRINOX,  Xeloda monotherapy, or LCCRT (long course chemo/radiation therapy). These chemo options are standard, traditional cytotoxic chemo regimens. Note: For M0-staged patients, targeted therapies and immunotherapies are not on the NCCN recommended list; those therapies are reserved for Stage IV patients.

After the team has determined the best overall treatment plan, then the patient will be informed about the specific interventions that are planned (if any) for each of the three phases.

Since there are 3 possible phases and each of the three phases could theoretically have or not have a treatment intervention, there will be 8 possible scenarios. 

The most common of these scenarios are the following:

Scenario 1-1-1 : neoadjuvant therapy > surgery > adjuvant ("mop-up") therapy
Scenario 1-1-0 : TNT > surgery > (post-surgery observation only)
Scenario 1-0-0 :  Habr-Gama protocol to avoid surgery *** > (post treatment Wait & Watch)
Scenario 0-1-1 :  Emergency surgery > adjuvant ("mop-up") therapy
Scenario 0-1-0 :  Surgery only (for Stage 1 and some Stage 2A patients)

*** Scenario 1-0-0 is when it is desired to eliminate surgery itself by imposing a powerful neoadjuvant chemotherapy regimen up-front designed to achieve complete clinical response ( cCR ) by obliterating the tumor and nearby lymph nodes. This approach is called the Habr-Gama protocol for avoiding surgery, otherwise known as Watch and Wait (W&W)
Last edited by Green Tea on Fri Jun 18, 2021 1:06 pm, edited 1 time in total.

DarknessEmbraced
Posts: 3816
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: New to the Club

Postby DarknessEmbraced » Sat Mar 06, 2021 11:02 am

I'm sorry for your diagnosis and I hope all goes well for you.*hugs*
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)

CancerBum21
Posts: 29
Joined: Fri Feb 26, 2021 6:27 am

Re: New to the Club

Postby CancerBum21 » Mon Mar 22, 2021 7:00 pm

@greentea thank you so much for your message and others for the support! It helped a lot.

After we finished the imaging and ultrasound it was staged as a T1 tumor and I decided to do TAMIS surgery and had the tumor removed.

We got the pathology back today and there was indication of at least one lymph node so it looks like we’re I’m going to need some post surgery treatment.
34/M
DX:(Rectal Cancer) 2/15/21
Stage: T1N0M0
TAMIS Surgery 3/10/21
Pathology: T1NxM0 - LIV positive, 1/1 lymph positive Stage IIIA
FOLFOX 6 rounds
Radation & Xelota 5 weeks

CancerBum21
Posts: 29
Joined: Fri Feb 26, 2021 6:27 am

Re: New to the Club

Postby CancerBum21 » Tue Mar 23, 2021 6:35 pm

Does anyone had any experience with adjunctive treatment for rectal cancer? I have an appointment with my oncologist and surgeon on Thursday and am trying to figure out what to expect and prepaid some good questions.

Since the Initial staging was T1 N0 M0 the treatment path was surgery and done. Now with the pathology report it seems like more treatment will be needed. It’s been upstaged to T1 N1 M0. The lymph node wasn’t detected on my MRI but found during the pathology report.
34/M
DX:(Rectal Cancer) 2/15/21
Stage: T1N0M0
TAMIS Surgery 3/10/21
Pathology: T1NxM0 - LIV positive, 1/1 lymph positive Stage IIIA
FOLFOX 6 rounds
Radation & Xelota 5 weeks

catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: New to the Club

Postby catstaff » Wed Mar 24, 2021 4:59 pm

The usual treatment for stage IIIA would be 6 to 8 rounds of FOLFOX chemotherapy. That's a combination of a drug called 5FU and another called oxaliplatin. Oxaliplatin usually causes peripheral neuropathy that diminishes (slowly) after the end of the treatment. Many patients try icing their hands, feet, and even mouths (with ice chips) to reduce the blood flow to the periphery to try to reduce accumulation of oxaliplatin there.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

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Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

Re: New to the Club

Postby Green Tea » Thu Mar 25, 2021 8:57 am

CancerBum21 wrote:Does anyone had any experience with adjunctive treatment for rectal cancer? I have an appointment with my oncologist and surgeon on Thursday and am trying to figure out what to expect and prepaid some good questions.

