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colon cancer, tumor, t4, stage 2, chemo vs no chemo

Franko47
Posts: 7
Joined: Feb 2009

i am trying to decide if i should do chemo..
my situation is as follows..
i had 1/2 of my large instestine removed, rt side... found in the colon and thru the wall was a t4 stage 2 tumor.. 18 nodes were looked at and they found no abnomal cells.. my liver the same and my chest wall the same.. bone scan neg.. buy they still recommended the study or if not the study one of the other alternative chemo treatments.
i am 62.. i want to know.. and hear from those that have a simular condition and have not taken chemo and those that have.. if i continue without chemo. they will monitor me with blood tests every 60 days.. then if the cancer comes back. i will do the chemo. but now. im thinking.. i may have a couple good quality years.. the risks for me not knowing if it will even make a difference or if theres anything left there to kill seems to be to risky... i wish they had better ways of finding cancer cells in our bodies.. but we are where we are.

are there many of you that have been succsessful without the chemo.
and if your having chemo. what are you being told to expect as far as increase in your prognosis.. how many years or what percent increase? what side effects are you experiencing.
and your age.
i really would value your options too.
Franko

polarprincess
Posts: 210
Joined: Aug 2008

Do you know what the differentiation of the cancer was? well, moderate, poor etc..? There is a calculator through sloan kettering that you can punch in the info about your cancer and t-stage etc..and then you can click with chemo and without chemo and it will show you what difference chemo would make in your situation. although of course i would discuss it with your doctor. http://www.mskcc.org/mskcc/html/83364.cfm There has been quite a controversy for some time about whether stage 2 would benefit from chemo or not, and the newest info has come out that some stage III people with positive lymph nodes that got chemo are having significantly better survival than stage II with high risk features that didn't get chemo. a T4 is considered to be high risk, as is poorly differentiated, and lymphovascular or perineural invasion. I just read an article recently talking about this which i will copy and paste here, but of course it is good news there were no lymph nodes involved or metastasis, but from my understanding when it goes through the bowel wall, there is greater risk of cancer cells getting into the blood stream and also of attaching to the abdominal area. I can tell you this: I thought FULFOX was pretty tough, but when i got just the 5FU chemo was seriously a breeze. I have felt completely normal. Maybe you could just give it a try knowing that if you can't take it, then you have the option to stop.. the 5Fu alone is what was used for many years, so maybe you could just do that without the OXY and hopefully just like me, you won't have any side effects. Good luck with whatever you choose to do.
Some Stage II Colon and Rectal Cancers can be More Dangerous than Stage III
Posted by Kate Murphy on May 21st, 2008
Tags: ASCO, colorectal cancer prognosis, stage II colon cancer, staging, survival

Advance Abstracts from ASCO 2008
How far a colon or rectal cancer penetrates through the wall of the bowel may be more important in deciding survival risks than current staging that focuses on positive lymph nodes.

Five year survival statistics for a large number of rectal and cancer patients verified an earlier study that found some stage III colorectal cancers had better prognosis than stage II cancers that extended through the bowel wall but did not invade nearby lymph nodes.

The information has implications for treating colorectal cancer after surgery.

Colorectal cancer is staged by looking at how far the tumor extends into and through the wall of the bowel T1,2,3, or 4), whether it is found in lymph nodes (N0, 1 or 2), and whether it has spread to distant organs or metastasized (M0 or M1). For instance, T3N0M0 is stage IIa, T4NOMO is stage IIb. Information about survival and recommendations about appropriate treatment are based on staging.

Currently stage III cancers are considered to have a higher risk of recurrence and eventual death than stage II.

During the American Society for Clinical Oncology annual meeting in Chicago, Dr. Leonard L. Gunderson, from the Mayo Clinic in Scottsdale, Arizona, will present an abstract of an analysis of SEER (Surveillance, Epidemiology, and End Results) data from 1992 through 2003 with staging and survival information for nearly 36,000 rectal and110,000 colon cancer patients.

According to the analysis, people with stage IIB tumors that extend through the bowel wall and are attached to nearby tissues or penetrate the membrane surrounding the intestines (T4 N0 M0) have poorer survival chances than those with stage III tumors that remain within the bowel wall but have spread to lymph nodes (T1- 2 N1- 2).

In addition, the statistics support a change in staging to separate stage IIB into further substages: IIB T4a would be tumors had gone through the membrane surrounding the bowels (visceral peritoneum) and IIC T4b where the tumor directly invades or is adherent to other organs or structures. Stage IIC has significantly poorer survival possibilities than IIB or stages IIIA or IIIB.

(Thanks to an alert commentor, we have corrected the above paragraph to reflect the real difference between stage IIB T4a and IIC T4b. It now reads correctly)

In addition, some tumors that have spread to more than 3 lymph nodes (N2) are less likely to lead to death at five years than previously suspected and are being reclassified as IIIA.

