Taking Supplements DURING chemoradiation?

KathiM said:

Larry, I was stage II rectal cancer, but squamous cell, instead of the 'normal' adeno. I received 2 sessions/4days each of 5FU/cisplatin and 25 days rads BEFORE surgery. In MY case, the turmor was ELIMINATED with this treatment. Because, you are right, this is VERY RARE, I did go ahead with the resection...rectum, sigmoid colon, 12 nodes (no node involvement) 'just for safety' (I would have driven my surgeon NUTS otherwise with what-if's). All the tissue removed (also a total hysterectomy) was NO CARCINOMA found...20/20 hindsight says I could have skipped the resection...but you never know...
On taking supplements, there ARE some interactions with chemo...I was told I could take my one-a-day vitamins if I felt like it, but the one onc said NO green tea (anti-ox) and another said FINE for green tea. I did green tea for the first session, and I must say I FELT better...
Hope this helps, Kathi

Hi Kathi,

Thanks for the response.

The subject of local excisions versus radical resections is a very controversial subject among the medical community. Depending on who you believe, the mortality statistics between a radical resection without chemoradiation and local excisions of early tumors is about the same. If I am eligible for the clinical trial I can hedge my bets a little. After the chemoradiation and excision the pathologist will examine the tumor. If it was not downstaged sufficiently then a followup radical resection would be performed. The downside of course is that there probably will not be any lymph nodes to examine.

Was there a specific reason that you choose to take the green tea for only the first session?

Thanks.

Larry

Kanort said:

Hi Larry,

You are very wise to be so involved in your treatment decisions. I was diagnosed in October 03 with stage 3 colon cancer with 3 out of 31 lymph node involvement. My oncologist allowed me to take a high potency multivitamin. I also was friends with a lady from Korea who provided me with some mushrooms that I boiled in water and drank daily. I also consumed enormous amounts of green tea daily. My latest scans in March showed NED. I also believe that consuming cinnamon will keep one's blood sugar lower, but I'm sure you probably already know this.

Keep us posted on your progress.

Kay

Hi Kay,

Thanks for the response.

Its good to hear that you are doing well.

Did your oncologist have an opinion regarding the green tea?

Yes, I just recently read about cinnamon, but have not tried it.

Thanks.

Larry

markatger said:

Hi Larry,

Welcome!! (But of course sorry to hear you've joined the club) Wow..you are very educated. I really admire that. I also am someone who really wanted to be informed and involved in my care decisions. This was often to the dismay of my oncologist unfortunately. If I could change a few things about my oncologist that would be one! I wish I had more time with him to ask my questions and be involved in the treatment decsisions. But at same time I felt like he was very good so I didn't want to change doctors.

Anyways...the only thing I can add in regards to supplements is about preventing Neuropathy. I developed it after 11 treatments of FOLFOX(5FU, Oxaliplatin, Leucovorin). Glutamine was suggested by both my naturopath AND by a nurse at my oncologist's office. I never did ask my onoclogist about it. But the fact that this nurse was willing to endorse it impressed me because basically all the staff at the oncologist's office won't encourage or discourage most naturopathic supplementation because there is not enough studies about it. Glutamine preventing neuropathy however seemed to be the exception.

I am taking it now, but I was told it works better as prevention. There is a little worrisome thing about it though. It is also often taken during treatment because it is very healing to the GI tract. I have read somewhere that there was a concern that you don't want to take anything that would encourage colon cells to heal while you were trying to kill abberant colon cancer cells. But, there seems to be other studies out there that state it doesn't heal the cancer cells.

Ask your oncologst about it! I'd love to hear what he says.

Best Wishes,
Maria

Hi Maria,

Thanks for the welcome.

Yes, I try to do my homework and be actively involved in my treatment decisions, but without being a medical professional it is extremely difficult to evaluate the various medical papers. Nevertheless, by learning as much as I can I will be more likely to tell if a doctor is on top of his/her game, or if they are blowing smoke.

Thanks for the information about Glutamine. I did a little reading on it. Yes, there seems to be a body of evidence that supports its protection of the gastrointestinal tract. One study indicates it was found effective in combating soreness and ulcers of the mouth. An other study found that it increased the cancer toxicity of methotrexate, a chemo drug.

