Rectal Cancer Stage IIa, Chemotherapy or Not

Neeno

Hi,

My dad is 61 years old and was diagnosed with rectal cancer about a month and a half ago. He already had a colectomy to remove his tumour and from the biopsy results we know the following:

- stage IIa (T3N0M0)
- 21 lymph nodes were sampled, all negative
- cancer cell type is poorly differentiated adenocarcinoma
- tumour is 4cm

A month after surgery, he consulted an oncologist on what type of adjuvant therapy he should be receiving. The oncologist initially suggested he doesn't need chemotherapy or radiotherapy and chemotherapy will only lower the chance of a recurrence by 3 to 4 %. My dad then mentioned his cancer cell type, which puts him at a higher risk of a recurrence. Probably sensing my dad was a little worried, the doctor agreed that the cell type is a troubling factor and said he could receive chemotherapy if he insist. Right now my dad is in a real dilemma on whether to receive chemo. If anyone has a similar experience or any suggestions that they could share will be much appreciated. Thank You.

theresa8

T3N0M0
Hi Neemo,
My husband, 62 years old was also diagnosed with a stage IIA (T3N0M0) rectal cancer last October. You didn't mention if your Dad had rectal cancer or colon cancer. My husband underwent 5 weeks of radiotherapy + chemo, he had a total response to this treatment. Five weeks later, surgery to remove part of his rectum. We then had a rough 2 months of post surgical infection which delayed the chemo for 8 weeks. Our oncologist suggested he do 4 cycles of mop up chemo for peace of mind. He's finishing up his last cycle next week and things went very well with very little side effects to the 5Fu and leucovorin. His biggest challenge with this cancer has been dealing with his temporary illeostomy. From what you wrote your Dad doesn't seem to have one so he must be feeling good he was spared this inconvenience. My husband will be getting his reversal surgery this September and he can't wait, I just hope everything goes smoothly.
I also asked the same question on this board back in March and everyone encouraged me to go ahead and chemo, so far no regrets since he's feeling JUST GREAT.
Wishing your Dad the best of health
Theresa

vhtqm1

what a pickle
there something the Dr. mentions that has be suspicious. "The oncologist initially suggested he doesn't need chemotherapy or radiotherapy and chemotherapy will only lower the chance of a recurrence by 3 to 4 %." i'm a stage IV patient and those whom i've read about here, there cancer is similar and are cancer free many many years later. i'm sure they'll chime in on this. i would seek a second opinion. ask them if they know the percentage of recurrence not happening. whenever a tumor is removed from the body there's always microscopic cells that shed off and travel throughout the body. this is how it can metastasize to another organ. usually with Colon Cancer the organ that moves the most blood ''the liver'' is a likely place where a lesion could form. lastly, if it was me i would hate to have a recurrence and wonder "if i only did the chemotherapy would this not have happened?"everyone is different and no choice is the wrong choice, especially if a second opinion gives you exactly the same information. i hope you get the help your looking for.

ed

jillpls

I vote for a second opinion first.
Get the second opinion at a good cancer center. It's worth the time effort and money to be sure you are doing the right thing. As for me, I would do the chemo thing because I agree with what has been said. I would hate it to come back and then have to say "shoulda, woulda, coulda....
God bless
Jill

John23

Absolutely, a 2nd opinion!

But, Re:
"The oncologist initially suggested he doesn't need chemotherapy
or radiotherapy and chemotherapy will only lower the chance of a
recurrence by 3 to 4 %. "

What the onco is telling you, is that the risks of chemo causing other
problems, is greater than the advantage it will provide. He will
do whatever you insist, if he can't convince you otherwise.

Chemo -will not- kill single cancer cells; it won't kill any cells that
are not growing faster than - or kill ones that do not - "look different" than
their surrounding cells.

The fear of dying causes many cancer victims to insist on therapy
that can be more harmful than good. Your Oncologist sounds fairly
honest if he's telling you the actual odds, rather than pushing a lot of
cash-producing medication arbitrarily.

A second opinion would be best, since an "opinion" is just an
"opinion". But don't let fear drive you off a cliff. Too many suffer
permanent damage from chemo and radiation only ending up with
a reoccurrence anyway, when they could have just as well taken a
day at a time without poisoning their entire body.

Every once-in-awhile we find an honest physician.......

You might have found yours!

Get another opinion, or three..... but do not allow fear to
make your decision!


Better health!

John

PhillieG

A Matter of Chance
Sorry to hear about your Dad. I would also get a second opinion. It can't hurt and it could help with the decision making. I'm not sure I would shop around until I found an opinion that was much different than the other opinions. There are no guarantees at all with cancer and any treatments that one can take. We are all different so what may work for one person may not work for another and visa-versa. Also, there is no one type of therapy that ONLY kills cancer cells. They have made advances in treatments over the years so they are able to better target the cancer cells, hopefully they can fine-tune it in the near future.

It seems that the reduction in the risk of the cancer returning is relatively small (3-4%) without chemo. I would have to be very comfortable with my decision if I decided to not do the follow up chemo. I think the stress of being uncertain if I was making the "right choice" could make the chance of recurrence even greater. It's a tough situation to be in. It's good that the doctor feels that it's not imperative that your father does the treatment but then your father has to be OK with whatever he decides.

