Endoscopic Ultrasound (EUS) for restaging tumor after chemoradiation?

db8ne1

Hi!

I'm fairly new here and was looking for feedback.

I was dx'd on Dec 7th 2012 with colorectal cancer T3 N1 M0.  (N is a guess on 1st EUS  - as cannot be confirmed until post surgery). EUS is just like a colonoscopy but using ultrasound to measure the depth of the tumor.  No drugs for the procedure, though :-(  However, it doesn't take too long. No pain, just discomfort.

Completed 6 weeks of chemoradiation on 2/13/13. Daily radiation and 5FU via a take home pump hooked up to my surgically implanted port.  I had an MRI recently - but that was to check out a spot on one of my kidneys (and to recheck my liver to be on the safe side - since it's right there...). Don't know the results yet - and it's secondary so I'm not too concerned about that.  However, today my oncology team had me scheduled for a 2nd post-therapy EUS to determine how successful the therapy was.  So, I fast all day yesterday and do the wonderful colonoscopy prep.  I had the same GI doc for this EUS and during the procedure he indicated that he really didn't like to do post therapy EUS's because they were generally not very helpful - although the PRE therapy EUS is the best option for initial staging (pre-therapy, of course). His rationale is that the radiation is still working, the intestines are still swollen from the effects of therapy, etc. He said he would suggest a PET scan instead for a more accurate assessment. So, he's still staging the tumor at T3.

My question is: Has anyone else had a similar experience post chemoradiation?  What's the standard? I'm wondering why I went through this if it's not really that helpful?  Not that it was horrible, but more of a waste of time, money, resources, etc. 

Thoughts?

Thanks,

J

taraHK

My experience

Hi J,

I don't have too many answers for you -- but will just share that I had EUS before any treatment. I then had chemoradiation before surgery (sounds similar to you) -- but did not have a repeat EUS at that stage. I guess just different protocols at different hospitals...I was also told that the radiation was still working -- had my surgery 5.5 weeks after chemoradiation ended.

PS I was also diagnosed as T3, N1 M0 -- although my N1 wasn't diagnosed till after surgery. The chemoradiation didn't downgrade my tumour. I would have had the surgery even if it had downgraded it to "nothing", based on what I was reading at the time.

Good luck and best wishes,

Tara

db8ne1

taraHK said:

My experience

Hi J,

I don't have too many answers for you -- but will just share that I had EUS before any treatment. I then had chemoradiation before surgery (sounds similar to you) -- but did not have a repeat EUS at that stage. I guess just different protocols at different hospitals...I was also told that the radiation was still working -- had my surgery 5.5 weeks after chemoradiation ended.

PS I was also diagnosed as T3, N1 M0 -- although my N1 wasn't diagnosed till after surgery. The chemoradiation didn't downgrade my tumour. I would have had the surgery even if it had downgraded it to "nothing", based on what I was reading at the time.

Good luck and best wishes,

Tara

Thanks for the response,

Thanks for the response, Tara.

I met with my radiologist this week and she confirmed that any test post chemoradiation was not optimal - including a PET.  However, internally at least, the tumor has shrunk and she is now calling it an "ulcer".  And, as you mentioned, the radiation is still working.  I still have to meet with the surgeon to schedule surgery.  But my latest MRI shows an abnormality on one of my kidneys - so off to a urologist first! 

I hope you are doing well!

Thanks again for your feedback.

Best,

J