. Just got back from having a flexible Sigmoid by the surgeon who will do my bowel resection for a cancerous polyp (it is very flat) on Friday, he likes to do his own scope and also tatoos the area. When the GI did the colonoscopy she thought the site was 20 cm from the rectum, he says it is more like 10 cm. This creates a bit of a challenge for him. If it was lower one type of procedure is clear, if it was higher another is clear. If he takes too much toward the rectum a danger of incontinence or problems with urgency occur. If he doesn't take enough and the pathology is invasive then that creates problems. Right now it looks non invasive insitue but they of course can't be 100% sure by looks. He says he is part of a study group of surgeons and the head one specializes in what is going on with me and he is going to confer with him and I am to call tomorrow to find out what the score is.

I was wondering if anyone else has had this situation and how it was handled.

Moondoggy

Moondoggy,
It IS common for surgeons to meet with their colleagues to see how likely it is that the procedure will be a success, whether you should do radiation first (which is the norm for rectal ca) to shrink the tumor and allow greater room for the surgeon to operate. 10mm is still sufficient to resect and reattach, causing you to NOT have a permanently colostomy. You WILL MOST LIKELY have a temporary ileostomy to divert stool and allow the resection and connection to heal, before permitting stool to enter that area. There ARE different approaches to give you a new larger "storage bin" by brining down more colon and create what's known as a "J-Pouch.)

It IS true that you will most likely have problems with urgency, etc. This will most likely happen, regardless of WHERE the transection and re-connection, although there are individual variances, and differences from patient to patient.

I wish you the BEST of luck. Please feel free to ask as many questions as necessary, and use the knowledge and support of the people on this Board. It TRULY is a help. :)

Questions for you... What stage are they putting you at now? What is the histology of the tumor-- poorly differentiated, moderately differentiated, and well differentiated-- going from most aggressive to least. (This info is found on the pathology report from the biopsy that should have been done during your colonoscopy... By the way, I am assuming it is an Adenocarcinoma, is this correct?) Also, you should have had a Trans-Rectal Ultrasound to help Stage the tumor. Did any nodes show up? Did you have a PET scan-- if not, why not? (this test will show whether you have spread or mets of the tumor). If you did have a PET scan, what did it reveal?

Sorry for all the questions. I know your head is probably spinning at this point. But, being an advanced rectal cancer survivor, I am familiar and we can best help you when we have all information.

Good Luck. I look forward to hearing from you. :)

Warm Regards,
CancerDad :angel:

PS. You can read through older posts. Mine specifically will many times talk about rectal cancer and its treatment.

Cancer Dad
I do not have the answers to those questions. I have had no scans only flex sigmoids and colonoscopy. A little background.. a large adenomatous polyp was found by sigmoid in June, biopsy said precancerous. Finally got a colonoscopy in September where the GI said it was a bit large and flat to be removed by colonoscopy and took some more samples. She was surprised to find there were cancer cells. In her diagram of the polyp she drew little dots here and there for those cells. I was referred to a surgeon with a very good reputation. He did his own sigmoid today. He feels as did the GI that it is likely non invasive and insitu He was glad he did the scope as he would have been under the impression that it was 20cm not 10 cm from the rectum. I have to call him tomorrow to see if his consult means any changes in his approach. I am due for surgery on the day after tomorrow, Friday. I will ask some of your questions. I am a person of very high anxiety levels. I worry about everything and everybody, always over analyzing, so I am shaking right now. On the other hand if I hadn't been pushy about several months of the Dr. telling me it was just hemorroids I could have been in even more trouble. Does everyone feel so overwhelmingly frightened of surgery, anasthetic, results etc. ?

Moondoggy

I know its hard but being able to have surgery is a good thing. After starting the chemo, I now look forward to stopping it for surgery. No one wants that surgery done but the time will pass quickly after recovery and you can be sure that the area is cancer free.
God Bless you,
Impactzone

MoonDoggy:
I posted an EXTREMELY LONG post and something happened and it did not post. In my post I basically said that IF I were told that I had a "pre-cancerous polyp," then there is NO WAY that I would be having surgery without first having a PET scan to determine whether there is any spread, and a TRUS (Trans Rectal Ultra Sound) to determine the depth of the lesion in the wall of the rectum, not to mention CT scans to look for lymph nodes, and a CEA bloodtest.

There are two procedures that can be done... the least invasive being a TAE or TRE (Trans Anal Excision or Trans Rectal Excision). In this technique, the colorectal surgeon operates THROUGH your anus to remove the tumor with a one inch circumferential margin, and then stitch up the rectum... that's it! It is for Stage 1 and 2 colorectal patients if you have radiation in stage 2. You have been told, however, that you have a "pre-cancerous polyp," NOT a colorectal cancer. Make sure to choose a colorectal surgeon who does this procedure... otherwise most like to cut you open unnecessarily. Most colorectal surgeons are also not aware of the new data that shows NO difference statistically for a stage 1 who has a TAE vs. traditional abdominal. Even Stage 2 works out to be comparable to the very invasive abdominal incision method, because radiation is given which puts you at the exact survival rates as the more invasive technique.