Since the Initial staging was T1 N0 M0 the treatment path was surgery and done. Now with the pathology report it seems like more treatment will be needed. It’s been upstaged to T1 N1 M0. The lymph node wasn’t detected on my MRI but found during the pathology report.

For Stage III-A adjuvant therapy the choice is essentially between FOLFOX vs. XELOX(CAPOX). The two are considered equivalent in terms of survival benefit. Both regimens use oxaliplatin, which is administered only intravenously, but for the 5FU chemo component, FOLFOX uses a pump to deliver 5FU/LV in liquid form while XELOX uses only the oral pill version of 5FU (i.e., capecitabine pills instead of 5FU/LV by pump).


If you are given a choice between the two, be sure to examine all of the pro's and con's before deciding. They have slightly different adverse event profiles, and they are different in the length and timing of cycles. They are also different in the number of trips to the hospital required.

For a 3-month (12 week) treatment period, for example, the FOLFOX regimen consists of a series of 6 two-week cycles while the XELOX regimen consists of a series of 4 three-week cycles, Thus, the FOLFOX regimen requires more trips to the hospital than does the XELOX regimen. Also, since the infusions for XELOX are given less often, they contain a larger dose per session than the FOLFOX, namely, 130 mg/M2 vs. 85 mg/M2 for FOLFOX. In either case the total dose of oxaliplatin administered over 3 months is the same for both regimens. It's just that the distribution per cycle is different. Please note that if they put you on the XELOX(CAPOX) regimen then each standard dose of oxaliplatin is a whopping 130mg/M2 and this might trigger more short term toxic reactions.

Since both regimens require IV infusion of oxaliplatin on Day 1 of each cycle, a decision must be made about the kind of IV connection to use, namely a central-line connection to the heart using a port, vs. a peripheral connection to a vein in the arm/wrist. (Most patients prefer the port option since it less likely to cause problems over the treatment period.)

If you are allergic or hypersensitive to many substances, you might want to look into the various ways to control the toxic reactions to oxaplation -- including, in the extreme, to drop the oxaliplatin component altogether if it causes too much peripheral neuropathy.


  1. Oxaliplatin - Treating peripheral neuropathy by naturopathy -

    Re: Oxaliplatin advice (post)
    http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=50311&p=385241#p385241

    Prevention and Management of Chemotherapy-Induced-Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Clinical Practice Guideline
    http://jco.ascopubs.org/content/32/18/1941.full.pdf+html

    Complementary Therapies for Chemo-Neuropathy: An Integrative Oncologist's Bag of Tricks
    http://www.integrativeoncology-essentials.com/2013/06/complementary-therapies-for-chemo-neuropathy/
    °
  2. Note: Oxaliplatin toxicity and oxaliplatin desensitization protocols -

    Oxaliplatin desensitization questions
    http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=35164#p246839

    Allergic reaction to Oxi
    http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=43093#p304849

    Desensitization protocol for oxaliplatin
    http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=57906&p=456018#p456018

    Hypersensitivity Reactions to Oxaliplatin and the Application of a Desensitization Protocol
    http://theoncologist.alphamedpress.org/content/9/5/546.full.pdf+html
    °
  3. Oxaliplatin - Slower infusion rate. Normally, the Cycle 1 infusion is run at a slower rate (like 3 hours instead of the normal 2 hour infusion). This is so that they can better monitor the patient for reactions during the first infusion. From Cycle 2 onward, however, they will probably try to set up the infusion at the normal rate (like 2 hours to deliver the same amount of chemo that was delivered over a 3-hour span in the Cycle 1 infusion). This might be too fast for you. It would be less stressful on your system if they continued with the slower infusion rate from Cycle 2 onward. The down-side to this is that your infusion sessions would be an hour or more longer than standard if you choose to go with the slower setting. This is something that you could discuss with your oncologist.
    .
  4. Oxaliplatin -Lower overall dose of oxaliplatin - I think the standard dose for oxaliplatin for the Capox protocol is 130mg/m2 administered over two hours, but the fall-back dose for patients who cannot tolerate this level is 115mg/m2. It might be better for you over the long haul if you were given the lower dose instead of the standard dose. With the lower dose of oxaliplatin you would have almost all of the benefits of oxaliplatin, but would have the added possible benefit that you may be able to tolerate oxaliplatin for the entire treatment period as opposed to having to drop it completely halfway through. This is also something you could discuss with your oncologist.
    .
  5. Oxaliplatin - Ice packs on feet during infusion There is some evidence that a patient can inhibit toxic doses of oxaliplatin from reaching the toes if the patient brings ice packs to the infusion session and places the ice packs on his feet during the two-hour infusion session.
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65168&p=507045#p507045

