Just Been Told

Hi,

2 days ago I went to the hospital for routine tests which included a colonoscopy. Cancer runs in my family but not in my wildiest dreams did I ever think I would have this type of cancer.  I watched my mother through Bone cancer and my mother in law go through leukemia.

I was told I have stage one rectal cancer (3cms) and am scheduled for surgery in 2 weeks to have the tumor removed.  I can't talk to my wife about this (don't ask) nor my sons as they live 9000 kms away from me and don't want to worry them, I will tell them after the surgery nor can I talk to my friends (they would not understand)

I guess what I am trying to ask someone is what am I looking at down the road, after the surgery, 6 months down the road. If you were at this stage and had the surgery I would really like to know how you are doing now as I really need to know what lays down the road for me.

Thanks for your time.

What Kind of cancer is it?  Where is it located? What kind of surgery?

The trend today is for preop Chemoradiation , followed by surgery plus more chemo if nodes are positive.

What Kind of cancer is it? 

From what I know so far they tell me Rectal Cancer.  It is located a couple of inches inside the rectum and is approx. 3cm in diameter.  From what I was told and it was very brief they are going to go in the same way that they gave me the colonosopy and cut the tissue out.  Problem is I live in a Spanish speaking country and unfortunately I only understand the language about 40%.  There was no mention of any preop Chemoradiation, most likely because they say it is still in the early stages.  I have to go back there this coming Tuesday for a quick chat, should I mention this to them?  Is it something that should be done prior to surgery?

Thank you for your time.

Transrectal excision is a new concept and is only for very select individuals.  If they do it and it is muscle invasive then you need post op chemo and radiattion.  The lymphnodes are not sampled , hence a transrectal ultrasound and even a PET may be indicated.  The ones I have seen are adeno ca arising in a villous adenoma , they resected it and found muscle invasion.  They gave the patient a choice of APR , post op rads / chemo or observation.  The obvious risk is are they leaving positive lymphnodes behind?  If it is anything other than a thin, non muscle invading tumor you are taking a risk or may have to have major surgery anyway.

You need a second opinion with physicians where there is no communication problems.  How can they give informed consent??

On 7/13/2007 crman wrote:

Hi,

2 days ago I went to the hospital for routine tests which included a colonoscopy. Cancer runs in my family but not in my wildiest dreams did I ever think I would have this type of cancer.  I watched my mother through Bone cancer and my mother in law go through leukemia.

I was told I have stage one rectal cancer (3cms) and am scheduled for surgery in 2 weeks to have the tumor removed.  I can't talk to my wife about this (don't ask) nor my sons as they live 9000 kms away from me and don't want to worry them, I will tell them after the surgery nor can I talk to my friends (they would not understand)

I guess what I am trying to ask someone is what am I looking at down the road, after the surgery, 6 months down the road. If you were at this stage and had the surgery I would really like to know how you are doing now as I really need to know what lays down the road for me.

Thanks for your time.

 I would go to the best cancer hospital that Spanish country has especially if there is a communication breakdown.  Any chance you can go state side and get checked?

I am probably too late in getting to you as I just read your post.  I also had a transanal excision, and no, this procedure is not new.  As a stage I, a transanal excision is an acceptable method of surgery and the one with the least amount of problems afterwards.  As for the radiation, usually it is not offered to stage I patients.  The risks involved do not justify it for stage I -at least that is how the medical community views it.

 The other author was correct in that no lymph nodes are taken during this surgery (I had this surgery a few months ago-little different story though) so that complete true pathological staging can be done.  However, statistics show that 95% of all stage I tumors do NOT affect the lymph nodes.  That is a risk you will have to take if you want this surgery.  Otherwise, you are looking at radical surgery that will take the nodes, but you will also have many more problems afterwards.  Here are the criteria which I would want to know about.

 Usually, transanal excisions are reserved for:

tumors up to 3 cm (the smaller the better),  stage I,  nothing over 30% of the circumfrence (that is an important factor and I would ask) and that the tumor is well to moderately well differentiated.  This you should know from the biopsy at your colonoscopy. 

A Dr, David Medich at Alleghany Hospital (Pittsburgh or Philly-always get them mixed up) has been doing transanal excisions with excellent results now for over a decade.  He also uses this technique for downstaged Stage II tumors (also no lymph node involvement on CT).  You might want to see if you are having a simple transanal excision or transanal microscopic surgery (TEM-don't confuse it with TME-total mesorectal excision).  The difference is that if your tumor is located fairly close to the anus, the surgeon is able to go in with a simple transanal excision (through your rectum-no incision) and get the tumor out, but if the tumor is higher than 8cm up, they still go in the same way but they are able to see the surgical field on a screen-similar to laproscopic surgery.  This enables the surgeon to have more success. 

As I said earlier, stage I patients are rarely offered the chemoradiation. If you can talk anyone into it, I would HIGHLY recommend it first.  That way, you can see how the tumor responds to treatment and ideally, it will shrink the tumor and sterilize the mesorectal area that contains the lymph nodes.  Most tumors respond by at least 50% and about 25-30% respond completely.  Whatever response you get, it only helps to make the transanl excision more successful.

You also need to know that you will be followed up VERY closely after this surgery.  I am having scopes (not colonoscopies-just little office scopes-not painful-embarrassing maybe but only last a few minutes) every three months for the first 2 years, then every 6 months for the next 3 years.  However, I was staged originally as a stage IIA (later my surgeon said really Stage IA), had the chemoradiation, 6 more cycles of chemo and then restaged to a definitive early, stage I.  The problem with staging after chemoradiation is that the ultrasound cannot distinguish between scar tissue and tumor.  So, when I had my excision, I was actually a ypT0 meaning no tumor was left.  Make sure (I am sure that they will do this-just make sure) that they are doing a full thickness excision with a good 1-2 cm margin.  You MUST have a full thickness excision to make sure that you have gotten ALL of the tumor and so that the pathologist can adequately assess the tumor depth.  You also need to know that usually if they cannot get good margins, they will most probably recommend radical surgery. 

I would also highly recommend chemotherapy or chemoradiation after the surgery to address any lymph nodes.  I did not have any after my surgery because I did the usual 6 courses & the radiation BEFORE my surgery.  However, with you, even if the tumor was classified as a T1orT2 and good margins were achieved, I would do the standard 6 cycles of chemo just to be on the same side.  That is the standard for someone who even comes out of radical surgery with 1 positive lymph node.  You don't have to take the infused type-ask for the oral 5FU-Xeloda which studies have shown is just as effective and even slightly more effective than infused.  Side effects are less than with infused but you do take it for 14 days on with 7 days off.

Hopefully you will get this before any surgery but even if you have had the local excision, please consult an oncologist and push for the extra chemo.  It may seem like a lot to go for 6 months, but better that than have a recurrence down the road.  If you are truly a stage I, your chances are good for no lymph node involvement, but it also depends on your T stage.  Ask questions, trust your gut and see about chemo.

I am doing wonderfully after my excision.  No pain, no problems, etc.  No, it doesn't hurt afterwards to go to the bathroom!

Hope this helps