adenomas polyps in latest Colonoscopy

I had one polyp in the first colonoscopy.  I asked what was the chance that they missed it in the first colonoscopy (where they identified the big tumor) and both the colonoscopy doctor and my surgeon said it was very possible (there seemed to be an indication of even "likely," that they had missed it with all of the confusion and blockage in the first colonoscopy).  They told me it was not cancerous, so I am not too concerned at this time.  I have another colonoscopy (1 year) coming up in November.  If colon cancer takes ten years to develop and they can clip the polyps, why worry?  If I have a ten year life span, I will be happy.  I think it is the cancer in other places we really need to worry about now.  My surgeon says if the cancer returns, I have a 60% chance it will be in the liver (probably site specific for where the original tumor was located).  That concerns me a lot more at this point in time.

I'm a bit surprised that you had a colonoscpoy so soon after finishing chemo. Maybe it's an annual thing from diagnosis? I wasn't expecting that one. The scariest thing for all of us is recurrence. I hope that they got it all out and that your scans are clean.

My last scope was a little later than it should have been , despite my howls of protest. It was three years from my previous one and produced 4 tuular adenomas between 4 and eleven point 5 mm. He said with my history of aggressive cancer I was very lucky that theywere all precancerous. I'm on two yearly scopes from now on. Ron.

My 1st colonoscopy  removed 4 polyps, but found 5 (including the bad boy).  A second colonoscopy the top-gun colonoscopist 3 weeks later, removed the bad-boy and 4 more !!  Then I had a partial colectomy ng a weel later since the margins of the cancerous polyp were too small.

So I had a colonoscopy a year later, from the top-gun and he found one 12mm sessile serrated on the right-side.

After reading a lot of papers, it's clear that colonoscopists miss a lot of polyps - maybe 25%!!!   They tend to miss sessile (flat) ones,  smaller adenomas, and polyps on the right-side colon.

They could have missed it the first time or even if they grew that fast i wouldn’t panic unkes they find more in a year. Even then they are pre cancerous so they won’t get a chance to be cancer since you are right on top of checking and screening. Of course you will worry but hopefully in time you will be less worried.

Is stay vigilant and do whatever you can to lower your risk. I've always thought//suspected that colon cancer and other digestive tract disorders ran in my Dads side of the family.  My cousin Bill came in to see me yesterday. He had some bad news. He lost his 48 year old daughter to colon cancer two weeks ago.So who knows it may be from Mums side of the family. Unfortunately it is not always possible to remove all risk factors. I cannot take aspirin at all because I take warfarin.  I have a lot of auto-immune problems that requires me to take strong immume suppressants twice a day. (cyclosporine) Because of the cyclo I have to have six monthly checks for skin cancers. My skin ca doc told me that if a heart transplant patient taking cyclo as an anti rejection drug lives for eighteen months past the transplant they are most likely to die from some form of cancer. I have already had several basal cell carcinomas removed. 

       It is a bit of a sweepstake as to what gets me first , cancer ,heart failure or kidney failure. Such is life. Wishing you all good health. Ron.

plsletitrain said:

Good it was caught early

Cancer really puts us into a limbo.  My lung nodule which has been there since my emergency colon resection was been monitored for over a year and I just hated it that I'm glad my onco suggested for me to undergo VATS to remove the nodule.  I'm praying its benign although its characteristics point to it being a met.  But at least start with having it removed first then I'll cross the bridge when I get there.

I guess we really have to have aggressive monitoring especially that we have little ones.  I take PET CT scans every 6 months and I try to keep a healthy lifestyle although its really hard to stay religiously fit.  I sometimes cheat with my food.  But we gotta to do what we gotta do.  Push for the PET scan to be done soon.  It will help both physically and mentally for us.

>>Cancer really puts us into a limbo.

Yes, that's the truth. Uncertainty, not knowing, is the key problem for me.  The thing about cancer is, there is no finish line.  At some point 5 or 7 years out, you can expect the chance of a recurrence is lower than the risk of other causes of death, which is at least marginally satisfying, but in the interim, we all live a few lab tests away from the prognosis of a very bad time.  I've read quite a lot on CRC recurrence lately, and well ...it's a lot like delayed stage IV.   You've got a modest shot at LT survival if your metastasis is resectable AND you respond to chemo.  You've got a slim chance if it's not resectable.  Only 25-30% of CRC mets are resectable.

The new circulating tumor cell count tests (ctc & ctdna) *promise* to offer a lot better insight into whether cancer remains, reducing uncertainty, but so far they have their own accuracy limitations.

So, I don't understand the 'fight cancer', beat cancer', 'conquer cancer' memes.  Cancer happens when one of the ~37 trillion cells of our bodies have a special little 'whoopsie'. Surgeons may extract and extinguish the source, and if they think it's probable that cells have spread they'll use some systemic chemo, causing a lot of collateral damage.  But the ability to detect residual cancer is extremely poor and their ability to extinguish nascent mets even poorer.  Then you learn to live with the makeshift 'pipes', and maybe start improving from the chemo damage.  This sounds like "take a hard beating and hopefully survive".   I don't see 'fight' or 'win' anywhere.  These cancer cells are a normal part of each of us, just misbehaving in a rather unfortunate way. There is no one to fight but ourselves.   Some of you might be old enough to recall the 'Pogo' comic strip quip, "We have met the enemy and he is us"; it applies to cancer.  Don't fight yourself, it's a losing battle.