While complicated, the proposed new staging categories will help patients and their doctors made decisions about chemotherapy treatment after surgery.

More specific information about stages and survival is listed in a table included with the abstract

beachinmom's picture
beachinmom
Posts: 76
Joined: May 2008

I am in a similar but different situation as you. The question about your tumor differention is an important one, as well as whether there was lymphovascular invasion. I will tell you what I chose, although I am not far enough down the line to tell if it was beneficial or not.

I was stage I, T2, poorly diff w/ lymphovascular invasion. I had my surgeon and my oncologist recommend chemo. I wanted to kick all those micromets to the curb. So, I did 12 rounds of folfox. It wasn't easy, but it wasn't terrible. I did not have to work as I stay at home w/ my kids so that made it easier, and I had a great support system. My only lasting side effect is a little bit of neuropothy that will hopefully go away given time.

I know everyone is different and so are the side effects. I went in to treatment w/ the idea of lets see what I can handle and if I can't, we will stop. I wish you luck in making a tough decision. I was the only stage one my onc had ever treated w/ chemo. There are no studies on treatments at my stage, and not many at yours. So, it is very hard to tell if it was beneficial. I just thought if it helps at stage 3, why not with me.

Good luck in sorting it all out.

tootsie1's picture
tootsie1
Posts: 5001
Joined: Feb 2008

I just looked back at my pathology report, which was VERY similar to yours, and I was told I didn't need chemo. Just wish there was one, true answer to it all, don't you?

*hugs*
Gail

Franko47
Posts: 7
Joined: Feb 2009

i talked with my oncologist yesterday

i was mistaken i thought i had perforation. he said there was no evidence of bowel perforation

my differentiation was between low and med

this was interesting.. my cea before my operation was .66 and after was .63 figure?

i had a close margin .. distance to bone

and cancer was found inside the blood vessel inside the tumor

again. 18 nodes clear, liver clear, chest wall clear. bone scan clear.

jsabol's picture
jsabol
Posts: 1156
Joined: Dec 2003

Hi Franko,
Sorry you have to be here, but a great place to get support. I am now over 4 and a half years out of chemo for stage 3, one cancerous small polyp, no invasion beyond submucosa (sorry I don't recall the t number). My CEA was less than 1, CT scan of chest/abd/pelvis were negative before surgery. ONE positive node, which my surgeon said would be my free pass to chemo.
I was treated with only 5FU and leucovorin, which were the standard for years; oxalyplatin was just completing trials, and my onc felt that the side effect profile would not justify the small increase in survivor benefit. As I recall, I was told that my chances of 5 year survival would be 80 percent with chemo, 60 percent without. My dad had died from metastatic colon cancer a few years earlier, and I wanted to do everything I could (at age 53) to ensure that would not happen to me. I am also a nurse, and comfortable with the risks/benefits that were explained to me.
My chemo was actually referred to as "chemo Lite", but I was greatly fatigued from it, despite being in great shape and without symptoms prior to diagnosis and surgery.
I will be prepping for my nearly 5 year followup colonscopy tomorrow; I am clear that I would do the chemo again; I wanted to increase all my odds, but I do know of some stage 2 here that did not have chemo. Maybe some of them will chime in also.
If you do decide to go ahead, you also have the option of altering or stopping the chemo if you do not feel the side effects justify the treatment. Hard decision, I'm sure; keep talking this out with your docs until you reach the answer that feels right for you. You may get more info from the help line at this site, too.
Best of luck, Judy

Buzzard's picture
Buzzard
Posts: 3073
Joined: Aug 2008

Here are my surgeons and Oncologists ideas of percentages.....first my deal...

Rectal cancer...tumor not through wall, no nodes involved...lost my rectum, spincter , anus, sewn shut and have colostomy.....54 years old.....starting my 10th of 12 treatments next Monday....

Oncologists opinion...50% chance of non reoccurence if no post op chemo is done and 55% chance if it is...I then opted not to do it until I talked to my Surgeon....Here is his take on it...He says Oncs are lowballing their percentages...He said its a 65% chance of non reoccurence if no post op is done or its an 85% chance of non reoccurence if post op chemo is taken.....Onc gives an extra 5% and surgeon gives an extra 20%...Let me ask you this , what is 5% worth when your talking about your life and what is 20% worth. Either increase in % is worth it to me. But its your choice, I say if you have loved ones around you owe it to them to do it if not for any other reason. If you take it you will never have to say well if only...but if you do you might say boy am I glad I did.....Post op chemo is no carnival ride...Its a very hard demanding, emotional and physically demanding 6 months, but it goes by before you know it. It basically boils down to how much you cherish life on earth and with no nodes involved with post op chemo you have a superb chance of living a normal long life....and if you stay clean for 5 years with no re occurence then they consider you cancer free and usually the tests end...You sir have the ability to do 6 months post op then have a great chance of another 20-30 years of life....God Bless you in your decision, whichever one it may be......

