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.)
: 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.