I have stage IV colon cancer and I did chemo after my surgeries. While it's not all fun and games I am totally comfortable with my decisions and with my oncologist. It's not an easy place to be, there's a lot of gray area with cancer. Nothing is written in stone and like I mentioned earlier, we all respond differently.

I hope your Dad does well with whatever course he decides to take.
-p

Jaylo969

another stage II here
I too had stage II with 26 negative nodes. My oncologist told me that by having chemo it might reduce my chances of cancer recurrance by about 7%.She gave me the choice of to chemo or not to chemo and I chose to chemo. After all was said and done I made it through 5 rounds of Folfox ( that was the cocktail that would *maybe* give me a 7% better chance )and then I was taken off Folfox due to severe side effects and placed on Xeloda. That lowered my percentages to about 3-4 %. Xeloda was very harsh for me too. I managed 4 rounds of it and then she stopped chemo. 9 rounds of chemo in all and she doesn't seem worried at all. It is me that is worried that some of the side effects did damage to other parts of my body and that it that might be permanent.

It is a personal decision. Stage II has a very grey area and they don't seem to know as much about it's recurrance as they do other stages. I believe that at one time with stageII/ NO/MO no chemo would have been offered.

Edited to say that I had right colon cancer and it appears that your Dad had rectal? That *might* make a big difference in treatment.

Best wishes to your Dad and hope all goes well.

-Pat

wifeandmom

Jaylo969 said:

another stage II here
I too had stage II with 26 negative nodes. My oncologist told me that by having chemo it might reduce my chances of cancer recurrance by about 7%.She gave me the choice of to chemo or not to chemo and I chose to chemo. After all was said and done I made it through 5 rounds of Folfox ( that was the cocktail that would *maybe* give me a 7% better chance )and then I was taken off Folfox due to severe side effects and placed on Xeloda. That lowered my percentages to about 3-4 %. Xeloda was very harsh for me too. I managed 4 rounds of it and then she stopped chemo. 9 rounds of chemo in all and she doesn't seem worried at all. It is me that is worried that some of the side effects did damage to other parts of my body and that it that might be permanent.

It is a personal decision. Stage II has a very grey area and they don't seem to know as much about it's recurrance as they do other stages. I believe that at one time with stageII/ NO/MO no chemo would have been offered.

Edited to say that I had right colon cancer and it appears that your Dad had rectal? That *might* make a big difference in treatment.

Best wishes to your Dad and hope all goes well.

-Pat

Another stage 2 voting for a second opinion
I can speak to the regret that can come from not getting a second opinion. Though my regret has to do with the surgery rather than the chemo decision (I did do the neo-adjuvant chemo and radiation, as well as 8 rounds of oxaliplatin and Xeloda after surgery). My first surgeon came highly recommended from my gastro as well as from local doctor ratings and from a friend who had him as her surgeon. I figured that was good enough and I was so overwhelmed with the diagnosis and wanted to just move as quickly as possible, so I didn't bother with a second opinion. I developed some complications that may not have been the surgeon's fault at all, but I'll never know. At least if I'd gotten a second opinion, I would feel like I did my "due diligence" and wouldn't be kicking myself now for not taking that step.

A second doctor may or may not make the same recommendation as the oncologist your father has already seen. That said, it still is your dad's choice. My mom had a stage 2 breast cancer this past year and was given the same odds (4% less likely to have a recurrence with post-lumpectomy chemo). At age 71, she decided the odds were in her favor to skip the chemo and stick with rigorous screening (along with 5 years of Femara). But another woman could be just as justified in deciding that the 4% was worth the chemo.

I wish your father well as he works to make this decision, and with whatever he eventually decides. And best wishes to you and the rest of your family as well.
Regards,
Dorothy

PGLGreg

New oncologist.
I'll add my voice to those suggesting a second opinion, or better yet, a new oncologist. It's my understanding that radiation is standard therapy for stage 2a rectal cancer, and what the oncologist is telling you sounds screwy, to me.

I was diagnosed with stage 2a rectal cancer at age 63 in 2005 and had the standard radiation therapy in early 2006 along with concurrent 5fu+leucovorin chemotherapy. It worked fine, for me. No sign of a recurrence after 4.5 years.

--Greg

Neeno

PGLGreg said:

New oncologist.
I'll add my voice to those suggesting a second opinion, or better yet, a new oncologist. It's my understanding that radiation is standard therapy for stage 2a rectal cancer, and what the oncologist is telling you sounds screwy, to me.

I was diagnosed with stage 2a rectal cancer at age 63 in 2005 and had the standard radiation therapy in early 2006 along with concurrent 5fu+leucovorin chemotherapy. It worked fine, for me. No sign of a recurrence after 4.5 years.

--Greg

Going with Chemo
First of all, thanks for all the comments and support that I have received from this forum. Like many of you have suggested, we decided to consult another oncologist. The second oncologist suggested chemo because of 2 high risk factors in my dad's case, the tumour grade (poorly differentiated adenocarinoma) and bowel obstruction at diagnosis. He said chemotherapy would lower the chance of a recurrence by 12.5%. Because of his comments, my dad has decided with chemotherapy.