2bhealed's picture
2bhealed
Posts: 2084
Joined: Dec 2001

Hi Franko,

My background cancer resume:

Stage III lymph positive, zero mets sigmoid colon cancer diagnosed 8/01. My Mayo Clinic oncologist recommended 5-FU (the chemo)and leucovorin (the "rescue" remedy) which was the first line chemo in its day.

I declined for many reasons but here's one--my tumor did not give off a CEA so I would not know if it was working or not. It was a crap shoot and after researching chemo, I decided it was not the crap I wanted to shoot into me. Chemo is a cytotoxic chemical that can be more deadly than the cancer. Chemo can cause secondary cancers, permanent heart and/or kidney damage, peripheral neuropathy, severe rashes, chemo-induced leukemia, and other health issues. I watched what chemo did to my sister when she was diagnosed with intestinal cancer at 29 years old. It affected me greatly. No one in my family has survived and so I embarked on a holistic journey to heal my cancer post surgery.

I chose to do CHEMA (juice of the plant) instead and have remained cancer free for 7 1/2 years. I did many other things as well including Eastern Medicine using Western diagnostics. Everything I did was with the intention of building up my immune system and supporting my body in healing.

Now, had my colon cancer been Stage II NO chemo would have been recommended by the Mayo Clinic. At the time, they were not advising chemo for stages I and II.

If you want statistics mine were: 30% of living 5 years cancer free without the chemo and 60% with the chemo. I ignored the stats until I beat them. An aside...I feel blessed that I did not have a CEA because I see what a little movement with them does to the emotional state of us cancer folks. Ignorance was bliss in my case.

I was 39 at the time of my dx with 5 children--the youngest being 20 months old whom I was nursing at the time. I had much to live for and plan on a long life free from cancer and/or the after effects of chemo. It was HARD work, lonely at times, and I was swimming against the current, but I live with not a single regret that I chose this path. It was mine.

We are all so different and what works for one may not work for another. My protocol was personalized for me because I put it together with the help of natural healers and practitioners.

I hope this helps.

By the way, my wonderful oncologist got colon cancer, Stage II, and he did not do any chemo and he JUICED!

peace, emily the juice chick

Shayenne's picture
Shayenne
Posts: 2370
Joined: Jan 2009

That is simply amazing! I would love to do that instead of chemo! I'd just be afraid these tumors wont go away by themselves. But that's an amazing story!

dixchi's picture
dixchi
Posts: 438
Joined: Jun 2008

I was Stage 2, no lymph node involvement, tumor had gone through only the first
layer or muscosa membrane and that was it. That was in 2004. I was 63 years old. Chemo was not recommended
and I was given statistics to support that. I opted not to have chemo.

In 2008, a large tumor was found on my liver. Had resection in July 2008 with 12 Folfox
treatments. Right now I am NED immediately after chemo treatment ended. My CT scan
is Feb. 12 and I will see oncologist Feb. 17 to see if I am still NED.

There has been controversy over how to treat Stage 2ers. I think the article is right
in that there needs to be more study done about the beast approach for us to take.
While all the drugs that I am getting now were not available in 2004, I still have
lingering doubts that I made right decision in not doing chemo. But that is water
under the bridge now. I would give it serious consideration before deciding not to
do chemo.

2bhealed's picture
2bhealed
Posts: 2084
Joined: Dec 2001

Hi Shayenne,

No, the tumors do not normally go away by themselves--not that I have ever heard. And knowing that, I worked hard, like I said, to support my body so IT would work properly and rid itself of the cancer. Not doing chemo does not equate not doing anything.

Doing "something"...ie, juicing, yoga, stress management, acupuncture, diet and exercise is so empowering to me.

My story is nothing compared to my friend Leanne whose child had tumors die and shrink after juicing. they set him up with an NG tube and pumped the juice directly into his stomach. He was 2. Now he's almost an adult (might be older actually--I lost track--they moved and so did we). She wrote a book about it, Your Child Doesn't Have To Die by Leanne Sorteberg.

peace, emily

2bhealed's picture
2bhealed
Posts: 2084
Joined: Dec 2001

Sorry about that.

