Rectal Cancer Advice Needed

RazlDazl
RazlDazl Member Posts: 4
edited March 2014 in Colorectal Cancer #1
My husband, age 81 and currently on coumadin for atrial fibrillation, has just been diagnosed with Stage 2 rectal cancer. We are starting a course of radiation pre-surgery shortly but it has been suggested that we consider doing concurrent chemo as well, something my husband is very reticent to embrace.

Would be interested in others in similar circumstances (on coumadin) who have decided to forgo chemo both pre and post op. My husband is a proud man, often mistaken for someone in his 60's,who's goal is to enjoy as much time as he may have left without having to endure months and sometimes years of recovery. Intellectually, I can almost justify this approach...emotionally, well, what can I say.

Any thoughts will be appreciated.

Comments

  • jsabol
    jsabol Member Posts: 1,145 Member
    #2
    Sorry you and your husband are here, but stage 2 is good news. My dad had a year of chemo for colon cancer at age 80 following his surgery. He did not require radiation, but tolerated his chemo really well (5FU and leuco only back then), better than I tolerated mine some years later.
    Best of luck to you and hubby, Judy
  • PGLGreg
    PGLGreg Member Posts: 731
    #3
    I had stage 2 rectal cancer at 63 with radiation after my LAR, that is, as adjuvant therapy. I was told that concurrent chemotherapy was more or less optional, but my oncologist recommended it. There really wasn't much to the course of treatment they gave me. It was just 10 injections of 5FU+leucovorin with a little nausea as the only side effect.
    I'm not sure I should be replying to this, since I was not on coumadin, and I don't really understand the nature of your husband's hesitation. I did find some references on an interaction between 5FU and coumadin that requires adjusting the dose of coumadin. But why not follow your oncologist's recommendation?
    -Greg
  • davidsonxx
    davidsonxx Member Posts: 134
    #4
    One thing to keep in mind is that if he does decide to do chemo it is not an all or none decision. He can try the chemo and if he tolerates it well great. If it makes him too sick he can always stop taking the chemo. Some people tolerate the chemo very well and have few side effects. Unfortunately there is no way to tell how a particular individual will respond to the chemo. You may also want to consider getting a second opinion. Chemo is generally optional for stage 2 but there may be a reason it is being suggested for your husband.
  • Golfgirl10
    Golfgirl10 Member Posts: 5
    #5
    RazlDazl - My husband was diagnosed with Stage III rectal cancer. He did six weeks of pre-surgery 5FU chemotherapy with radiation. Once the chemotherapy ended the side effects went away. The burns from radiation took a couple of weeks before they started to subside. Your husband will be closely monitored while on chemotherapy. If it becomes too much for him the oncologist will make adjustments. I would encourage him to try.
  • taraHK
    taraHK Member Posts: 1,952 Member
    #6
    I was diagnosed with Stage III rectal cancer. I had presurgical chemoradiation (followed by surgery, followed by further chemotherapy). My understanding is that the chemo in the presurgical chemoradiation is to enhance the effectiveness of the radiation. In my own experience, the chemo part was pretty mild. Also, for me, the postsurgical chemotherapy was not too bad. Not fun! but I was able to keep fairly active, etc. Of course it is your/his decision. I wish you all the best as you face the decisions as well as treatment. Tara
  • RazlDazl
    RazlDazl Member Posts: 4
    #7
    davidsonxx said:

    One thing to keep in mind is that if he does decide to do chemo it is not an all or none decision. He can try the chemo and if he tolerates it well great. If it makes him too sick he can always stop taking the chemo. Some people tolerate the chemo very well and have few side effects. Unfortunately there is no way to tell how a particular individual will respond to the chemo. You may also want to consider getting a second opinion. Chemo is generally optional for stage 2 but there may be a reason it is being suggested for your husband.

    Hi and thank you for taking the time to respond.

    While the side effects of chemo does cause some concern, it is the fact that my husband is on coumadin for his atrial fibrialltion that causes the most anxiety. The cardiologist has advised that it would be much better if my husband could be cardioverted before surgery but that can only be attempted if his coumadin level is maintained in a therapudic level for four consecutive weeks. Coumadin is a bear of a drug to control, sensitive to diet, drugs etc. and it's our fear that chemo will complicate matters to the point that cardioversion will not be possible. Coumadin is prescribed to avoid blood clots which is a real danger with a-fib so we feel that we are now between a rock and a hard place. We have heard of horror stories of coumadin/chemo interactions and this is our greatest fear. If it were simply a chemo issue the decision would probably be a lot easier. Add coumadin to the mix....we just don't know.

