On 10/15/2007 mikk5 wrote:
My husband has stage 3 rectal cancer with three nodes involved near the tumor. He has completed 6 weeks of xeloda (Oral 5 FU), radiation and avastin treatments. He will have surgery in 6 weeks. We want to know how neccessary the post surgery chemo is. How much does it affect recurrence? Does anyone have any information on this?
Hello,
I am certainly no expert, but the chemo after radiation is really for a good reason. First of all, neoadjuvant chemoradiation (what you are doing now) has been shown to cut the rate of local recurrence in half. That and the fact that most tumors respond well to the radiation & help in sphinter saving surgeries makes the neoadjuvant radiation a very good therapy. Since your husband has three nodes involved (and this is only known by PET/CT scans at this time) I would HIGHLY suggest having adjuvant therapy. The fact that even one node is involved means that the cancer has already "broken free" so to speak from the original tumor and has/is circulating in his body. The PET/CT scans can only tell you whether or not there are lymph nodes or spots on other organs after they reach a certain size. In other words, there could very well be microscopic amounts of cancer cells in your husband's body that have settled in other places but are not yet big enough to be seen on the PET/CT scans.
The chemoradiation, while excellent, only totally eradicates the tumor and all cancer cells in the field in approximately 25% of all cases. The remainder, while usually having a good response, will still show viable cancer cells after surgery.
The fact is that only 40% of all stage III cancers are "cured" by surgery alone. This is due to the fact that microscopic cancer cells are still out there in other areas of the body. These cells have a better chance at being erradicated if they are caught early. That is why the standard treatment is to have adjuvant therapy after surgery. No, it isn't all that much fun, but it's not that horrible either. Here is a link to an article which might give you some more insight.
http://www.clickonium.com/colorectal-cancer.net/html/stage3r
Remember that the chemoradiation that your husband just had, only really affects the cancer cells in the field of radiation, not in other places in his body. So, if there are cancer cells floating around his liver, the radiation would not have affected those. Please don't dismiss the adjuvant chemo. It will greatly impact his survival.
Jaynee