Plan of action

vanser

Hello again,
I have posted a few questions to this site and have had great responses that have helped my family to "navigate" through my mom's treatment.
(My mom was originally diagnosed in Jan 03 with colon cancer in the sigmoid colon with 4 lymph nodes affected.
She had a local recurrence in June 03 and again in Feb 04. These have not been large tumors, but cancerous cells picked up during follow up colonoscopy)
The doctors still seem optimistic, as it is locally confined. We met with the surgeon today, who wants to operate to take out the infected areas. However, he does not think radiation or chemotherapy are a wise course of action.
Does anyone have any thoughts on this plan? I felt that perhaps they should be more aggressive. Does anyone have stats on local recurrence?
Thanks again,
Vanessa

Maggie215

Hi,
My dad was just diagnosed. But, being a cancer survivor myself.. why is that the doctor does not want to go with the alternative chemo or radiation? What are his/her reasons??

vanser

Maggie215 said:

Hi,
My dad was just diagnosed. But, being a cancer survivor myself.. why is that the doctor does not want to go with the alternative chemo or radiation? What are his/her reasons??

Hello & thanks for the reply,
The doctor said that he does not think radiation will be helpful, since she already received radiation last year and it may be harmful to surrounding organs (and further weaken tissue). He said that preoperative chemotherapy was not necessary because he feels that the recurrence can be removed surgically. He also mentioned that after the surgery they may go ahead with further chemotherapy. (he mentioned that although there was a recurrence, because it was local, the previous course of chemo may have worked at preventing distant recurrence, but they will have to evaluate with the oncologist what will be next).

Great to hear that you are a survivor - Congratualations & I am hoping the same for my mom. Although it is quite discouraging that she has had three surgeries already.

aspaysia

vanser said:

Hello & thanks for the reply,
The doctor said that he does not think radiation will be helpful, since she already received radiation last year and it may be harmful to surrounding organs (and further weaken tissue). He said that preoperative chemotherapy was not necessary because he feels that the recurrence can be removed surgically. He also mentioned that after the surgery they may go ahead with further chemotherapy. (he mentioned that although there was a recurrence, because it was local, the previous course of chemo may have worked at preventing distant recurrence, but they will have to evaluate with the oncologist what will be next).

Great to hear that you are a survivor - Congratualations & I am hoping the same for my mom. Although it is quite discouraging that she has had three surgeries already.

Your doctor is right about radiation damage. I had pre-op radiation/chemo before removal of initial tumour. It caused healing problems and They could not give me the follow-up chemo. A local recurrance necessitated further surgery with intra-operational radiation. That tisssue was really fried. I had heavy duty wound management with wound vacs and muscle grafts and hyperbaric treatment. I finally got my chemo after everything healed and now get scanned every three months. Because the last one was clean I am going back in four months. One small step...

vanser

aspaysia said:

Your doctor is right about radiation damage. I had pre-op radiation/chemo before removal of initial tumour. It caused healing problems and They could not give me the follow-up chemo. A local recurrance necessitated further surgery with intra-operational radiation. That tisssue was really fried. I had heavy duty wound management with wound vacs and muscle grafts and hyperbaric treatment. I finally got my chemo after everything healed and now get scanned every three months. Because the last one was clean I am going back in four months. One small step...

Hi -
Thanks for the information - based on your experience it sounds like not doing the radiation is the right course of action.
Congratulations - it sounds like you are doing great after such a long ordeal. One small step is still a step in the right direction !

grandma047

Hello, I had rectal cancer, first diagnosed in July, 2003. Had colon resection, early stages, no lymph nodes, no spread, clear margins. No further treatments. It recurred in Jan. 2004. I am having pre surgery chemo and radiation. I pray that it is not doing damage. Maybe because I haven't had it before, it won't. I have two more weeks of treatment, then a 4-6 week break and surgery with a permanent colostomy, then more chemo. I am willing to do whatever it takes to get rid of this, so I'm praying that I'm doing the right thing. I wish your mom all the luck in the world and pray that she will not have any more recurrences. I pray for all my friends and family while I am having radiation treatment. I will add your mom to my prayers. Keep us updated.
Love and prayers, Judy H(grandma)

KrisS

grandma047 said:

Hello, I had rectal cancer, first diagnosed in July, 2003. Had colon resection, early stages, no lymph nodes, no spread, clear margins. No further treatments. It recurred in Jan. 2004. I am having pre surgery chemo and radiation. I pray that it is not doing damage. Maybe because I haven't had it before, it won't. I have two more weeks of treatment, then a 4-6 week break and surgery with a permanent colostomy, then more chemo. I am willing to do whatever it takes to get rid of this, so I'm praying that I'm doing the right thing. I wish your mom all the luck in the world and pray that she will not have any more recurrences. I pray for all my friends and family while I am having radiation treatment. I will add your mom to my prayers. Keep us updated.
Love and prayers, Judy H(grandma)

Radiation is not as frequently used in treatment of tumors of the colon because it can damage surrounding small intestine.

