Pre op vs post op “help”

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Wdr
Posts: 2
Joined: Sun May 21, 2023 9:27 pm

Pre op vs post op “help”

Postby Wdr » Sun May 21, 2023 9:32 pm

Greetings- I was diagnosed 2 weeks ago with t2/t3 colon cancer. The surgeon wants to operate first but the radiologist wants to start chemo first. They essentially want me to decide. How did you go about making this decision if you were faced with something similar?

Thanks

weisssoccermom
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Location: Pacific NW

Re: Pre op vs post op “help”

Postby weisssoccermom » Mon May 22, 2023 9:46 am

Welcome,

First of all I'm sorry you have to be here. You'll find a lot of information.
A quick couple of questions.

1. Have you had a CT or PET scan yet? That should be done before anything else.

2. Did the surgeon indicate that this was an emergency? Is the tumor blocking your intestine.

3. You indicate that the tumor is T2/T3....which says to me that you did have some testing done.....perhaps a CT and/or a rectal ultrasound.

4. Usually for colon cancer, they don't stage you until after surgery but with rectal cancer, they do do a preoperative staging . Do you have rectal or colon cancer? They are treated differently.

5. The biggest question is: do you have an oncologist? He/she, NOT the radiologist is the one who should be making the decision about chemo.

My suggestion is that you get with an oncologist asap to find out the path you should be taking. Remember, a surgeon is a doctor thst wants to operate...the radiation oncologist wants you to start radiation (usually done with chemo...concurrently). The oncologist is the one who should be deciding about chemo.

Good luck and let us know what you decide.
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Wdr
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Joined: Sun May 21, 2023 9:27 pm

Re: Pre op vs post op “help”

Postby Wdr » Mon May 22, 2023 9:10 pm

Thanks for your reply

1) yes both Ct and mri of abdomen, pelvis, & lungs

2) not quite an emergency but very concerning as it’s a large tumor that is moderately differentiated and has pushed all the way into the muscle. Lymph nodes look good and it hasn’t spread

4) colon

5) I met with the oncologist today is he wants me to have surgery first to try and avoid unnecessary treatment if possible

Surgery is in 36 hours

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Peregrine
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Re: Pre op vs post op “help”

Postby Peregrine » Tue May 23, 2023 1:08 am

Wdr wrote:Greetings- I was diagnosed 2 weeks ago with t2/t3 colon cancer. The surgeon wants to operate first but the radiologist wants to start chemo first. They essentially want me to decide. How did you go about making this decision if you were faced with something similar?

Thanks

Wdr -

Welcome to the Forum, and I'm sorry to hear about your recent diagnosis.

If your cancer is rectal cancer (not colon cancer), then you can get an overview of your treatment options here:

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=66167&p=512290#p512290

Also, here is some information that applies to both newly-diagnosed rectal cancer patents and newly-diagnosed colon cancer patients:

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=66469&p=514839#p514839

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Jacques
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Re: Post op “help”

Postby Jacques » Thu May 25, 2023 3:52 am

Wdr wrote:... Surgery is in 36 hours

Presumably your colon cancer surgery is all finished by now and you are in recovery mode awaiting discharge from the hospital. The oncologist will probably want to wait a month or so before starting any kind of chemo regimen in order to give the surgery and anastomosis sufficient time to heal properly.

Meanwhile, here are some things to think about while you are awaiting the possible start of a chemo regimen.

1. Comprehensive  baseline data.  The medical team will need to have a complete set of baseline (i.e., pre-surgery) medical documents in order to properly assess the next steps to take. Here is where the medical team will look at the big picture and decide what (if any) chemo regimen can safely be applied.  The main baseline documents that the oncologist and medical team will need to have at hand are the following. (If some of these documents are missing or incomplete, you may be able to take some corrective actions in the next couple of weeks or so to remedy the situation) :

    a. Medical History Form. Normally, this is a form that the patient fills out. It is important that the patient include all important medical events in the past, as well as all current medical conditions that are under treatment (e.g., heart conditions, diabetes, asthma, bronchitis/emphysema, high cholesterol, thyroid problems, auto-immune conditions such as celiac disease, lupus, etc.) The list should also include medical conditions that are not currently under treatment but probably should be, like obesity,  nicotine addiction, other addictions, etc. In addition, if there has been a history of cancer in your family, it would be important to fill out the hospital's Family History of Cancer form.

    b. List of Medications/Supplements.  This is a comprehensive list of prescription meds, over-the-counter meds, supplements (e.g., vitamins, minerals, herbal preparations), recreational drugs, etc.,  that the patient is currently taking. This is needed in order to check if there will be any important, serious interactions between meds currently taken and any new chemo regimen.

    c. List of Baseline Lab Tests Done. This is a comprehensive list of blood tests, tumor tissue tests (biopsy results), done before any surgery and before any chemo or radiation interventions. The list should be comprehensive, but at a minimum should include a baseline CEA test result, and MSI status of the tumor (i.e., MSI-high vs. MSS; or dMMR vs. pMMR)  This is explained more thoroughly in the following post:


    d. Reports from Baseline Scans Done. This is a comprehensive list of reports from CT, MRI, PET/CT and ultrasound scans done before surgery.

2. Comprehensive  post-surgery data. There are several post-surgery documents that are crucial for the medical team to have in order to decide what (if anything) needs to be done after surgery.

    a. Pathology Report from the Surgery. After surgery, the surgeon will send the removed specimen ( tumor/lymph nodes) to the hospital pathologist to prepare a pathology report. The pathologist may send part of the specimen out to special labs for tests that cannot be done in the local hospital. The pathologist then prepares a report of his/her findings and conclusions. The report may come in two or more parts -- the part(s) done at the local hospital, and the part(s) done by outside labs. It will be important for the medical team to have a complete pathology report for your type and Stage of diagnosis. Some of the important factors are covered in the documents below and usually include about a dozen or so mandatory items, as well as a long list of optional items.


    b, Surgeon's Report. This is a written report describing what was observed and what was done during surgery, including the type of surgery attempted and what actions were taken during the surgery (e.g., which blood vessels had to be cut off and at which level, what other structures or organs were removed during surgery in addition to the primary tumor and nearby lymph nodes, etc.). Normally, this report is filed in the patient's hospital chart, but it may not be posted in the patient's on-line portal. I think that in most U.S. states it is a patient's right to have access to the surgeon's report. You can ask what the policy is at your local hospital.

    c. Scan reports for any post-surgery scans done.

    d. Lab reports for any post-surgery lab tests done (e.g., CEA test, CBC/differential panel, Comprehensive metabolic panel, etc.)
3. Suggestion: If you have the time and energy over the next couple of weeks, you could read through the material listed above and see if any important items are still missing or incomplete in your file, and then you might be able take corrective action to try to fill in the missing gaps. In the past on this board there have been some patients who were put on ineffective or even life-threatening chemo regimens because of insufficient data collection done prior to imposing the chosen chemo regimen.


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