Hello fellow survivors, I am new to CRC (stage IIIa)

[loxitup]

Hi all, I'm new to the club and will appreciate any advice you have! It's great to see there's a nice community here.

I'll state my journey so far, forgive me if my wording or terminology is not descriptive enough.

I am otherwise healthy 49m of average height/weight no other medical conditions or medications.

- 15 years ago, a colonoscopy found small polyps, had them removed and a follow-up colonoscopy where they found less of them.

- fast forward to 12/20/23, had a routine colonoscopy after a long and gap discovered adenocarcinoma in cecum, sent to lab, confirmed.

- immediately went to healthier diet halting all alcohol and sugar.... KETO

- 1/11/24 Had laparoscopic right hemicolectomy on ascending colon from a great surgical team, back to normal functioning very quickly.

- 1/19/24 Pathology Report result: 2.3mm, poorly differentiated, only into submucosa, 1/27 lymph nodes affected, puts me at Stage III.a (about to find an oncologist)

So this is where I'm at so far and I'm curious to know how quickly I should get on to chemo and what kinds of questions I should ask the oncologist? Physically I feel ready, so I assume ASAP? Any other comments welcomed

[Peregrine]

Hi all, I'm new to the club and will appreciate any advice you have! It's great to see there's a nice community here.

I'll state my journey so far, forgive me if my wording or terminology is not descriptive enough.

I am otherwise healthy 49m of average height/weight no other medical conditions or medications.

- 15 years ago, a colonoscopy found small polyps, had them removed and a follow-up colonoscopy where they found less of them.

- fast forward to 12/20/23, had a routine colonoscopy after a long and gap discovered adenocarcinoma in cecum, sent to lab, confirmed.

- immediately went to healthier diet halting all alcohol and sugar.... KETO

- 1/11/24 Had laparoscopic right hemicolectomy on ascending colon from a great surgical team, back to normal functioning very quickly.

- 1/19/24 Pathology Report result: 2.3mm, poorly differentiated, only into submucosa, 1/27 lymph nodes affected, puts me at Stage III.a (about to find an oncologist)

So this is where I'm at so far and I'm curious to know how quickly I should get on to chemo and what kinds of questions I should ask the oncologist? Physically I feel ready, so I assume ASAP? Any other comments welcomed

Welcome to the Forum!

Welcome Wagon

Questions to ask the doctor

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60747&p=481109#p481109

http://go.ccalliance.org/treatmentquestions

https://health.usnews.com/conditions/cancer/articles/questions-to-ask-your-oncologist-at-your-first-cancer-appointment

NED roll call

For Stage III's: NED for how long now?
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=10574&p=77441#p77441

[rp1954]

The big kahuna is post operational inflammation and immune depression, then rapid wound healing and then avoidance of infections.

What meds and adjuncts you had before, during and after surgery depresses or enhances inflammation or your immune function. Some common ones: morphine (surgery, bad), trammadol(surgery, good) megavitamin C, D, K2 (good), IV vitamin C, celebrex (good), cimitidine (good if CA199 is average or higher). These may still have some immediate benefit potential, as well as long term. We used a lot of immune stimulating and inflammation fighting adjuncts,

Now is a little difficult, but the keto diet aspect that can be important later is cruciferous vegetables, like broccoli and caulifower, ect.

Folofox is somewhat better at residual cancer kill these days and should be considered for a recommended shorter course if without risk factors but might monitored more intensively for a year or two once the blood work restabilizes postchemo.

If you are an active patient you might want to consider reading and partially backfilling this thread - A 12-point checklist for newly diagnosed patients and Day1, Week1

[loxitup]

Update:

So it's about 4 weeks after my surgery and now I've seen 2 oncologists about my treatment plan. Based on these visits I'm going to go with the 3-month CaPox option. (1000 xeloda 2x/day and 130 oxiliplatin every 3 week)

There is some question as to whether they will need to lower my dosage during the treatment but I guess that is based on how I respond. I'm considering going without the port installation, but I'm up in the air about that.

Any particular feedback? how often would I run into a problem? it will be at Sloan Kettering if that makes a difference

[Peregrine]

Update:

So it's about 4 weeks after my surgery and now I've seen 2 oncologists about my treatment plan. Based on these visits I'm going to go with the 3-month CaPox option. (1000 xeloda 2x/day and 130 oxiliplatin every 3 week)

There is some question as to whether they will need to lower my dosage during the treatment but I guess that is based on how I respond. I'm considering going without the port installation, but I'm up in the air about that.

Any particular feedback? how often would I run into a problem? it will be at Sloan Kettering if that makes a difference

Thanks for the update. Yes, I have some feedback. You stated that your CaPox regime will be:

(1000 xeloda 2x/day and 130 oxiliplatin every 3 week)

but this statement is inadequate because it does not specify the units of measurement. Your CaPox regimen is probably something like the following:

(For each of the four 3-week cycles:

• Capecitabine 1000mg/m2, twice a day for days 1-14
  
• Oxaliplatin 130mg/m2, Day 1)

It is essential to understand that your dose is dependent on your Body Surface Area, (which can change from one cycle to the next if your weight changes significantly). To determine your Body Surface Area, expressed in meters squared (m2), you can use the online calculator :

BSA Calculator
https://globalrph.com/medcalcs/body-surface-area-bsa/

Then, once you know your Body Surface Area you can determine how many small (150mg) capecitabine tablets plus large (500mg) capecitabine tablets to take each morning and each evening (with meals) in order to reach the required daily dose in mg/m2.

In other words, you and your doctor have to pay very close attention to the details in order to insure that you are being properly dosed at each cycle.

You can determine the number of small and large tablets to take by looking at Table 2 in this document:

https://www.ema.europa.eu/en/documents/product-information/xeloda-epar-product-information_en.pdf

Also, your treatment plan didn't mention dosing for days 15-21 in the three-week cycle. Normally
in the standard CapOx regimen, the third week of each cycle is a rest week, i.e., no doses of any kind during that week. Is that what they told you?

In cancer chemotherapy it is always important to pay attention to the fine details.

[loxitup]

Thank you that's EXACTLY it! and sorry if I sounded vague, the details are absolutely critical...

I trusted the procedure because it was a major cancer center, but it should always be reviewed thoroughly before jumping in because I didn't realize the dosage would be 130 × BMI (1.9), but it went fine.

I had the first infusion of cycle 1/4 today (about to take the first cap after eating). I opted for no port - found a decent vein (slightly sore). So far tingly hands and mouth feel from cold. Nausea is mild so far. Hydrating and I'm lightly active. I understand it'll get tougher. I'll report back again