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Looking for input surgery v chemo??

Lori-S's picture
Posts: 1287
Joined: Sep 2010

i'm seeing both my onc and the surgeon tomorrow and I I'd like some input or opinions from the family.

I'm really leaning towards getting surgery and then restarting chemo as opposed to restarting chemo and waiting for surgery. My last chemo was Jan. 31. Am I correct in that it is recommended that surgery be 4 to 6 weeks after chemo? And restarting chemo should be 4 to 6 weeks after surgery? given that it would be maybe 12 weeks/3months of no chemo. I most likely will be put on FOLFIRI w/Avstin or maybe Xeloda w/Avastin. That is still up in the air.

Since I now have a new growth in my colon and spots on my lungs do you think that it would be too determinal to wait that long before having chemo again?

Having the surgery will be a reversal/reconnect of my end colostomy, hernia repair, adhesion removals and a good look see at what is going on since I can't have contrast dye with my CTs.

I am waiting to be scheduled for the colonoscopy to take a better look at the new growth in the colon. We don't know what is going on with the liver because of lack of contrast dye and my onc would feel better about that after having the look during surgery.

I am just concerned about such a long time before starting chemo because we know that my cancer is a fast growing, aggressive cancer. Remember that my cancer was growing even with the FOLFOX. What do you all think about waiting that long to start chemo under the circumstances?

Thanks for your input.

herdizziness's picture
Posts: 3642
Joined: Apr 2010

From what I understand, the chemo that stops is the Avastin. I was still doing my Xeloda until 2 weeks before surgery. Started the Avastin and Xeloda back up, 4 weeks after surgery. I'd think, on my part, I'd do the chemo with the Avastin if things weren't slowing down in growth for awhile first, waiting on the surgery.
I'm really too new at this to have an good opinion to give you though.
Will be thinking of you and a prayer or two your way along with some good vibes and hugs thrown in to boot!!
Winter Marie

Lori-S's picture
Posts: 1287
Joined: Sep 2010

I luff ya girl!

One of the reasons for wanting the surgery first .... besides just being tired of the colostomy ... is dealing with the blockages from the adhesisions and hernias is really getting tricky. I don't want to go through the misery that I had with the last obstruction.

I'm still weighing it all out though. There is a part of me that is a bit afraid to delay the chemo for an extended period right now with all that is going on. That's why I figured I'd get some input.... to help me weigh these things out.

HUGS to you my little collegiate!

impactzone's picture
Posts: 531
Joined: Aug 2006

You can always do chemo. Surgery may be limited depending on health and anything else that shows up. I would lean toward the surgery but that would be me. Is putting in a pump in the liver an option? There is a procedure that directly gives the chemo to that organ. I forget what that pocedure is called. Good luck

okthen's picture
Posts: 232
Joined: Jun 2010

Hi Lori....I have no input for you, but just hadn't had a chance to post much and wanted you to know that you and your son have been in my prayers.
And will continue to be, of course!

Lori-S's picture
Posts: 1287
Joined: Sep 2010

Been thinking of you. How the heck have you been doing? You and that royal crown are missed. HUGS

Buckwirth's picture
Posts: 1272
Joined: Jun 2010

Chemo first. If the surgery was to remove a tumor I might respond differently, but surgery can have issues that further delay the chemo.

Of course I have zilch medical training, and in your shoes would go with my oncologist's recommendation.

Whatever you decide, I hope all goes well!

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KathiM's picture
Posts: 8077
Joined: Aug 2005

before my surgery. It seems many of the drugs used in chemotherapy retard healing...so they need to wait until the worst is out of your system...

my last chemo was January, May was my surgery, but that length was because it wasn't sure whether surgery was necessary....the same tough position as you, I was given a choice!

Dutch hugs, Kathi

PhillieG's picture
Posts: 4885
Joined: May 2005

I did chemo first way back when it all started. I'm glad I did. My first "onc" wanted to do the opposite. I got a second opinion at Sloan K and my onc there felt very strongly about doing chemo first to shrink the tumors, then operate. My situation was different than yours but I did do FOLFOX with Avastin and it did the trick.
good luck

maglets's picture
Posts: 2589
Joined: Jun 2006

who wants to make these decisions???/

for what it is worth I have always had surgery first.....3 times and chemo to follow...

good luck Lor


Sundanceh's picture
Posts: 4408
Joined: Jun 2009


Such a quandry to be in:(

I'm leaning with Kathi here - I'm due for a surgery now myself, but the consensus is to wait 6-8 weeks after chemo is finished before attempting the surgery. The explanation to me was that our bloodwork gets all messed up during treatments and surgery can cause issues when chemo is involved. I'll have to wait until treatment is over before I can schedule the procedure.

