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Chemo after surgery with no visual cancer cells present?

ritaclough's picture
Posts: 44
Joined: Sep 2010

Friday they removed my recurring colon cancer from my ovary via hysterectomy and next they want to repeat chemo treatments similar to the treatment I just got over last Nov. Just isn't making sense to me. Why would I want to do the same chemo when it didn't kill the cancer that was obviously in my ovary the first time? It only suppressed it. I did send a piece of my tumor to ChemoFx so they can test varying chemos against it so that should hopefully help I guess. I'm going to be having a PET and CT scan to see if they can spot any other cancer cells and I'm thinking if there are no visual signs of cancer why would I do chemo? Chemo is so hard on a body that's trying to get healthy again. Especially hard on the liver. Wouldn't it make more sense to strive for a healthy body and wait to see if any cancer appears and then treat it? What are your thoughts?

Sundanceh's picture
Posts: 4408
Joined: Jun 2009

Different chemo regimens can be used - like the difference between Folfox and Folfiri along with many combinations like 5-fu in either the pump or by pill as Xeloda.

The theory, as it goes, is that cancer cells spread systemically through the bloodstream and can attach literally anywhere and begin to amass forces and develop into a tumor. Doing chemo post-op is supposed to provide a greater percentage of success than forgoing treatments.

I made this error (well me and my onc) when I first got started - we did surgery and no follow up chemo - year and a half later, it wound up in my liver and that was surgery followed by chemo etc.

Even with that, I've just had my 3rd recurrence and am again on chemo (tumor cells present) and will be starting radiation yet again.

This is a difficult question to really answer and ultimately will come down to you and youru oncologist on what is the agreed best protocol. I would get my CT and PET scans done and see what the results of that are and then make a decision on what was best between you AND your medical team.

I know it seems like WHY? Wish I had an EASY button to help make the decision with you, but sometimes it is better to err on the side of caution than look back and say, $hoot, it got back out under the fence.

Doctors can never really tell us if they is a cancer cell present in our body - the scans are only as good as to pick up certain sizes once the tumor has grown enough to be detected.

So, it comes down to what you feel comfortable with.

There are alternative practices out there and for some folks, they have really worked. The immune system is important and chemo is very hard on the body - so it's like a real dichotomy as to what is the best path.

You can research alternative treatments while you do your PET/CT, and once the results are in, you will be armed more with knowledge that will better help you make a good decision.

I am wishing you nothing but the best!


ritaclough's picture
Posts: 44
Joined: Sep 2010

Thank you Craig Your information has been very helpful to me

PGLGreg's picture
Posts: 741
Joined: Jul 2006

Craig's answer seemed to me to be very thoughtful and entirely correct. And he knows lots more about it than I. To answer specifically your question:
"Why would I want to do the same chemo when it didn't kill the cancer that was obviously in my ovary the first time?",

I'd say that chemo does two things well, typically. It shrinks tumors (but usually can't eliminate them entirely), and it kills the microscopic cells that cannot be detected but can later cause recurrence.
The chemo you had before did its job to shrink the tumor. The surgery has done its job to remove the tumor entirely. Now you want chemo to do its second job: kill those residual microscopic cancer cells. So I think you should follow your doctors' recommendation.


Nana b's picture
Nana b
Posts: 3045
Joined: May 2009

Yep, Yep.. sounds right to me! Hang in there!!

John23's picture
Posts: 2141
Joined: Jan 2007

"I'm thinking if there are no visual signs of cancer why would I
do chemo? Chemo is so hard on a body that's trying to get healthy
again. Especially hard on the liver. Wouldn't it make more sense
to strive for a healthy body and wait to see if any cancer
appears and then treat it? What are your thoughts?"

You should allow your instincts and intuition to guide you, not fear
of "doing the wrong thing", or not following the mainstream path.

You are absolutely right, regarding a weak body being unable
to fight and heal. What good is an immune system that's being
damaged by what was intended to help?

There is no chemotherapy regime to date, that can isolate a single
idle cancer cell, much less kill it; If it can't be identified, it can't be touched.