>> I guess we really have to have aggressive monitoring especially that we have little ones. 

I used to think that too, but now, ~22 months after surgery and becoming a lot more educated on the topic, I'm beginning to have serious doubts.  The recent "FACS trail" showed there is a LITTLE marginal improvement in the ability to detect metastases that are surgically resectable with curative intent when aggressive surveillance is performed, and there is no statistical benefit in terms of 3-year or 5-year survival. Cochrane Library (a highly respected organization for meta-reviews and analyses) shows a similar result.  More early detections and surgeries in the intensive follow-up groups, but no better outcomes.

Intensive surveillance has to be weighed against all that radiation you are getting from CTs and PET scans.  In fact, the NCCN guideline (v2, 2018) frowns on PET scans for surveillance since they state there is just a tiny chance that a PET would find anything that a  contrast-enhanced CT wouldn't have seen (get a CONTRAST CT first, then a PET only if the CT showed something).  Note the CT done together with a PET/CT are almost always non-contrast for technical reasons.  In the 22months since diagnosis, I've had 5 sets of CTs and two PET scans - mostly triggered by elevated CEAs and some naughty looking stuff on CTs that later disappeared.   What a waste. What a load of mental torture.

https://jamanetwork.com/journals/jama/fullarticle/1814213?resultClick=1

It *seems* that intensive CEA (despite it being a really crummy test) surveillance is as good as any surveillance, and has the advantage of costing $50 and not dosing you with radiation.

The "CEAwatch protocol seems like the most effective schema, BUT the overall survival is no higher than standard surveillance.

https://www.ejso.com/article/S0748-7983(15)00512-0/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/28376235

http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD002200.pub3/abstract

"Authors' conclusions

The results of our review suggest that there is no overall survival benefit for intensifying the follow-up of patients after curative surgery for colorectal cancer. Although more participants were treated with salvage surgery with curative intent in the intensive follow-up group, this was not associated with improved survival. Harms related to intensive follow-up and salvage therapy were not well reported."

darcher said:

medicine is limited but better than nothing

  I have to agree the CEA is lousy at best for a lot of us.  Mine is (wait for it)... 1.3. The same as it was when I had the tumor.  For me it's not a good indicator but who knows, maybe it's good if the cancer has passed some benchmark in growth or development enough so that it releases that enzyme..  

  Same probably goes for a lot of these tests we go through.  The PET scan is still on for October.  When they pulled these two buggers out they were each cut out in 4 pieces.   Small bits and probably explains why it took a week to go to the bathroom again.  I got the official biopsy results and one in the ascending colon was nearly but not quite benign.  The other, in the transverse colon was a lot closer to being what we don't want.  Doc said he wants me back in a year.  No problem.  I'll be back in six months if it's any better.   A colonosopy is 1000 times more tolerable than the alternative.  

  I think a lot of the speculation and grey area in testing is due to the varying degrees of what constitues an aberation in cellular strucutre that becomes cancer in its true form, it grows uncontrollably.  I remember when they did the biopsy on the tumor.  It was said to be inconclusive. Maybe it didnt have enough of what ever it is that defines the absolute threshold of being cancer but to look at the picture, it sure as hell didn't belong there.   I had to sign off on them treating it as cancer. Turns out it was.

   Even though both my parents had cancer and my brother as well, I don't have any of the genetic markers for it.  Turns out, this was caused by the steal mill poluting the river we swam in as kids.  It got in the air too and may explain why my brothers wife and daughter both got cancer.  I think the environment is more at fault for it than anything else.  We're not dessigned to injest so many artifical chemicals.  There is no way to test the toxidy level without it taking decades..  

  So, for now I'm going to live as clean as possible which means reading the content lables of things bought.  If I can't pronounce it,, I probably wont buy it. 

  

    

Well I agree with you wanting to eat clean. I take issue that the grains, fruits & vegetables we consume are not as the good Lord intended them to be. Everthing is GMO,GMO GMO. The grains that were here before mankind took hold of the land no longer exist. The farmers wanted thicker crops that grew faster. We buy fruits and vegetables and they are modified the same. You can't buy a tomatoe in the store, plant the seeds and volia have your own plant growing and florishing, as that would put them out of business. 

I also have an issue with our very own human waste. The latest practice is that they are taking it treating it, mulching it and are turning "Bio-solids" into fertilizer. Yes I know it make me sound like I am a raging loon, but this is true. In my old community they wanted to put in a "bio-solids mulching facility" within a mile of my home. The engineers laughed at us when the residents argued that medicines could seep into our ground water as well as radiation from cancer patients....long story short we won our battle but not the war. VitAg opened up a facility just a bit further down the road in another county and is bagging human waste as "fertilizer". Cattle are grazing on it, the farmers are using it and the vast majority of the public is in the blind. 

So there is my rant for the day. Do we really know what the heck we are eating?