From Juice Alive by Steven Bailey, ND:

....fruit and vegetable juices have been used for centuries by healers because of their healing and medicinal properties. In fact, the word chemical is related to juicing. It is derived from the Greek word chemia, which means "the juice of the plant." pg 1

I have been spelling it wrong all this time! Whoops! What a dork! HA!

thanks for making me find the quote so I could correct my boo-boo!

peace, emily

Kathleen808's picture
Kathleen808
Posts: 2282
Joined: Jan 2009

Hi Emily,
Can you give more info on what you did? Have you written about it in another post? Also, what did you say about the Omega 8003 juicer? yeah or nay? Thanks for your info. We go see the oncologist for the first time today. Dick's pre-op CEA was 1.2 so my guess is that is not a good way for us to track his cancer.
Thanks.
Kathleen

2bhealed's picture
2bhealed
Posts: 2084
Joined: Dec 2001

Hi Kathleen,

I have been posting on here for over 7 years so I have literally hundreds of posts I am pretty sure. They switched to a new system recently (in the last year) and so it doesn't show that I have posted that much. You can look in the archives. I also have a webpage on here that tells my story though I haven't updated it.

I don't have any personal experience with the Omega 8003 (except that my friend has one) but I understand they're supposed to be good. I bought a Champion years ago because that's what was recommended to me by Leanne (mentioned above) and didn't take the time to do a lot of research on it. I have been happy with it. www.discountjuicers.com and www.mercola.com will both give you advice on juicers.

hope this helps.

Yeah, sounds like Dick's tumor didn't give off a CEA either.

peace, emily

Franko47
Posts: 7
Joined: Feb 2009

Emily

can you tell me more. or direct me to where i can find out more about this.

it cant hurt improving our diets.. i eat mostly veg.. have for about 4 years now.

but i would be interested in mixing in some of this juicing ive heard so many talk about.

Thank You
Frank

ballman
Posts: 1
Joined: Feb 2009

Franko, I too have asked that same question to take chemo or not? Mine was a little different situation for I have stage 4 colon cancer. I had been through the surgery and chemo than had to decide to go on or not to go on maintenance chemo. What I asked myself was this.."Would I regret not doing it later?" If I did the chemo and the cancer came back at least I knew I had done everything I could to stop the cancer. No regrets, for I promised myself I would fight it with all my being. I did the maintenance chemo. 2 year survivor!

Jimbob-'s picture
Jimbob-
Posts: 50
Joined: Jan 2008

I was Stage One, No bowel perforation, no Lymphnodes were affected, Just an ugly looking tumor that took my rectum.

My surgeon, GP and two oncologists, i demanded a secnd oncology opinion, said my case did not indicate chemo. I agreed and in april I will be 4 years clear. Damn Cancer left me with a colostomy which I consider better than the alternative.

You were stage two, I think if there were any doubt i would be opting for the chemo.

Jimbob

PGLGreg's picture
PGLGreg
Posts: 741
Joined: Jul 2006

I had a stage 2a rectal cancer removed when I was 63, 3 years ago. I'm fine, now. I had chemotherapy and radiation, as my doctors recommended. I was told I had at least a 75% chance of surviving 5 years, with treatment, and now I think my chances are considerably better. Get the chemo.

Franko47
Posts: 7
Joined: Feb 2009

i have one more appointment with my oncologist on the 26th. he is new. i had a hard time understanding the last one.

i am leaning toward not taking the chemo.. but i will go in with and open mind and see what else i can learn..

i am glad to hear you doing well.. you are over the hump and well on your way to your first 5 years.. i hear that if you make the first 5. your chances of ever dieing from it are very low.
thanks for your post.
wishing you many more healthy years..

franko

PGLGreg's picture
PGLGreg
Posts: 741
Joined: Jul 2006

Of course you're right to discount any of our individual experiences, since they are all just anecdotes. The best estimate of your odds will be from the aggregate results for many patients, and your oncologist will be better informed about that than any of us.

msccolon's picture
msccolon
Posts: 1956
Joined: Oct 2004

We are, after all, just a few of the THOUSANDS who get colon cancer every year.
mary

Franko47
Posts: 7
Joined: Feb 2009

your guys are very supportive and that makes me feel great about this site..
im finding there is a risk either way...
i will post again after my next appt.. on the 26th.
i do read each post here and i find value in each of your opinions and experience.
thank you very much
Franko

Franko47
Posts: 7
Joined: Feb 2009

WOW.. TO SAY IM OVERWHELMED IS TO UNDERSTATE..
im very grateful to all your repsonses.. i thought id never get anyone to understand or relate to what i was going thru. this posting site is very valuable. almost everytime i read someones post i gain a little more..
i going to speak to a doctor today. I have compiled several questions taken from your comments.. i will post again after i talk with him.. being in a holding pattern waiting to see if you going to land or crash is not fun.. but i can see you have all been well informed and have had to go thru the same thing.. thanks again.. hope to hear from you again soon.
much thanks
very grateful that you share your experiences . very
franko

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