Unless, you are in dire emergency, they want to postpone surgeries while in treatment.

I've always leaned towards surgery - just feel that attacking the problem physically beats doing the chemical poisoning; I'm just about done with Cyotoxins, they are hurting me worse than the disease.

Wish I had an absolute answer for you, but as I've always said there is ABSOLUTE ANSWER for Cancer.

Of course, whatever way that you feel comfortable will be the answer, in accordance with your medical team, of course.

I do hope things get better for you, a break is definitely being ordered for you:)


abrub's picture
Posts: 2094
Joined: Mar 2010

The current feeling at MSK is that at least for Stage 4, unless there is pressing reason (obstructions or threats thereof count) chemo should be the primary attack method: http://www.medscape.com/viewarticle/703644

However, you have to do what makes you most comfortable, after you've discussed all pros and cons with your drs.

JoyceSteele's picture
Posts: 146
Joined: Nov 2010

Hi Lori:

This is what I have always been told by MD, oncologist and surgeon at Mayo as well in answer to your questions below.
My last chemo was Jan. 31. Am I correct in that it is recommended that surgery be 4 to 6 weeks after chemo? And restarting chemo should be 4 to 6 weeks after surgery?
JS> It is almost mandatory for elective surgery that you wait 6 weeks after your last Avastin treatment. As far as starting chemo AFTER surgery, I am not sure if it makes a difference what the chemo is, or not. I am having a resection in a few weeks, because it will be only one lobe and then the 2nd one later, I will be on chemo immediately following the surgery.. they call it a "baseline" chemo while I heal to keep the remaining liver tumors from growing. There is no waiting time.

Even my dentist refused to do work when I was on Avastin because as others have said, it prevents wounds from healing, can cause serious bleeding. I had to wait a few extra days for the incision for my port was completely healed to start Avastin, my onc told me if it did not heal then it never would. Yikes.

I have been off Avastin for 5 weeks for the first time in 15 mos, so I can have the liver resections. Whatever you decide, best wishes, hugs and prayers coming your way. Joyce

plh4gail's picture
Posts: 1238
Joined: Oct 2010

My friend and buddy...I am way too new for any advice. I only want to tell you I started my folfox 4 weeks after my reversal.

Any chance they will remove the tumor while they are in there?

Love, hugs, and thinking of you!


Lori-S's picture
Posts: 1287
Joined: Sep 2010

It is greatly appreciated. Like most of us I'm sure, I always like to have as much information as possible before making important decisions.

Gail, I will talk to the surgeon tomorrow and ask a lot of questions. The new tumor appears to be sitting at almost the site where the old tumor that was taken out of my small bowel. I'm sure that while the reversal, hernia repair, adhesions are being taken care of that removal of the new tumor would also be on the table .... literally???? haha.

Yes, I have already been hospitalized with obstruction and managing the adhesions and hernias are getting trickier and tricker. I do have pain and sometimes can't eat at all just because I have to wait for things to clear certain areas or I will just throw up whatever I put in. It's literally become a real pain and now my colotomy bags aren't getting more than a couple of days use because they can't fit right due to the ever changing size and position of the main perastomal hernia. Some days it gets close to feeling like I'm going to end up in the ER again with an obstruction. It's just such a mess.

I will ask the onc tomorrow about the possibility of starting the new chemo w/o Avastin and if it can be done that way right after surgery. Thanks for that input,I didn't even think of that posibility. I would feel better about having the surgery if that could be done and not having to wait as long to start back on chemo. The onc has said that we are looking at FOLFIRI w/Avastin or Xeloda w/Avastin. Seems like it might be possible to do either of those 2 without Avastin to start and then just add it on later after healed from surgery.

Again, thanks everyone for your input

thxmiker's picture
Posts: 1282
Joined: Oct 2010

Surgery gets rid of the tumors. When my surgeries they went in for a specific tumor and found additional tumors that also got removed. Then Chemo to follow. Chemo before surgery is to reduce the size of the tumors before surgery.

The resection of the colon is dependent upon one's surgery. i have had it done twice. The first time took me four months before I was good to get out of th house on my own. The second time I was out and about before a month was up. What is the average down time for your surgeries. We had doctors tell us what the average is for all surgeries of this type. When we asked what is their experience, they would not give us a straight answer. We went with a surgeon that would give us straight answers.

Best Always, mike

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