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Why do the radiation ?

Dharma girl
Posts: 40
Joined: Jan 2011

On 12/19/10 mom had emergency surgery, removed a bowel obtrusion and five lymph nodes. Colostomy.

On 12/23/10 she was diagnosed with 3/c Colorectal Cancer.

On 1/27/11 She had a PET Scan.

On 2/4/11 We received the PET results, it came back “clean” “no hot spots” her blood work looked good as well.

Her oncologist wants her to do:
six rounds chemo
six weeks chemo and radiation
ending with four rounds of just chemo

My question is since chemo works systemically through the body, why do the radiation ? I know that radiation works at the site of the original cancer, but since the cancer has not metastasized why take the add risk (radiation can cause cancer) ?

We have asked her doctors and they have all said “it is up to you”. So has anyone skipped that radiation ? If so what kind of results did you get ?

Any feedback would be appreciated, thanks.

Patteee's picture
Patteee
Posts: 950
Joined: Jul 2009

with your Mom, was the cancer rectal or colon? It seems pretty standard with rectal to have radiation and not standard with colon. I didn't have radiation, mine was far enough into the colon. I am interested in hearing what others say about this. Once the tumor is out, what is the point in radiation? To make sure that the original site is cancer free?

Dharma girl
Posts: 40
Joined: Jan 2011

Both colon and rectum.

Sundanceh's picture
Sundanceh
Posts: 4342
Joined: Jun 2009

Hey, Dharma

Is your username from the TV show "Dharma and Greg?"

Your point is well taken. Radiation is usually saved for a physical mass or residual cancer cells in an area where the surgery could not get clear 100% margins.

Once an area has been radiated, you're done attacking that area with the rads. So, it seems wise to save that big gun when there is actually something to target.

As for systemic chemo with no evidence of cancer cells, this has always been a tough call as to which way to go and most of us leave it to the individual's choice. But this subject has always intrigued me and I had a theory that I ran by my onc.

It goes like this: If there are no cancer cells present that we can detect and no visibile mass that can be seen, does it really make sense to introduce chemo. Do the benefits outweigh the risks.

My onc said, that in his opinion, if there is no evidence or mass, to not do the chemo. Of course, it's still the individual's choice and that of your medical team, but this is what I've learned.

My condition (as an example) was the surgery did not get me clear margins, therefore, I had residual cancer cells in my chest wall - and thus radiation 30x. Also, chemo for 6-months.

You've brought up some good points - that's my take on this. I would always question radiation unless there is a valid need for it - it's an all or none deal and once done...it is done. And not so much that it causes cancer (though it could). Rather, it is a tough treatment and fries your insides, killing some good cells as well as the bad ones being targeted.

Take care/Craig

Dharma girl
Posts: 40
Joined: Jan 2011

Dharma is a Buddhist term referring to the teachings of the Buddha .

My mom really, really, really wants to skip the chemo as well(I‘m sure she would love your onc lol), but five of her lymph nodes came back positive,
so it seems like she should do “something.” But radiation seems like too much.

You are absolutely right when you said “It's an all or none deal and once done...it is done“. A person facing cancer has to make some really tough decisions.

Thanks for your input, I will pass this on to my mom.

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

In the first case where she has already had surgery and post surgery chemo ( correct?) I would think that the chemo is mop up for her and that radiation would be nothing more than adding more scar tissue to an already scarred area.....if in fact there was a tumor then prior to surgery sure radiation is a normal protocol, but afterwards and after they have already taken out the mass....I think its a useless treatment saved for hopefully not another day........
Second case scenario....In the last or above post you stated that there were 5 nodes involved.....Are they worried about the surrounding area being involved ? did they not attain clear margins and hope to kill what is around the main focal point of surgery...If in fact it is in the lymphatic system then the chemo will do as much as possible as far as mopping up radical cells...but even then, the radiation usage after the fact still evades me as to the reasoning ?

Being nosey, I would like to know his reasoning for the want of radiation after the tumor and post chemo have been completed...although I know its none of my business, but just to maybe help someone else someday in offering suggestions in making decisions ....love to you and yours, buzz

Dharma girl
Posts: 40
Joined: Jan 2011

Well, she has not started any chemo yet. First she is having problems with her insurance and second she has an abscess tooth and is trying to get rid of the infection. She has decided on Xeloda.

Yes, five nodes were involved and maybe that is why her Doctors what to do radiation, although I have not heard any of them say that.

