Follow up testing

I can understand your reluctance to refuse this biopsy procedure.  We all love hearing that we are in the clear.  However, I really do not see the need to go through a biopsy if you are getting scans because of the potential for healing difficulties.  Neither my colorectal surgeon nor my radiation oncologist favor routine post-treatment biopsy, unless there are troubling symptoms to warrant one, all because radiated tissue can sometimes not heal, as you already know.  I have never had a routine biopsy and I am over 6 years out of treatment.  The only time since treatment that anything in the area of my tumor has been biopsied was when, at 2 years post-treatment, my colorectal surgeon noticed 3 very small internal anal condylomas (warts) during my routine anoscope.  She said they did not look cancerous, but could become so down the road, and she recommended removal, which was done in the hospital under general anesthesia.  As is normal, they were sent for biopsy, but came back negative.  I can say that my healing process went well, but that is not always the case for others.

Here's the thing I don't understand about routine biopsies.  This cancer could come back--we all know that.  But where in the anal canal would it come back if it were to do so?  At the site of the original tumor or at another location, perhaps on the other side?  How does the doctor determine exactly where to get the biopsy sample from, especially when "everything looks great" after doing an anoscope?  Going in and doing multiple punch biopsies in several locations sounds like a recipe for disaster, healing-wise, to me.  I just would not allow it to be done, unless and until there was evidence of recurrence.

Here's another thought.  We are all aware of the changes going on in healthcare.  A couple of years ago, I learned that both my medical oncologist's and my colorectal surgeon's group practices became "affiliated" with the hospital.  I am not exactly certain of the meaning of the word "affiliated" in this case, but now any time I go to either office, all of the paperwork I sign has the name of the hospital included on it, which leads me to believe that the hospital now owns those practices.  I can't help but think that in these type of arrangements, the doctors get some pressure from the hospital to help bring in revenue, which may cause them to do procedures that may not be considered unreasonable in the big picture, but unnecessary on a case-by-case basis.  Something to think about.

My cancer was staged right on the fence between a 1 and a 2 and I had no lymph node involvement, just like you.  I still see my colorectal surgeon every 6 months for DRE and anoscope and my medical oncologist every 6 months.  The med onc continues to get CT scans on me and this last summer I had some iffy areas show up on the one in June, so it was followed up by a PET scan, then another CT 2 months after the PET.  I am scheduled for another CT scan in February to look at the questionable area on my liver again.  No one has been able to identify what this is and I really think if any of my doctors thought it was possibly cancer, I would have had a biopsy of my liver by now.  I am seriously thinking about not having the next CT or at the very least, making it my last.  The anxiety is really beginning to get to me.  I cannot keep doing this!

Please let us know what you decide and take care.

Martha