    We are growing in our serenity to accept the things we cannot change, and getting the strenth to change the things we can....It's the wisdom to know the difference that we're having difficulty with.
  • Faith88
    Faith88 Member Posts: 55
    #8
    Is your husband reticent because he is afraid that the chemo will effect his quality of life, or is it the concern over the coumadin?
    My husband was on chemo for stage III and developed a bad clot towards the end of chemo. he went on coumadin without too much of a problem. He is still on the coumadin but thankfully finished the chemo last December.
    I would check with your oncologist and get an opinion from him. It may just mean closer monitoring of blood levels.
    I wish him/you well. And I say the Serenity Prayer everyday! I love that one.
    -Faith88
  • RazlDazl
    RazlDazl Member Posts: 4
    #9
    Faith88 said:

    Is your husband reticent because he is afraid that the chemo will effect his quality of life, or is it the concern over the coumadin?
    My husband was on chemo for stage III and developed a bad clot towards the end of chemo. he went on coumadin without too much of a problem. He is still on the coumadin but thankfully finished the chemo last December.
    I would check with your oncologist and get an opinion from him. It may just mean closer monitoring of blood levels.
    I wish him/you well. And I say the Serenity Prayer everyday! I love that one.
    -Faith88

    Faith... thanks for taking the time to reply.

    Back in December at his annual physical, it was found that my husband had atrial fibrillation and was placed on coumadin to minimize the risk of blood clots and stroke that can result with that condition. Now that rectal cancer has been discovered there is talk of chemo, which, as you have experienced first hand, has an inherent risk of clots as well.

    The a-fib condition complicates the cancer surgery so it is very desirable to attempt a cardioversion before surgery which is only possible by maintaining a therapeutic INR level and this is done with coumadin. Chemo while on coumadin complicates everything.

    Since quality of life is a major concern, we are hoping that the surgeon can remove the cancer by a TEM procedure and not the more radical surgery which is the norm. In an attempt to facilitate this, a six week course of radiation is being proposed to shrink the tumor for easier removal. Chemo has been suggested to facilitate the radiation but at what cost? While we have been advised that this TEM will not allow the lymph nodes to be removed for testing, it is a choice we have made in order to avoid major surgery with all its inherent risks and to maintain a quality of life that he has enjoyed for almost 82 years. Of course, there is no guarantee that things will go as planned, but we will cross that bridge when and if the time comes. We are adopting the attitude that knowledge is power and are exploring all avenues just in case.

    God give us the strength...
  • PGLGreg
    PGLGreg Member Posts: 731
    #10
    RazlDazl said:

    Faith... thanks for taking the time to reply.

    Back in December at his annual physical, it was found that my husband had atrial fibrillation and was placed on coumadin to minimize the risk of blood clots and stroke that can result with that condition. Now that rectal cancer has been discovered there is talk of chemo, which, as you have experienced first hand, has an inherent risk of clots as well.

    The a-fib condition complicates the cancer surgery so it is very desirable to attempt a cardioversion before surgery which is only possible by maintaining a therapeutic INR level and this is done with coumadin. Chemo while on coumadin complicates everything.

    Since quality of life is a major concern, we are hoping that the surgeon can remove the cancer by a TEM procedure and not the more radical surgery which is the norm. In an attempt to facilitate this, a six week course of radiation is being proposed to shrink the tumor for easier removal. Chemo has been suggested to facilitate the radiation but at what cost? While we have been advised that this TEM will not allow the lymph nodes to be removed for testing, it is a choice we have made in order to avoid major surgery with all its inherent risks and to maintain a quality of life that he has enjoyed for almost 82 years. Of course, there is no guarantee that things will go as planned, but we will cross that bridge when and if the time comes. We are adopting the attitude that knowledge is power and are exploring all avenues just in case.

    God give us the strength...

    I'm not saying it's not important to avoid major surgery -- probably I don't appreciate all the risks -- but I had the major surgery, and here I am. It did take me 10 days in hospital, and with TEM (as I understand it) probably it would have been substantially less. So that's 5-7 days of my life gone. But, trying to keep things in perspective, an extra week in the hospital is not a huge problem.
    -Greg

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