rectal cancer surgery

luna5311
luna5311 Member Posts: 1
in Colorectal Cancer #1
Female (middle aged)--- Stage IIA Colorectal cancer – T3 (tumor presented at 11 cm up), N0, M0, Grade G2, moderately differentiated adenocarcinoma

Completed 28 days of chemo-radiation - have had no side effects & bowels are functioning normally

First, my surgeon is recommending Total mesorectal excision (TME)and surgical removal of entire rectum (& maybe construct a J-pouch)for tumor 11 cm up. Based on my individual case, which is borderline mid/upper, is it reasonable to have a Partial Mesorectal Excision (PME) or is a TME always done? In my case, if a TME is warranted, does this mean that the entire rectum needs to be removed? Anyone have a similar case?

Second, I know the temporary ileostomy is usually done on patients who have had neo-adjuvant chemo-radiation therapy but did anyone not have a temporary ileostomy in mid/upper (11cm) rectal cancer.

I would like to balance the issues of recurrence, recovery and quality of life/future functionality & appreciate hearing other people’s experiences. Thank you!

Comments

  • PGLGreg
    PGLGreg Member Posts: 731
    #2
    It sounds like you're doing
    It sounds like you're doing well and have good prospects. I have no idea at all about the PME/TME choice. But here is a consideration that may not have come up: your surgeon might not know exactly where your tumor is. I was diagnosed by colonoscopy with a tumor 17cm up from the anus (thus not clearly rectal), but my surgeon told me before surgery that these estimates can be way off. And indeed, at surgery time, my tumor turned out to be only 5cm up from the anus, and thus clearly rectal.

    My surgeon also told me before the operation that he didn't know just what he'd be doing until he had me opened up and could take a look. A colostomy was possible, but he'd avoid it if he could, and he'd leave me some rectum if possible, but no guarantee. Luckily, he decided I didn't need an ostomy and he could leave me some rectum.

    So, I think you should not expect your surgeon to commit himself 100% to one course of action, previous to the operation.

    --Greg
  • pete43lost_at_sea
    pete43lost_at_sea Member Posts: 3,900 Member
    #3
    ask me about quality of life next week and next month
    getting the ileostomy bag off Friday, I am so not going to miss it.

    had surgery 10 2010 and six months chemo.

    I got three surgical opinions, my tumour was 6 cm in and I was very lucky to keep my butt.

    But I still got it, and now I have to learn how to use it.

    Your surgeon sounds honest. Maybe a second opinion may help.

    Its a big decision, TME is a pretty good surgical technique.

    Recurrence I have heard has to do with the qualityt of the surgeon, you don't want him spilling any tumour cells all around your open gut. I surgeon quality is a critical factor.

    Find the best surgeons you have access to and that you can afford. That the best any of us can do.

    I also had preop chemoradition so I presume your tumour is a reasonable size, I was T3/4 N1 M0.

    goodluck,

    Pete
  • Fight for my love
    Fight for my love Member Posts: 1,522 Member
    #4
    Hi,my husband was diagnosed
    Hi,my husband was diagnosed with stage2a rectal cancer in May,2009.He had properative chemo and radition,surgery and adjuvant chemo.He finished all the treatments in April,2010.My husband's case was the tumor located very low,very closed to anus.So the surgeon took out the whole rectum,my husband ended up with a permanent colostomy.

    My husband used to hate the colostomy,but he is getting better with it because he accepted he has to live with it.The colostomy is functioning relatively well for him.The only problem he is having now is the hernia.Many people with a colostomy develop hernia easily.But other than that,my husband is doing good.

    Hope for the best for you.
  • KathiM
    KathiM Member Posts: 8,028 Member
    #5
    I was staged 3, because of the lymph nodes....
    But, it was squamous cell, so VERY radiation sensitive. Mine was lower...in the first rectal fold....

    A sigmoidoscopy after pre-surgical chemo/rads showed a complete response. But then, my (truly) world-famous gastric surgeon called from a conference he was attending. He said he had held a tumor board with all of his peer/collegues and, based on my age, and life expectancy, they recomended going forward with the J-pouch. He did leave the decision to me, tho...just said 'it depends on if you mentally can deal with the uncertainty or not'....

    I am not a gambler, so I went ahead with the surgery. I had all but a small section of rectum removed, my sig colon also removed, and a pouch made from descending colon. I was kind to my body, and it took a good year at least to 'retrain' things to behave. 6 months after the surgery, I was in treatment for primary-site breast cancer....

    Now, 6 years after surgery...I am living well. I still need to be careful with some foods...popcorn is out for me. But I don't know that all of these would not still had happened without the surgery...the rads left my left hip disabled, and I am lactose intollerant, where I wasn't before this time.

    If you believe in your surgeon, listen to him. I said (because this was not a usual case) "If this was your wife, what would you do?"....he answered honestly.

    Hugs, Kathi
  • plh4gail
    plh4gail Member Posts: 1,238 Member
    #6
    Hello
    Hi I am a stage 3c diagnosed last june, my tumor was 5cm and circumfirential and 6 cm up, I had 6/12 lymphnodes positive at surgery . I went through the chemo/radiation in July/August. I had my resection in October with a temporary loop iliostomy. I had my resection in november because the iliostomy wasn't working the way it was intended. Now I am finishing up my 12 chemo treatments. For my surgery I had a laparoscopic lower anterior resection.

    I had a lot of side effects from the radiation and chemo and had to wait 6 weeks before surgery. It sounds like you are doing great! Good luck with your upcoming surgery and ask away with questions, someone usually had some answers.

    Gail

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