Need advice - New elder colon cancer patient

[craycray]

My mother, who is 78 and is a lifelong smoker, was just diagnosed with adenocarcinoma from the biopsy of a large tumor in the sigmoid section of her colon. The tumor is so large that they could not even get a pediatric scope past it when doing a colonoscopy. We also had a follow-up CAT scan that thank goodness shows the liver is ok, but potentially few metastatic lymph nodes (subcenterimeter pencolonic).

Gastroenterologist sent mom to a colorectal surgeon who recommended performing a sigmoid colectomy and potentially also left hemicolectomy. I guess surgery would be done before any chemotherapy. The surgeon seems to have good online reviews, but I am not sure if the surgeon has any experience with removing large tumors. None of the surgeon’s online reviews mention tumors or cancer.

I know surgery is required, but I want to ensure we are due diligent and first talk to an Oncologist. For large tumor removal, has anyone had experience with using a colorectal surgeon that does not specialize in surgical oncology? Would we be missing the mark if we don’t look into doing HIPEC during the surgery that is offered at Sloan Ketter?

Does anyone have experience with colorectal surgery at Hopkin’s Sidney Kimmel, which is close to us? I was surprised that they have very limited reviews on their colorectal surgeons. If their surgery department is top notch, then I would prefer to transfer her entire care over there. I also would really prefer to work with a team of doctors rather than feeling like we are doing this on our own.

[Rock_Robster]

All good questions. Just because it’s obstructing the scope doesn’t necessary mean it’s a bulky/advanced tumour - do you know the T-staging from the imaging? Also any other tricky features that might warrant more complex surgery.

I don’t think anyone would be advocating for something like HIPEC unless there’s evidence of abdominal spread, which may well not be known until the time of surgery. I think the main thing to confirm is whether this would be a ‘standard’ resection, or something more complex. Of course given the choice I would always recommend a board-certified colorectal surgeon specialising in cancer.

[rp1954]

My mother, who is 78 and is a lifelong smoker, was just diagnosed with adenocarcinoma from the biopsy of a large tumor in the sigmoid section of her colon. The tumor is so large that they could not even get a pediatric scope past it when doing a colonoscopy

Your mom is obstructing. Many patients have a circumferential mass that squeezes the colon closed.
Your need to do something before the colon squeezes shut and pressures up - dangerously complicating surgery, scary and unpleasant.
In my wife's case, there was a 6-7mm channel when CT scanned, causing dirrhea for a month but misdiagnosed.
We were able to immediatlely start things like high dose vitamin D3 (a very common, serious CRC deficiency), cimetidine (off label) and other goodies.
By surgery, my wife's sigmoid had opened up to about a 14 mm channel after 4 weeks of immune stimulation and anti-inflammatories, with a lot of tumor destruction.

You should study the links in my last post, Day1, Week 1
Also you might read about White Swan's aged mom.

Gastroenterologist sent mom to a colorectal surgeon who recommended performing a sigmoid colectomy and potentially also left hemicolectomy.

that's usually the most favorable plan

I guess surgery would be done before any chemotherapy.

Your mom's age and condition are likely to limit chemotherapy harshness (MTD-Maximum Tolerated Dose) and duration, if used at all.
Again, you might read about White Swan's aged mom.

The surgeon seems to have good online reviews, ...
but I am not sure if the surgeon has any experience with removing large tumors.

Primary colorectal cancer and GI problems are so common that they have their own specialty.
A board certified colorectal surgeon is THE surgical specialization for this surgery.
The surgical oncologist is more generalized for other less common cancers and will tackle distant mets.

I know surgery is required, but I want to ensure we are due diligent and first talk to an Oncologist.

The [medical] oncologist is really for chemo, typically after surgery for colon cancer. Before surgery you don't have all his desired information.

For large tumor removal, has anyone had experience with using a colorectal surgeon that does not specialize in surgical oncology?

Do you have a CT scan yet? An experienced colorectal surgeon has seen a lot.

Would we be missing the mark if we don’t look into doing HIPEC during the surgery that is offered at Sloan Ketter?

HIPEC is a later, demanding surgery for carefully selected, strong and fit mCRC patients dx'd with peritoneal mets.
Also one surgery at a time usually has better long results.

[Peregrine]

...
Would we be missing the mark if we don’t look into doing HIPEC during the surgery that is offered at Sloan Kettering?

As others have already said, HIPEC is unlikely to be considered at this point in time. It is an extremely difficult surgery, even for patients who are only 30 years old (see links below). For a patient 78 years old with significant comorbidities, HIPEC probably would not even be considered because of its life-threatening potential.

HIPEC successful
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=48401&p=365875#p365875

HIPEC not successful
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=45327&p=327827#p327827