Thanks for creating a signature. This will help in the long run to allow members here to understand your situation at a glance, especially if you keep your signature up to date as new information comes in.
I have some comments on your initial signature, however. Given that your surgery is scheduled as soon as next week, I would say that there are some important items that should already be in the signature right now but are not there. The missing items (in my opinion) are:
- Specific type of cancer, e.g., adenocarcinoma, etc.
- Grade of tumor, e.g., G1, G2, G3, or G4, depending on level of differentiation detected
- Estimated T-value of the tumor on the TNM scale, e.g., T1, T2, T3, or T4, depending on the estimated depth of tumor invasion into or through the colon wall, as seen from the preliminary scans. By this point in time the surgeon should at least know whether the tumor has grown through the colon wall or not, and maybe should have also done an MRI to see the tumor outline in greater detail.
- Estimated N-value of local lymph node involvement on the TNM scale, e.g., N0, N1, or N2, depending on how many enlarged lymph nodes were detected on the preliminary abdominal CT scan. Given that your baseline CEA is 16, this strongly suggests that there is local lymph node involvement, i.e., either N1 or N2. In any event, the surgeon should already have an idea of how complicated the surgery will be and how difficult it will be to obtain clear surgical margins all around.
- Estimated stage, based on estimated TNM scale, e.g., Stage 1, Stage 2, or Stage 3 (assuming that M-value is M0, thereby excluding Stage 4)
- Type of surgical procedure - Several types of surgery are available for dealing with masses in the sigmoid colon, but your signature does not mention which type of procedure will be used.
- Precise location in the sigmoid colon, i.e., whether the mass is in the lower part of the sigmoid colon near the recto-sigmoid junction, or in the upper part of the sigmoid colon far away from the recto-sigmoid junction.
- MSI status - Since you already have the results from the IHC test with all 4 proteins being expressed normally, then your MSI status is pMMR (i.e., proficient mismatch repair) which is more or less equivalent to MSI status = MSS (i.e., microsatellite stable)
The fact that you have been given only a very sketchy description of what the mass really is and how aggressive or invasive it might be gives the impression that the surgeon is not really very concerned about details. There are some details (like how far down the lower cut will be made) that could be important for post-surgery recovery and quality of life. Also details about how much of the sigmoid colon the surgeon is planning to remove, e.g., left hemi-colectomy vs. sigmoid colectomy only.
Before you have surgery you will probably have to sign an Informed Consent form. Be sure that all of your questions regarding the surgery have been answered before you sign this form.
I signed the form today - I’m going to call the Dr. tomorrow and try to get more answers to these questions. They were not able to see the mass in the CT scan at all, they only have seen it from the colonoscopy/sigmoidoscopy.
They also couldn’t see any lymph nodes in the scan.
Where would the grade of tumor be listed? In my biopsy report it says:
“Superficial fragments of rectal mucosa with at least high grade dysplasia/intra mucosal carcinoma”
I did ask him if he knew the stage and he said he won’t know until it’s out and they see the lymph nodes.
He explained to me what is going to be done (remove a section of my colon and reattach the rectum to the rest) and that it’s going to be done laparoscopically by a robot. He outlined where he will cut in a diagram.
He is a board certified surgeon at MSK and has great reviews. Now I’m getting concerned? He answered a lot of my questions but I didn’t know he was supposed to give me such detail.