Rectal carcinoma is different because there is less small intestine in the pelvic region and if you keep your bladder full it will displace much of the small intestine completely out of the field.

It is harder for surgeons to manipulate the rectum than the colon, so any shrinkage and killing of tumor cells at the edge of the tumor has a large benefit in reducing the risk of local recurrance.

Radiation still reduces wound healing, which is why, if reanastomosis rather than a permanent colostomy is planned, they still frequently do a temporary ileostomy, reversing it several months later, to allow the rectal surgical site time to rest and reduce the risk of breakdown of the sugical site.

When I had a second surgery to remove peritoneal metastatic nodules, I was put on preop chemotherapy to control the tumor, while I was getting back in shape for this second surgery. I was taken off of chemo, however, 6 weeks prior to surgery to prevent problems with wound healing etc.

Best wishes for sucess for your Mom Vanessa, and for you Judy.

Kris

spongebob

KrisS said:

Radiation is not as frequently used in treatment of tumors of the colon because it can damage surrounding small intestine.

Rectal carcinoma is different because there is less small intestine in the pelvic region and if you keep your bladder full it will displace much of the small intestine completely out of the field.

It is harder for surgeons to manipulate the rectum than the colon, so any shrinkage and killing of tumor cells at the edge of the tumor has a large benefit in reducing the risk of local recurrance.

Radiation still reduces wound healing, which is why, if reanastomosis rather than a permanent colostomy is planned, they still frequently do a temporary ileostomy, reversing it several months later, to allow the rectal surgical site time to rest and reduce the risk of breakdown of the sugical site.

When I had a second surgery to remove peritoneal metastatic nodules, I was put on preop chemotherapy to control the tumor, while I was getting back in shape for this second surgery. I was taken off of chemo, however, 6 weeks prior to surgery to prevent problems with wound healing etc.

Best wishes for sucess for your Mom Vanessa, and for you Judy.

Kris

Kris -

All I can say is you know your stuff!! WOW...

I'm glad you're here!

- SB

vanser

KrisS said:

Radiation is not as frequently used in treatment of tumors of the colon because it can damage surrounding small intestine.

Rectal carcinoma is different because there is less small intestine in the pelvic region and if you keep your bladder full it will displace much of the small intestine completely out of the field.

It is harder for surgeons to manipulate the rectum than the colon, so any shrinkage and killing of tumor cells at the edge of the tumor has a large benefit in reducing the risk of local recurrance.

Radiation still reduces wound healing, which is why, if reanastomosis rather than a permanent colostomy is planned, they still frequently do a temporary ileostomy, reversing it several months later, to allow the rectal surgical site time to rest and reduce the risk of breakdown of the sugical site.

When I had a second surgery to remove peritoneal metastatic nodules, I was put on preop chemotherapy to control the tumor, while I was getting back in shape for this second surgery. I was taken off of chemo, however, 6 weeks prior to surgery to prevent problems with wound healing etc.

Best wishes for sucess for your Mom Vanessa, and for you Judy.

Kris

Hello all -

Thanks for the info Judy & Kris,
Many thanks also for including my mom in your prayers Judy - we will do the same for you. My mom has not felt like using this chat room, but I have been relaying all of your stories to her and they have made her feel a great deal better (mentally at least.)

Kris - one more quick question - were you put on a different chemotherapy for this second surgery?

aspaysia

vanser said:

Hi -
Thanks for the information - based on your experience it sounds like not doing the radiation is the right course of action.
Congratulations - it sounds like you are doing great after such a long ordeal. One small step is still a step in the right direction !

Not everyone is so sensitive to radiation. THe docs were following a protocol for rectal ca. based on body mass. My skin was delicate and could not tolerate a regular dose for my height and weight. The recurrance made them get even more aggressive and more radiation was ordered. A very nasty business all around. Hope your Mum come out of this OK.

KrisS

vanser said:

Hello all -

Thanks for the info Judy & Kris,
Many thanks also for including my mom in your prayers Judy - we will do the same for you. My mom has not felt like using this chat room, but I have been relaying all of your stories to her and they have made her feel a great deal better (mentally at least.)

Kris - one more quick question - were you put on a different chemotherapy for this second surgery?

Yes Vanessa- I was switched to oxaliplatin/5-FU leucovorin. I had been on 5-FU/ CPT 11 initially because it was all that was available. Oxaliplatin was unavailable except through clinical trials until within a few weeks of my first surgery.

One note- when I had recurrance after my second surgery, after 4 mths off chemotherapy, I was placed back on oxaliplatin/Xeloda Although my oncologist was worried that the tumor cells came back so quickly because they were resistant. However, it has controlled my tumor for the last 9 mths.

Best wishes,

Kris