If your regimen involves Xeloda (capecitabine) then you should be prepared to deal with possible onset of Hand Foot Syndrome:

Hand Foot Syndrome (HFS)
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60725&p=480859#p480859

Please let us know which regimen you will be following, and let us know when you will be starting the first cycle.
Thank you.

catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: New to the Club

Postby catstaff » Thu Mar 25, 2021 2:20 pm

He said he's a rectal cancer patient and even for post-surgery chemo I think they generally do a shorter series of either FOLFOX or XELOX than they do for colon. However, it still is often necessary to reduce or eliminate the oxaliplatin after only 6 or 7 cycles.
Addendum: One or perhaps the main reason for the shorter course of chemo in rectal is because they usually pretreat with radiation, but the original poster didn't mention that. So 12 cycles may be the standard of care here. The oncologist will let him know.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

CancerBum21
Posts: 29
Joined: Fri Feb 26, 2021 6:27 am

Re: New to the Club

Postby CancerBum21 » Fri Mar 26, 2021 9:06 pm

Thanks again for all your comments and info. I’m going to look into ice packs for my feet!

I spoke with my oncologist today briefly on the phone. We have an appointment next week to go into more details. The current plan is 6 rounds of FOLFOX so about 3 months. I didn’t get the dosages yet, I’ll ask. Then it’s likely I will do a round of radiation as well. I need to setup that appointment still.

One of my concerns at this point is fertility. I didn’t have time to get into it on the phone with my oncologist but I bet I can bank some sperm or something. I’m a relatively young guy, 34. We have 2 kids already, but I guess I would just feel a little emasculated knowing there’s a chance I could never be able to have another baby. Highly unlikely we will but still.. does anyone have experience baking sperm?
34/M
DX:(Rectal Cancer) 2/15/21
Stage: T1N0M0
TAMIS Surgery 3/10/21
Pathology: T1NxM0 - LIV positive, 1/1 lymph positive Stage IIIA
FOLFOX 6 rounds
Radation & Xelota 5 weeks

User avatar
Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

Re: Some FOLFOX and adjuvant chemo/radiation resources

Postby Green Tea » Sat Mar 27, 2021 2:05 pm

Good luck on your upcoming FOLFOX regimen!

  1. Here are some resources that you might find useful in your conversations with your medical oncologist:

    Questions to ask the doctor
    https://health.usnews.com/conditions/cancer/articles/questions-to-ask-your-oncologist-at-your-first-cancer-appointment
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60747&p=481109#p481109
    http://go.ccalliance.org/treatmentquestions

    Some additional FOLFOX resources
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=64235&p=502673#p502673

    Side effects of FOLFOX regimen
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44542&p=321388#p321388
    .
  2. Here are some resources concerning pelvic chemo/radiation that may be useful in your discussions with your radiation oncologist:

    Types of targeted rectal radiation
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=48936&p=372445#p372445

    Preparation for neo-adjuvant chemo/radiation (rectal cancer patients)
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=63715&p=500312#p500312

    Radiation side effects
    Radiation Therapy Side Effects and Ways to Manage Them
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44619&p=321925#p321925
    .
  3. You can use your next appointment with the doctor to update and finalize your risk-factor profile. As mentioned earlier, for rectal cancer patients there are a number of important data items that are used by doctors to assess the risk of recurrence once the tumor has been removed by surgery. You can look through all of your recent pathology reports, surgery reports, scan reports and lab reports to see if you can identify these various items. The oncologist may be able to help you if you can't find some of them in your reports.

    The most important data elements to be captured by the time surgery has removed the primary tumor are:

    Tumor type - Adenocarcinoma; villous adenoma; signet ring-cell carcinoma, etc.