A crude analogy would be to remove your rectum and give you a permanent colostomy because you have a pimple on your buttocks. I don't mean to sound harsh, but, a surgeon who is TRULY CONCERNED ABOUT YOU will NOT operate on you, giving you a MAJOR ABDOMINAL PROCEDURE cutting into your belly, without first staging the "cancer" if it is, or if it is just a "pre-cancerous polyp-- VERY DIFFERENT. You NEED TO BE STAGED, YOU NEED TO HAVE A PET SCAN TO MAKE CERTAIN YOU DO NOT HAVE SPREAD OR METS. You also MUST HAVE A TRUS (Trans Rectal Ultrasound) which lets the surgeon know what layers of the wall of the colon the "cancer" (if that's what it is) has invaded to aid in Staging. The error in placement of the "polyp" is a HUGE mistake. MOST people with rectal cancer have chemoradiation first to shrink the tumor and give the surgeon more room to work, and also to kill any stray cancer cells which could be disturbed and re-root elsewhere.

YOU MUST HAVE A PET SCAN to determine the extent of any spread or mets prior to ANY surgery, and a TRUS (Trans Rectal Ultrasound) which determines the depth of the lesion/polyp. In addition, a colorectal surgeon would probably want a CT of your pelvis and abdomen and chest to see if there are any inflamed lymphnodes indicating possible spread to the lymph system. Any Surgeon who will operate on you without having this data available is NOT CONCERNED about your well-being. You literally could be having major surgery that is COMPLETELY unnecessary, or that COULD be done a non-invasive way.

I mentioned two procedures... the second is VERY INVASIVE... involves a full belly incision from your navel or just above, through or around and down to an inch into your pubis...about 1 inch into your pubic hair. Then, it is VERY possible that you may end up with a permanent colostomy, which if you NEED, is not that bad. I have one, but I had ADVANCED COLORECTAL CANCER. You have a PRE-CANCEROUS POLYP.

Personally, there is NO WAY I would proceed with the surgery, and I am appalled that they scheduled it in the first place without having all the necessary data.. First of all you need the following pre-surgical in addition to atleast 2 consults with colorectal surgeons who perform the TAE or TRE procedure... run a search, you will find someone. You also need a TRUS... the colorectal surgeon can do this for you, a PET SCAN to determine possible mets, a CT scan of your pelvis and abdomen and chest will show whether you have inflamed lymphnodes which will all help with staging.

Truly, the reason why you are probably so nervous is because deep down you KNOW that they should not be coming NEAR YOU WITH A SCAPEL until you have gotten this other testing and had the opportunity to make an INFORMED DECISION. BY the way, MOST colorectal cancers are slow gtowing enough that you are causing NO additional harm by waiting until you have had the tests, been properly staged and informed of your options. Most people hear the "C" word and get frightened (rightly so), but you need to know the histology of your "cancer" among other things... staging, other approaches, etc

Remember, the choice is YOURS, and we are all here for you no matter what your decision to support, lend our experience, knowledge, etc.

Best of luck, and please keep us posted.:)

Fondly,
CancerDad :angel:

Just want to echo what CD said...You should DEFINITELY have the Transanal Ultasound as well as a CT scan at a minimum. Also, research indicates (google rectal cancer and you will find studies to back this up) that having radiation BEFORE surgery dramatically reduces recurrence rates in rectal cancer. In fact I just read a new study about this last night that says that it will decrease recurrence rates to as little as 1%. I would ask to speak to an oncologist and/or radiation oncologist before going through with the surgery. Unless you are blocked and unable to poop, then there is no reason to jump in to surgery in just a couple of days. Please make sure you have a board certified colorectal surgeon do this surgery. It will make a big difference in your post surgical happiness.


Please print out CD's post and call your surgeon...take a breath...do some reading up online...this is a HUGE, life changing surgery! While it is an absolutely necessary surgery if you have a malignant tumor, there ARE some things you can do prior to it to get the most "bang for your buck"...

Good luck and please keep us posted.
Cats

I will be talking with the surgeon today. I have been told the polyp is cancerous. The initial biopsy showed precancerous but the second one showed cancer.

Moondoggy

I will be talking with the surgeon today. I have been told the polyp is cancerous. The initial biopsy showed precancerous but the second one showed cancer.

Moondoggy

Hi:
I KNOW your head must be spinning... for me, I just went numb. In any event, IT IS necessary for you to get a PET scan, CT scan, and Trans Rectal Ultra Sound to Stage the cancer.

Like I said there are two VERY different procedures that can be done based on the results of your Staging. If you are Stage 1 or 2, you DO have the option of a MUCH less invasive procedure which I would encourage you to look into.

Often times we hear the word "Cancer" and freak out and just want it out and gone. And then many times, the physicians act the same way. But you HAVE to remember that with colorectal cancer, especially rectal cancer, there are DIFFERENT protocols... chemoradiation prior to surgery with rectal cancer is STANDARD PROCEDURE. Also, you REALLY need to know from the biopsy what the Pathologist saw and wrote the report in terms of histolgy-- specifically differentiation... as I said Poorly differentiated grows quicker and more aggressively than does Highly differentiated.

I wish you the BEST of luck. Please feel free to lean on us with questions or for support. :)

Warm Regards,
CancerDad:angel:

Just want to say that I agree with what Cancer Dad has told you - it seems like they should be getting more info, and they are not, prior to deciding which path to take. CD is absolutely right about PET and CT scans.

And chemo/radiation is the standard pre-surgical treatment for rectal cancer. Rectal cancer has a higher local recurrence rate than colon cancer, and this presurgical treatment cuts that risk down notably.

Just my 2 cents !

Jeni