The immune system, when it's operating properly, can and does remove
dead and dying cells, even those that are trying to continue living
on their own.

Good physicians will weigh the benefits against the risks. Any
physician that is willing to pump carcinogenic compounds into
your body, knowing full well that it may do absolutely nothing more
than make you terribly sick and weak, isn't much of a physician.
Or more simply: if the odds are against it helping at all, and instead
it will do more harm, why is it being administered?

If you had tumors, or cancerous clusters, and they could not be
reached surgically, then I could understand (as you could), the
use of chemo. But why, if there are no signs of cancer cells?

We read here day after day after day of reoccurrence after long
periods of chemotherapy. Each patient took the treatments because
they feared not doing the treatments. Some of those patients
continue to seek more chemotherapy treatments, simply out of
fear of not having the treatments.

I find it frustrating to have people I have come to care about, lose
their battle with cancer, simply because they fear trying anything else.

There are quite a few of us here that have backed away from chemo
and radiation, and are doing well. Yes, we can suffer a major setback,
and we could end up dying from cancer, but it will be the cancer
that kills us, not the chemicals they wanted to pump into us.

There are no guarantees with any treatment, and this board certainly
has it's share of failed attempts, but if you have the chance to toss
fear aside, you just might find yourself alive and well for as many,
or more years, than if you've done otherwise.

Do what your heart and mind tells you; do not allow fear to guide you.

But do not do "nothing"; you have to do whatever it takes to get
healthy and build your immune system. You have to take the time
to research the many other ways that can be used, to stay alive.

You -can- do it.

Best wishes for better health!


ritaclough's picture
Posts: 44
Joined: Sep 2010

I have a natural instinct to agree with you John. They believe I possibly had even just a single cell that dropped down to my ovary from my initial tumor that the previous chemotherapy just suppressed and didn't kill. As soon as I was off chemotherapy the cell grew rapidly but made it at least the size it could be removed. I have a Dr appointment tomorrow and these questions to take with me. I'm also curious to see what Chemofx reports back after they test my tumor against the chemotherapy's available.

Fear is a big thing there's no doubt about that. There's sooo many homeopathic products out there it's enough to make your head spin. I have been in contact with Life Extension a research supplement company that I do trust but trust for a cure? That's the tough part. The only thing I've started on so far is Tagament. After reading the research on that in the hospital I went right down to the hospitals pharmacy and got a bottle. I can't believe Dr.s aren't prescribing that to colon cancer patients. I plan on adding more, am waiting back for a call from Life Extensions Oncology Dept. but presently am unsure weather chemo is right for me...I don't have peace about this decision at all yet.

John How do you and the others that haven't gone the chemotherapy route kept the cancer at bay? I am already a healthy eater sense the end of my last round of chemo. I've gotten rid of white flours and most sugars so refining diet should be easy for me. All the many supplements out there are confusing though.

John23's picture
Posts: 2141
Joined: Jan 2007

Drop a PM to "2bhealed" (Emily), and "Scouty". They've used
"juicing", nutritional supplements, and other health support
methods to fight cancer.

I recently bought a "Champion" juicer (Emily recommends those).
I felt that although a diet didn't seem to matter much for me
(I never eat veggies and fruits) if I can drink the equivalent
of a few leafs of lettuce, 1/2" of cabbage, 2 carrots, an apple,
spinach, celery, and some radish tops, in one 6oz glass.... well...
Good 'nuff! It can't hurt.

You can look at my "profile" and read what I did. My wife and
I have used Traditional Chinese Medicine for other serious
ailments, and it worked wonders. TCM is a science that is
over 4 thousand years old, and is continued to be practiced
alongside western medicine in China's finest hospitals.

There are indeed, other ways to fight cancer.

Individuals feel compelled to tell other cancer victims to beware
of anything not approved by the FDA, or that does not conform to
the most conventional practices of western medicine.

They fear cancer and they fear doing anything that is not suggested
by their physician. They place their life in another's hands, rather than
trust their own intellect and judgment to save their own life.