    Tumor size - (in mm or cm)

    Tumor grade -
      G1: Well differentiated (low grade)
      G2: Moderately differentiated (intermediate grade)
      G3: Poorly differentiated (high grade)
      G4: Undifferentiated (high grade)
    TNM code: e,g, T3N1aM0
    • T-stage of primary mass: The initial T-stage of the tumor before any intervention, i.e., T1, T2, T3, T4a, or T4b -- the degree to which the tumor has grown into or through the rectum wall.
    • N-stage: The N-stage of the regional (mesorectal) lymph nodes. i.e., N0, N1a, N1b, N1c, N2a, or N2b according to the number of suspicious local lymph nodes appearing on the scans or confirmed in the pathology report.
    • M-stage: Level of remote metastatic involvement (in liver, lungs, peritoneum, etc.) found by scans
    Stage - Stage I, Stage II, Stage III or Stage IV (with subscript, if applicable)

    Orientation - Orientation of tumor within the rectum: Dorsal-wall (near spine)/ventral-wall(near bladder)/left-wall/right-wall.

    Distance from anal verge (AV) - . Distance between the lower aspect of the tumor and the ano-rectal ring (sphincter muscle). Degree of sphincter involvement.

    Proximal and distal surgical margins - clear vs. involved: Amount of cancer-free space in rectum wall above or below the tumor.

    Radial surgical margin - Amount of cancer-free space between the tumor and other important nearby organs/structures. The smallest distance (mm) between the tumor and the Mesorectal Fascia (MRF)

    MSI or dMMR status - Whether the tumor is Microsatellite-High (MSI-H), or Microsatellite-Stable (MSS)

    LVI- Lymphovascular invasion, present vs. absent

    PNI - Perineural invasion, present vs. absent

    Baseline CEA vs. Post-surgery CEA - Initial CEA level prior to any treatment intervention vs. CEA level just after tumor removal.

    It would be good if you could identify all of these items now, because they are what determine the type and degree of adjuvant therapy that you will need.

Please let us know when you finally start your treatment regimen.

Thank you.

CancerBum21
Posts: 29
Joined: Fri Feb 26, 2021 6:27 am

Re: Some FOLFOX and adjuvant chemo/radiation resources

Postby CancerBum21 » Tue Mar 30, 2021 8:48 am

Thank you again for all your info. It has helped a lot. We just had a new baby so I'm just getting to all the reading about this that I would like to do.

Here's what I have from the pathology report:

Tumor type - Adenocarcinoma

Tumor size - 17 x 5 Millimeters in greatest microscopic extent

Tumor grade - G2: Moderately differentiated

[*]T-stage of primary mass: T1 - Tumor invades submucosa

[*]N-stage: pN1a: One regional lymph node is positive (only one lymph node was removed during the TAMIS/TAR procedure)

[*]M-stage: Level of remote metastatic involvement (in liver, lungs, peritoneum, etc.) found by scans[/list]: none found by CT, only did MRI of pelvis

Stage - Stage IIIa

Orientation - Orientation of tumor within the rectum: This lesion was located at the 10 to 12 o'clock position with patient in prone, anterior and right laterally at ~ 3 cm from the anal sphincter complex, 5 cm from AV. This lesion was excised with a full thickness excision

Distance from anal verge (AV) - .~ 3 cm diameter lesion on the first fold 5 cm from AV

Proximal and distal surgical margins - clear vs. involved: The mass is 0.4 cm from the proximal margin, 0.6 cm from the distal margin, 0.3 cm from the
left margin, and 0.9 cm from the right margin

Radial surgical margin - Deep margin: 3 mm away - not sure if this is what you were looking for here. I couldn't find anything on the pathology that referred to this...

MSI or dMMR status - No loss of expression of mismatch repair proteins is noted. These results indicate that this tumor is microsatellite
stable (MSS)

LVI- Lymphovascular invasion: present

PNI: absent

Baseline CEA vs. Post-surgery CEA - Baseline CEA 1.5 / 10 day Post Surgery 1.6 ng/mL
34/M
DX:(Rectal Cancer) 2/15/21
Stage: T1N0M0
TAMIS Surgery 3/10/21
Pathology: T1NxM0 - LIV positive, 1/1 lymph positive Stage IIIA
FOLFOX 6 rounds
Radation & Xelota 5 weeks

catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: New to the Club

Postby catstaff » Tue Mar 30, 2021 3:34 pm

The LVI alone is reason enough for a round of chemotherapy. Also too few lymph nodes were removed to assess whether there's more involvement (12 inspected by the pathologist is the accepted minimum). But with the chemo your odds should be pretty good.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-


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