Based on this limited information, I would not unduely worry about it helping cancer cells grow.

I just spoke with my surgeon. It looks like I am eligible for the clinical trial. So my next step is to select radiation and medical oncologists. I wonder how receptive they will be to discussions of supplementation during treatment.

Larry

DK2006 said:

Hi Larry,
Your post is interesting. Thanks for educating us on new treatment options.
I'm just curious on how the doctors can stage your cancer right now. My staging was done after surgery. How can they possibly tell if there is lymph node involvment without doing a biopsy? You didn't ask for advise about which option to take, but if it were me, I would have a resection and not do chemo. My resection was a piece of cake compared to chemo (only my two cents and I hope that I don't offend you). My oncologist ( who is not progressive in any way) told me not to take any supplements during chemo. Anyway, it's great that you are so active in your treatment! Let us know what you decide. Best wishes, Donna

Hi Donna,

Thanks for your response.

No, I did not ask for advice on the treatment options, because I did not think it would be fair to ask others to put a value on MY rectum and plumbing. ;-) However, even though you have expressed your opinion, no offense is taken. I sincerely appreciate your thoughts.

In answer to your question, as I understand it, there are two types of staging 1)clinical staging and 2)pathological staging. Clinical staging includes such things as X-rays, biopsies of the tumor, CT Scans, PET Scans, Endoscopic Ultrasound, etc. (In my case I have had the Ultrasound and biopsies performed twice by different specialists to confirm the clinical staging.) Pathological staging for colorectal tumors requires radical resection where the tumor and lymph nodes are removed and examined by a pathologist.

Obviously pathologic staging is more accurate, but as Kathi described, once you undergo a radical resection (to get the best staging) you can not go back and tell the surgeon in 20/20 hindsight to reinstall your rectum and colon since it turned out it your nodes were clear.

The fact that I have a moderately early tumor provides me with more agonizing options than if I had a later or earlier tumor. If I had a stage II tumor (T3)there would be nothing to agonize over. It would be just as you suggest, no chemoradiation and a radical resection. Likewise if I had an even earlier stage I tumor (T0 or T1 versus T2) the normal treatment would be a local excision without chemoradiation. So the logic of the clinical study is to turn my T2 into a T0 or T1 and use the treatment typical of an early stage I. With that additional option comes a lot more to think about.

In agonizing over the decision here is some of my reasoning. First, while I am very concerned about the short-term prospects of chemoradiation, (hence this thread) I have tried to focus only on balancing the relatively long-term effects when attempting to reach a decision. I figured that I will just have to tough-out the unpleasant five weeks of treatment in order to maintain the very attractive possibility of saving my rectum and colon. The potential long-term effects of chemoradiation are reduced bowel and bladder control, and sexual dysfunction. However, according to my surgeon, if I chose the radial resection without chemoradiation there would be an even greater likelihood of these adverse effects since the tumor is moderately low and in a very small area to work.

As I mentioned earlier, I can hedge my bets a little because the tumor and surrounding normal tissue will be removed via the local excision. The surgeon said there might even a small chance of getting a node to look at when removing the tumor and surrounding tissue. The pathology report on this tissue will provide better staging than clinical staging, and based on that additional information we will be able to determine whether I need to proceed to a radical resection or not.

I have studied a number of relevant medical papers on the subject rectal surgery. I figure there is about a 60-70% change of downstaging the tumor to at least a T1. So the chances are in favor of me not needing the radical resection. Therefore, in this scenario I am comparing the lower probability of having a damaged rectum and colon due to radiation, versus the certainty of not having a rectum and sigmoid colon at all.

On the other hand, if it turns out that I do need the radical surgery after all, the long-term adverse effects of chemoradiation plus radical surgery would not be exactly additive as in 1+1=2, because the portion colon and rectum damaged by the Chemo would be removed anyway.

I have also studied the relative recurrence statistics of both local excisions and radical resections. Both procedures leave up to a 10% chance of a recurrence, so nothing is sure in this world.

Sorry for the long-winded explanation, but as you may have gathered, writing this down is somewhat therapeutic in that its more about convincing myself than anyone else. ;-)

Larry