As far as your question about the radiation after chemo, I think that you misunderstood. This is the treatment plan:

six rounds of chemo
six weeks of chemo AND radiation
ending with four weeks of JUST chemo

He called this plan the “sandwich treatment” or “layered treatment”

Again, we don’t think that she should have the radiation if the chemo treats the whole body.

Please feel free to ask me any question. I don’t think of it as you being nosy. (-:
Thanks for you input we really appreciate it .

D

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

Radiation for rectal cancer will considerably improve her chances of survival. Answering your question, no, I did not refuse radiation for my rectal cancer. I think that would have been a little crazy. After surgery 5 years ago and radiation with a short course of chemotherapy, I have completely recovered from my cancer. I really think your mother's best course is to follow the recommendation of her doctors.

--Greg

Dharma girl
Posts: 40
Joined: Jan 2011

Thanks for replying. So, just to make sure that I understand you had radiation AFTER surgery ?
I guess what we don't get is the PET scan came up clear,no tumors or hot spots. So why Ten rounds of chemo with six weeks of radiation ?

Dharma girl
Posts: 40
Joined: Jan 2011

Thanks for replying. So, just to make sure that I understand you had radiation AFTER surgery ?
I guess what we don't get is the PET scan came up clear,no tumors or hot spots. So why Ten rounds of chemo with six weeks of radiation ?

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

"So, just to make sure that I understand you had radiation AFTER surgery ?"

Yes, I did, though that is unusual. Ordinarily for rectal cancer, radiation is given before surgery. I had it after, because before the time of my surgery, it appeared I had colon cancer, rather than rectal cancer. When the surgeon opened me up, it became clear that the cancer was in the rectum, so then radiation was scheduled ("adjuvant" therapy). Better late than never.

To try to answer your question why when the PET scan is clear, radiation and chemo may still be recommended: you can't trust the diagnostics. There may very well be cancer which is not detected. The bottom line is: will you survive? Stage 2 or 3 rectal cancer patients who have radiation, regardless of whether tests show the presence of cancer after surgery, stand a better chance of survival than those who do not have radiation. That's why radiation is considered standard treatment for stage 2-3 rectal cancer.

--Greg

lisa42's picture
lisa42
Posts: 3663
Joined: Jul 2008

Hi,

Yes, radiation is usually standard for rectal cancer, but not for colon cancer. Usually, however, the radiation is done prior to surgery and I don't know that it would be done if there aren't any current cancer cells or a tumor in the rectum.
If there is still a rectal tumor, then i would probably do the radiation. If not, I wouldn't- my opinion. I had radiation on my rectal tumor & it did make it disappear, whearas it had just grown slightly smaller with the chemo, but then the radiation knocked it out of there.
Now, about radiation aftermath... they don't tell you that you very likely may suffer longterm effects from the radiation there- it can affect the surrounding bone area causing it to become brittle. It can cause longterm problems with rectal bleeding and/or diahrrea, as well as loss of bowel control. I had my radiati on 3 years ago & I've been having more issues lately & the oncologist thinks it may be from some radiation damage. I must add that I have also suffered a rectal tumor recurrence & that is definitely causing some of my problems, but the onc doesn't think all my problems are from the tumor recurrence. A colonoscopy a year ago showed an area with red "stuff"- when I saw it on the colonoscopy tv screen and asked what that was, I was told that it was many blood vessels close to the surface, which will bleed easily when agitated. I was told it was damage from my radiation.

So, there are pros and cons to think about and discuss with the oncologist.

Best wishes-
Lisa

okthen's picture
okthen
Posts: 232
Joined: Jun 2010

Hi Dharma...my husband also had Rectal Ca..he opted for surgery before any chemo or radiation...in hopes that the TEMS procedure could remove all the tumour.
After going through that it was discovered that the tumour was too deep and then they found one positive node. He was then scheduled for a resection, then chemo 6 weeks after that.

He refused radiation.
His Onc talked with us about the fact that the tumour was very close to his colon (where radiation wouldn't be recommended anyway), that there was just a sliver of the rectum left, and that the chemo should indeed kill any cells in the rectum.
It was of course our decision, well, my husbands, and he chose no. The potential side effects were not worth it to him.
Now, if he has another recurrence, it will be heartbreaking with a bunch of "what-ifs" flying around....this is all so hard, as you know.
I am sorry for these tough decisions you and your mother are facing...you are both in my thoughts...
Chriss

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