Study from MSKCC: "Surgery Not Necessary for Most Late-Stage Colorectal Cancers"

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abrub
abrub Member Posts: 2,174 Member
edited March 2014 in Colorectal Cancer #1
Surgery Not Necessary for Most Late-Stage Colorectal Cancers

May 30, 2009

NEW YORK, NY

http://www.mskcc.org/mskcc/html/92848.cfm


I've posted this link on a few of the threads - thought it merited a thread of its own. I found it on the Memorial Sloan-Kettering Cancer Center website.

It certainly goes against "gut" (no pun intended) feelings of get the cancer out, but I see Dr. Paty's point.

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  • dschreffler
    dschreffler Member Posts: 58 Member
    #2
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    Very interesting and inline
    Very interesting and inline with neoadjuctive treatment that seems to be the recommendation for stage2/3 cancers. Goal being to contain/shrink tumors before cutting.
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #3
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    My situation to a T
    The first Dr who "found" my cancer wanted to cut me open right away. Thankfully I went to SK and we did chemo first to shrink liver mets since I was not in danger of a blockage. It worked like a charm. I knew a person with a very similar dx as I had. Like I said, I knew that person.
    We're all different but if it's not vital to operate, I agree it's better to eliminate what you can first.
    Good article, thanks for posting it.
    -p
  • Betsydoglover
    Betsydoglover Member Posts: 1,248 Member
    #4
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    No colon surgery for Stage IV
    This is definitely interesting. In my case, my surgeon and my GI doc both thought I needed surgery in 2 weeks to avoid an obstruction. Hard for me to disagree since I was having a degree of discomfort. So, in my case, sigmoid colectomy first was the right approach. Waiting 6 weeks for chemo (even with liver met) was the right thing for me.

    Just wanted to mention that sometimes surgery is really the right first step.

    Betsy
    diagnosed Stage IV 5/2005
    sigmoid colectmy 6/05
    6 cycles Xeloda/oxaliplatin/Avastin
    NED after 2 cycles
    11/2008 lung nodule shows up
    4/2009 nodule removed via VATS
    6 cycles of Xeloda+ Avastin, now on Avastin only
    NED - PET every 3 months
  • abrub
    abrub Member Posts: 2,174 Member
    #5
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    Betsydoglover said:

    No colon surgery for Stage IV
    This is definitely interesting. In my case, my surgeon and my GI doc both thought I needed surgery in 2 weeks to avoid an obstruction. Hard for me to disagree since I was having a degree of discomfort. So, in my case, sigmoid colectomy first was the right approach. Waiting 6 weeks for chemo (even with liver met) was the right thing for me.

    Just wanted to mention that sometimes surgery is really the right first step.

    Betsy
    diagnosed Stage IV 5/2005
    sigmoid colectmy 6/05
    6 cycles Xeloda/oxaliplatin/Avastin
    NED after 2 cycles
    11/2008 lung nodule shows up
    4/2009 nodule removed via VATS
    6 cycles of Xeloda+ Avastin, now on Avastin only
    NED - PET every 3 months

    Agreed
    You are absolutely right, Betsy. An obstruction takes precedence.

    I was with Dr. Paty of the article yesterday - spent 2 hours discussing my case and the world, including that article, and he emphasized that if there is no blockage, this is an appropriate route. If there is a possible obstruction, then surgery is a must. You had a blockage - no options.

    The article doesn't apply to my cancer - stage IV Appendix Cancer, low-grade tumor. However, when we meet with Dr. Paty, we discuss many aspects of colorectal cancers.
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #6
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    abrub said:

    Agreed
    You are absolutely right, Betsy. An obstruction takes precedence.

    I was with Dr. Paty of the article yesterday - spent 2 hours discussing my case and the world, including that article, and he emphasized that if there is no blockage, this is an appropriate route. If there is a possible obstruction, then surgery is a must. You had a blockage - no options.

    The article doesn't apply to my cancer - stage IV Appendix Cancer, low-grade tumor. However, when we meet with Dr. Paty, we discuss many aspects of colorectal cancers.

    2 hours!!
    2 hours with Dr Paty!??!! I am jealous! He is fantastic!
  • abrub
    abrub Member Posts: 2,174 Member
    #7
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    mom_2_3 said:

    2 hours!!
    2 hours with Dr Paty!??!! I am jealous! He is fantastic!

    Dr. Paty and I are friends as well as dr/patient
    A variety of personal links means that we've become friends, and our meetings (much more than appointments) take place out of the scope of the clinic, with its time constraints. After all, we must catch up on family, his research projects, travel, and other things. Can't be done in a 15 minute clinic slot, so we use my appointments as a semi-annual excuse to catch up.

    And he gets to cut me open again in June! (Wait - I'm not thrilled about that...) Actually, I'm glad that I'm no longer wondering when the surgery will be. It's been a "not yet, but soon" for a while. We finally agreed that this year is the year, and for me the sooner the better. He's traveling a lot between now and June, so I want to wait until he's back, and will be around post-op.
  • abrub
    abrub Member Posts: 2,174 Member
    #8
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    Popping this back to the front of the board
    Seems the questions re treatment of Stage IV have come up anew, and I want people to see this to learn of options.
  • banma
    banma Member Posts: 9
    #9
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    abrub said:

    Popping this back to the front of the board
    Seems the questions re treatment of Stage IV have come up anew, and I want people to see this to learn of options.

    chemo before surgery / surgery before chemo?
    There are advantages & disadvantages to both sides of this. If you do chemo first, you benefit from having an instant attack on the tumor and on systemic cancer wherever it may be. Those are both crucial things. But leaving the tumor in may have have costs as well. It means any surgery one gets will be after some amount of chemo, which can weaken the body. And for the important percentage of people who don't respond to first-line chemo, things can progress to a more difficult surgery or no surgery at all. For those who do respond to chemo, sometimes the tumor in the colon actually diminishes so much it causes a perforation.

    And the longer you leave the tumor in, the greater the overall tumor load in the body for a longer period of time. So potentially you need more chemo to kill more tumor (and nobody wants more chemo than is necessary.) And you give the tumor more time to act negatively on the immune system, if indeed that is what it does (as is suspected.) Of course one can monitor with scans & bloodwork, but it's not at all an easy situation.

    That's my whole point -- that this can be a very difficult question. I think good oncs & surgeons can legitimately disagree.

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