It's very understandable - the fear of dying. And it is very understandable
that any individual would have a tremendous fear of dying due to their
own lack of knowledge of how to survive. But to place so much blind faith
in physicians that base their knowledge on what the manufacturer of the
medications provides for information, is terribly sad.

People will believe in a manufacturer's claims, but refuse to believe
in the statistics provided by the same entities... go figure..

It's fear. It's only the terrible fear of dying, that drives the multi-
billion dollar industry. And it's that fear that keeps so, so many
individuals coming back for more....

There's nothing wrong with using mainstream medicine, there are
millions that are alive today, thanks to the proper administration of
those medical practices. Chemotherapy doesn't have to be a bad word;
there are many here that give credit to chemo for their continued life.

Radiation is fine, if there's no other possible option to save your life.

But the indiscriminate use; the arbitrary application of such powerful
and toxic products, just to satisfy the fear of not doing it, is a path
I personally will not take.

I wish I could inspire others to shed the fear, and use their own
common sense and intuition; the powers that were given to the
common animals...... the blade of grass.... the power of one's
own self to be able to survive by one's own common sense....

Because they just might find that they can survive, without all
the toxic chemicals and radiation that were intended to "cure",
but manage to be so destructive..

Do whatever your instincts tell you to, regardless if it's chemo,
or an alternative, but do not ever look back and wish you
took another path. Likewise, do not refuse to go a path, chemo
or otherwise, for fear you might look back and wish you didn't.

Trust in -yourself- to make the right choice to be as healthy as
you can, under any circumstance.

You can do it; -you- can do anything!


(homily complete, ehh Roger?)

(heh heh)

Posts: 489
Joined: Dec 2009

I just want to say a quick THANK YOU John! I know the decision to not take chemo is not always well received. I decided against my oncologists recommendation to go through chemo prior to my liver resection, and then again for "preventative" measures AFTER my surgery. I can't really say anything that you haven't spelled out. I just simply felt that it was not the right thing to do. I signed up with an Immune Enhancement Clinic, and felt I was much better served there. I just felt that I could not subject my body to chemo for "preventative" reasons.

I wish all of us well through our journeys and know that decisions have to be individual, but what a great site to gain "insight" as to what others feel has worked for them.

tiny one
Posts: 467
Joined: Jan 2009

I had a colonoscopy in January 2007. They found a polyp which could not be removed then. The polyp I'm told was cancerous. I had a resection and a temporary ileostomy. My surgeon advised me that I would need to do chemo and radiation. I knew in my heart that I was cancer free after surgery, but chose to do chemo and radiation. I told myself that the treatment would not keep me from doing the things I liked to do, which was gardening, I kept very active. My side effects were very mild. Don't assume that chemo will be hard on you. I am cancer free for 3 years.

HeartofSoul's picture
Posts: 732
Joined: Dec 2009

One of the most critical aspects of treatments is what occurs after surgery to remove the cancerous tissue and cells. When a surgeon says he "got it all", he means he removed what he could see. The chances of recurrance often lie in the pathology report along with the stage.

I can speak from experience. Here is an exmaple

In Mar 2008 I was dx with non seminoma embryonal cancer and surgery was performed to remove the 6 cm mass and the surrounding tissue. Margins were clear and my surgeon said he got it all. The next month, April 2008, I had a cat scan, full body pet scan and blood tests incl tumor markers and the results showed no evidence of disease.(cancer). I was sent to a med oncologist for a consultation in May 2008 and after reading the reports, scans and data of my cancer, which was in remission, he said he wants to start 4 rds of chemo within 2 weeks. I asked why and suggessted can we not keep close surveilence every incl blood work and scans every 2 months. The Dr replied that due to the aggressivness of the cancer i had and the data in the path report, it could easily recur and metastasize. We both discussed the strategy further and then said becuase i was already on immunosuppressant meds daily for a organ transplant several years ago, he was open to close monitoring of any recurrance. Had i pressed for chemo treatment , he would have started the treatment in a week. This was end of May 2008, in early August 2008, i went back for a cat scan. I had a recurrance of my primary cancer, stage 3, grade 3 and i had tumors in numerous lymph nodes, lungs and was in process of almost reaching the liver.
I was sch for 20+ treatments of chemo over a 2 month period from Sept to Nov 2008 but in the 2nd rd of treatments, i suffered a heart attack from the chemo. weven though I didnt feel the heart attack, I was hospitalized IC for a week and recovered for another 2 weeks, before restarting the same chemo cocktails until i finished in Dec 2008. My concern is with what cancer is not seen than what can be detected via scans. Ive been in remission since Dec 2008

