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ONLY chemo without surgery? anyone?

gizzyluv's picture
gizzyluv
Posts: 144
Joined: Feb 2013

I have a new question to ask....Has anyone here (Stage 4) had ONLY chemo without surgery? And if so, why didn't you have surgery & how did it go? I'm asking because there is always the chance the dr's won't be able to take out Jason's tumor, if the chemo doesn't shrink it enough or if after chemo the dr. still feels like it won't be safe to try & remove it. I pray that doesn't happen, but there's always the chance. Thanks in advance! Kris

abrub's picture
abrub
Posts: 1543
Joined: Mar 2010

That has become the new protocol, if the tumor is not causing a blockage.  See

http://www.mskcc.org/pressroom/press/surgery-not-necessary-most-late-stage-colorectal

for recent studies on this approach.  Dr. Paty is a brilliant researcher - one of the big names in colorectal cancer (and I'm fortunate to have him as my dr.)

PatchAdams
Posts: 272
Joined: Nov 2011

Chemo only cures a few cancers such as leukemia, lymphoma and 2 other more rare types.  It controls (for a while), it shrinks, it kills off wayward cells (in some instances) but it cannot and does not cure colorectal cancer. 

 

The article cited in the above thread is NOT for those who can have surgery with curative intent.  Dr. Paty says: For this population with metastatic disease that cannot be cured by surgery, undergoing colon surgery is not always necessary.....  

The article also says....... there was not published data to support this approach.

John23
Posts: 1832
Joined: Jan 2007

 

“For this population with metastatic disease that cannot be cured by surgery, undergoing colon surgery is not always necessary,” said Philip Paty, a surgical oncologist at MSKCC and one of the study’s lead authors.

 

 “If the colon tumor is not causing obstruction, perforation, or bleeding we’ve found these patients are best treated with chemotherapy. By moving straight to chemotherapy, patients can avoid the risk of surgical complications and can start treatment for all sites of disease without delay.”

 

For this retrospective study, a multidisciplinary team looked at 233 metastatic colorectal cancer cases treated at MSKCC from 2000 to 2006. Their analysis showed that 217 of the 233 patients, or 93 percent, did not have complications that required resection of the primary tumor. Only 16 patients required colon surgery for symptom management.

 

From here:  http://www.mskcc.org/pressroom/press/surgery-not-necessary-most-late-stage-colorectal

 

Cancer often grows faster when it’s moved on to a different organ. I suppose what the good Dr. Paty is saying, is that it is better to address all the various sites of metastatic cancer at the same time using chemo, rather than surgically address the primary tumor and have to wait until healed to address the balance (other locations).

 

Personally, I would prefer getting the biggest tumor out surgically ASAP, regardless. Even Dr. Paty admits,

“…..There will always be the need for individual exceptions based on the clinical situation……”

 

And with that last sentence, I would suggest that you seek other opinions from colorectal surgeons that are not of the same group or organization as your present ones.

 

Especially with cancer, it’s always best to get other qualified opinions.

 

Best wishes,

 

John

lilacbrroller's picture
lilacbrroller
Posts: 334
Joined: Jun 2012

I'm stage IV and not slated for surgery. I am not entirely happy about this, as everything I've read on this board and on the 'net says that people have a better chance of survival if the tumors are removed surgically. when I was diagnosed last summer, I went to a surgeon first and he ordered scans to see where the tumor was and if it had spread.  Since it had in fact spread (liver - large tumors, lungs - little bitty ones) he recommended that I try chemo first to shrink everything, so that surgery might be possible.  So I did that. 

I finished one cycle (my first) of chemo - Folfox plus Avastin - and am getting scans to see how well it worked.  I was seeking second opinions and went to MD Anderson in Texas. Well, my rectal tumor (which was 5 cm) is gone as a result of chemo.  Colonoscopy and biopsy of surrounding tissue confirmed this.  I'm really happy because now I don't have to agonize over whether to have surgery on that area or not, and it buys me some time.  Rectal cancer surgery is difficult because the rectum is situated inside the pelvis, and everything is more difficult to reach, apparently.

Supposedly the liver tumors are gone, and they can't detect anything in the lungs but haven't ruled it out.  I have a CT scan tomorrow to be sure.  I'll see my onc on Thursday to talk about options.  If everything is gone, I'll take Xeloda until it stops working. If some bits remain, we'll have a chat and decide what to do.  Maybe beads in the liver, or even laproscopy if there is a solitary lung met - I don't know.  But probably more consultations will be necessary. 

I wish your husband good luck during his chemo. I got plenty of rest, drank a ton of water (1+ liters a day), and avoided food with additives so as to lessen the burden on my liver. Also i ate lots of protein to build red blood cells. Not sure if that helped but I"m sure it didn't hurt. Definitely water, water, water.  

best

Karin

PhillieG's picture
PhillieG
Posts: 4683
Joined: May 2005

I started by doing chemo first due to the location of a large tumor in my liver which made me inoperable at the time. After 6 months (5 months on Avastin) on chemo my liver tumors shrunk enough to make me a candidate for surgery. Nine years later I'm still here, still in treatment and doing well while living with cancer.

You say there's a chance the Dr's won't be able to operate. That also means there's also a chance they can operate.