To better understand what your pathology report means, consider asking the following questions of your doctor: (medical oncologist)

•What is the type of cancer, and where did it start?
•How large is the tumor?
•Is the cancer invasive or noninvasive?
•How fast are the cancer cells growing?
•What is the grade of the cancer?
•Has the whole cancer been removed, or is there evidence of remaining cancerous cells at the edges of the sample?
•Are there cancerous cells in the lymph or blood vessels?
•What is the stage of the cancer?
•Does the pathology report specify the tumor characteristics clearly, or should I seek another pathology opinion?
•Do any tests need to be repeated on another sample or in another laboratory?
Obtaining a second opinion

It may be valuable to seek the knowledge and advice of more than one doctor regarding the diagnosis and treatment plan, which is based on the pathology report and the results of other diagnostic tests. This is called a second opinion. If you pursue a second opinion, obtain the pathology report and other medical records to share with the second doctor, but be aware that doctors work closely with their own pathologists and may prefer to have their pathologist's opinion, in addition to the original pathology report. Additional tests can be performed on the biopsy if deemed necessary or if the results of the original report are in question; the tissue specimen is kept for a long time and is available upon request. Learn more about seeking a second opinion.

The report may also contain information about the size, shape, and appearance of a specimen as it looks to the naked eye. This information is known as the gross description.

What information does a pathology report usually include?
The pathology report may include the following information

Gross description: Color, weight, and size of tissue as seen by the naked eye.

Microscopic description: How the sample looks under the microscope and how it compares with normal cells.

Diagnosis: Type of tumor/cancer and grade (how abnormal the cells look under the microscope and how quickly the tumor is likely to grow and spread).

Tumor size: Measured in centimeters.

Tumor margins: There are three possible findings when the biopsy sample is the entire tumor:

Positive margins mean that cancer cells are found at the edge of the material removed.
Negative, not involved, clear, or free margins mean that no cancer cells are found at the outer edge.

Close margins are neither negative nor positive.

Other information: Usually notes about samples that have been sent for other tests or a second opinion.

A pathologist is a doctor who does this examination and writes the pathology report. Pathology reports play an important role in cancer diagnosis and staging (describing the extent of cancer within the body, especially whether it has spread), which helps determine treatment options.

Posts: 3692
Joined: Oct 2009

Wow, you have been through a lot. It is great + inspirational to hear you are in remission after all you have been through.

HeartofSoul's picture
Posts: 732
Joined: Dec 2009

Thank you Anne.

Despite being diagnosed with type 1 diabetes at the age of 20 in 1977, developing hypoglycemic unawareness (loss of ability to detect low blood sugars), numerous seizures and subsequent ambulance rides to ER for recovery, open heart surgery at age 43, 3 attempted pancreas organ transplants with first 2 failing (so i could be insulin indepdendent & not have diabetes), and two cancer diagnoses in 2008, I feel im very lucky in my life.

I was able to live my childhood and teenage years in very good health, build a career as a software engineer for 30 years, marry a woman who has dedicated her love unconditionally, and have the chance to provide support & compassion to help make a difference in the lives of others with diabetes and cancer along the way. The moment I embrace the most is when i became a liver donor when I was younger to another human being so they too can get a second chance

The link below is a song and lyrics I wanted to share

"There But for Fortune Go You and I" Joan Baez


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