My opinion is that how you treat your cancer early on makes all the difference in the world.
Try to get the best care possible which often means the Best Doctors and Best Hospitals

Randy33
Posts: 53
Joined: Jan 2011

I was Stage 4 with a 2cm met in my liver. I had 10 rounds of Folfox + Avastin after which my tumor had disappeared. I am over 4 years NED since then.

       Randy

annalexandria's picture
annalexandria
Posts: 2325
Joined: Oct 2011

if it's possible to get one.  One other thing I would suggest is to try, as hard as it is, to not look too far down the road at this point.  Kind of like the AA people, we cancer folk really have to take it "one day at a time".  There's a decent chance that the chemo will get it to the point of being resectable, and then you and Jason are in a whole new ball game (or he may even achieve long-term NED like Randy from chemo alone, although I think that's pretty unusual).  For me, the best way to approach things has been to assume that I am going to be one of those people who get lucky and make it through (even though I know perfectly well the odds).  It makes living day to day a lot more pleasant, and if I get proven wrong at some point, then I'll just deal with it when it comes.  Just keep thinking (and telling Jason) that he's going to make it!  Stay strong~Ann Alexandria

gizzyluv's picture
gizzyluv
Posts: 144
Joined: Feb 2013

First, let me say that I'm still trying to learn how to navigate around the site so I want to say that this is for EVERYONE who replied to my post, I think sometimes it looks like I'm just answering 'one' person & that just isn't so, so this is for everyone.....

THANK YOU ALL for your advice, opinions, & sweet comments....it really makes me feel better knowing that just because Jason may not have surgery at all isn't automatically a "bad" thing. The stories about being NED for years with ONLY chemo is SO encouraging! I know we aren't suppose to speak too in debth about our religious beliefs, but just let me say that when I took care of my mother, (who btw suffered from severe COPD, but no cancer, thank god) my sisters & I were told we would be lucky to have her 5 years....I can now proudly say that because THE best Doctor (his office is "upstairs" Wink) had the last say in it, she was with us for almost 18 years.....so, that being said, I know the doctors have their opinions & their beliefs, but I personally believe that what is meant to be WILL be, regardless of what any of us say or do. And no, of course I'm not one of those people who don't believe in medical treatment, after all, God made doctors for a reason, right? (ooops, I mean "the Doctor upstairs"....) so, yes I want Jason to have the chemo, and I will do everything in my power to help him through every last bit of it, I will do what I can to improve what he eats, I will love him & make him as comfortable as I possibly can, & above all, I will try my best to make him feel like he's not sick at all....but I truly believe that it's all in "his" hands. And I trust that "he" will take care of both of us, the way we were meant to be. I apologize if I have offended anyone, which I don't think I have or I wouldn't have said anything to begin with. I just love all of you & feel blessed to have found you all! ((((HUGS)))) Kris

Trubrit's picture
Trubrit
Posts: 1712
Joined: Jan 2013

I actually should go and read the guidelines for this message board, but my thoughts are (and I may find I'm off base) that if you post about feeling God's love and help in JASON & YOUR life, and not preach that others should believe, then you are fine. 

I think its grand when people post how their belief system, wether it be religious or not, has helped them. 

So, as long as your not on here telling people they SHOULD believe in the 'Dr. Upstairs' (I loved that), then go ahead and expresss yourself, as that in itself brings comfort to you, and those who believe. 

rogina2336's picture
rogina2336
Posts: 188
Joined: Apr 2011

My husband was diagnosed in Nov. 2010 stage IV "inoperable".  Chemo for life.  Too many mets in and on his liver, we were told if they operated on his liver it would look like swiss cheese.  So we take it all in stride from treatment to treatment, there are good days that are celebrated and there are bad days that get cursed at.  And it does at times become overwhelming.  Do the best you can and remember to take care of yourself. Smile  Blessings to you and yours in this journey.  Kim

tachilders's picture
tachilders
Posts: 315
Joined: Jun 2012

That's me.  Only option I have been offered is chemo for life from both the local oncologist and my oncologist at Northwestern.  I did 12 rounds of FOLFOX + Avastin, and got shrinkage in most tumors, but nothing disappeared completely.  Probably not a good sign for long-term survival.  Am currently on 5FU + Avastin for the past 2 months, and am scheduled for CT scans on Thursday to see if I'm stable or improving on this regimen.  If not, I will start irinotecan along with the 5FU and Avastin.  I may also be going to Germany for for biologically based treatment (Removab and a dendritic cell vaccine).  I don't think I'm a good case to compare to, as my tumors mets are pretty widespread and advanced.  The crazy thing is that I have handled chemo well and feel very good on a day to day basis, so quality of life is very good (and I'm very thankful for that). 

Tedd

belindahill's picture
belindahill
Posts: 144
Joined: Jan 2011

Hi gizzy luv, my husband did have surgery to remove the primary from colon August 2010. Ten months later he had mets to perineum, lung and liver, no surgery this time, he has been on chemo since then. He will be on chemo for life, we have very good days and yes some bad days, but he's here, and we are hoping he will continue for a very long time. Sending all my thoughts to you both, and hoping that he will be able to have surgery. Good luck. 

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