I was diagnosed with stage II T3 colon cancer, went to the oncologist for follow up after surgery yesterday and he basically said I'm in a gray area, and this is a tough decision that me and my family will have to make. Here's the good news:
Clear margins, no lymph node involvement (31 lymph nodes biopsed, all cancer free), no blood vessels involvement in the area, no obstruction, no perforation, no spread outside of the muscle wall in the colon. He also said the tumor was moderately aggressive, but closer to the less aggressive side. He said if I decide to have chemo, just to be as aggressive as possible (as i'm only 30) he would support me totally. and it would be a 6 month course (12 treatments total with 5-FU, Oxaliplatin, and I think Leucovorin.
I just don't want anything to go unmissed, but it seems as chemo might be a whole lot of overkill in my particular case. Anybody out there had stage II and had this plight of deciding to have chemo or not? Thanks all, I'm just a tad bit neurotic these days
I understand completely what you are going through, we went through that with my dad. My dad had stage III rectal cancer and after the surgery, he was also cancer free, meaning no cancer on lymphms. But we decided to go through the 16 weeks of chemo and he had his second surgery last month on 16th and he is doing great. The chemo was not bad, he only felt a bit tired Friday every week when he is going to hospital for the chemo. You are only go 12 weeks, not too bad and like u said, u have gone through this far, do not miss anything (b/c some cancer cells can be formed later), get rid of all possiblities when u can.
This is going to be a tough decision for you to make. It does seem that they like to give some chemo to make sure there are not any miniscule cancer cells floating around. To give oxaliplatin for Stage 11 does seem overkill to me but it will be interesting to see what others think on that one.
I am so glad your cancer was dx quite early and that you have a great chance of compete recovery.
Keep us updated,
Husband dx July 2003, advanced rectal cancer stage 111C; myself dx July 2006 indolent lymphoma; husband dx February 2010, stage 2 prostate cancer.
My father~~s cancer was stage 2 in 2003.He also had different opinions to do chemo or not.He was very exosted after the surgery.I read arguments of different oncologists( I wish I was aloud to put site refference).Statistics says after stage 2 80% of patients recover any way-with chemo or without.
20% of people have cancer spread if they don~~t have chemo.But 18% have it spread even after chemo.So the advantage is only 2%.That applyes only on stage 2 cases,for others there is usually no questions to chemo or not.
My father didn~t have chemo 2 years ago.Now he is stage 4.He had 9 cycles of 5 FU,leucovarin,oxaliplatin and Avastin.Last ct scan was normal.
He is on Avastin now.
Now 2 years after the surgery he is still sure he wouldn~~t do chemo for 2 % advantage.
I wish you luck and be in 80% of thouse who recover
I was diagnosed with stage 2 but with a + included.. I perforated before they could take the mass out.. so yeah Ive been doing chemo for the past 2122 weeks with only 4 left to go!! Tho im only on FA and 5fu. I guess for me, I would do the chemo just to give you that extra chance.. Anyway the decision is up to you, goodluck with any way you choose to go..
I think I agree with the poster that says about the 2% benefit. Really, there is NO ASSURANCE that the cancer will not come back whether you do or don't do chemo. If I were you, I would consider the path report... you had 31!!! Negative lymph nodes. Meaning your chances that it began to spread are VERY SLIM. Is there a chance there? Sure. Is there a chance you could get in a car accident, or have a tree fall on you... yes on both counts.
This is an individual choice, and since you are only considering 5FU/Leucovorin, that's NOT a strong chemo regimen. So you could play the scenario either way. It's a tough decision. I would be ecstatic, personally, with your results, and would probably chance it and track it very closely. If you have ANY sign... you can do the chemo then. I am 33, started bleeding at 28... similar story, but I had no choice of more chemo with so many positive nodes. If I had the choice, I would NOT subject myself or my family to that. But, as I say, it's an individual decision. I think your oncologist is being extra careful, and covering his butt by presenting you all options.
I could have sworn I responded to this thread once already but it isn't here. ???
I also had clear margins, no lymph involvement, no mets and tumour confined to one , defined location. The docs told me that it was a toss up as to whether or not to do chemo or not or chemo plus radiation. In the end they wanted to go for both and i agreed.
As explained to me there was a 90% chance that the surgery cured me, the chemo would reduce that 10% by more than half to around 4% chance or reoccurance and that the radiation would half that again. So I went from a 10% chance of reoccurance to 2% or less. (statistically speaking of course)
For some people that would be just too confusing but math has always been a forte of mine.
It's true that in your case it becomes a personal choice. In a way that's a tough position to be in. When it is a clear cut path..possible spread...than the decision is a no brainer. Here is the question to ask yourself....Will I regret not doing the chemo if at some point it comes back? I know it's a no brainer if it does come back..you'll probably think hey... I should have. But..will the peace of mind, knowing that you did whatever you could do be worth the chemo now? If you think it will give you that extra confidence that you got it all and any remote chances of that straggler out there will be gone..than go for it. don't underestimate that peace of mind. Trying to sleep late at night always wondering is just a plain "pita"...sleep well.
Once again, I will chime in... I have already stated my position that it's a personal choice, and I wouldn't do it. I'd like to respond specifically to Maria that it "can't hurt." Let me tell you, the long lasting effects from radiation are enormous... it literally burns your tissue, like being put in a microwave oven. (I realize Sammy is considering Chemo). Same goes for the chemotherapy. Many people react differently to it, but for the most part, you DO suffer, as it kills GOOD cells as well as those nasty stragllers. You have to keep in mind that your body has irregular cells all the time... usually, our immune systems are capable of handling it. But Chemo, for almost all, DOES have effects... you are putting a poison in your body.
Some oncologists would not even offer you the chemo, Sammy. Why don't you make this decision easier on yourself and say "ok, I'm going to get 2 more professional opinions." And get referrals to Lahey and Dana Farber, both in Boston, and see what they have to say. Lahey clinic is specifically known, as is Henaman (spelling???) and Cleveland Clinic as one of the three I mentioned as being the tops in colorectal treatment. I would suggest other bigger cancer centers, which are great for ALL kinds of cancer like Farber, but due to your proximity and the fact that you have one well known cancer center and one well known colorectal cancer center, I think it will do....
CD I disagree with you on the Chemo side of it.. Sure dont do the radiation if its not necessary but if it were me, I would do the chemo. Like u said, it isnt even a strong dose... (like me)... Mine wasnt a strong does.. (5fu/fa) ..and so she wouldnt get alot of the bad side effects.. Up to you tho.. Only you know whats happening to your body.
Goodluck and take time to smell the roses.
There will be those that agree and disagree. This is why I say it's an individual choice. But, like I said... with all the negatives you got Sammy, there is NO GUARANTEE that the chemo will do ANYTHING one way or another. Maz, in your case, you had a perf, which put you in another category altogether which definitely warranted chemo in my opinion. But getting the opinions of two other professionals can only help you to consider this difficult decision. I seem to be the only one who believes you should wait and see. Maybe that says something. I'm also one of the one's who went through what John Hopkin's calls the death regimen" of chemotherapy and radiation. Maybe this colors my judgement... all the more reason for additional opinions from professionals.
We had to make the chemo decision too. As i mentioned in previous posts the docs were split as to the benefits of using oxaliplatin to stop recurrence. There are not enough stats to give anyone a clear answer. Husband chose to take the chemo as we knew :-
...he had an aggressive cancer,
...he had already used 6 cycles prior to liver resection to shrink tumors
the benefits of a final 6 cycles were judged to be less severe on side effects as he had a 6 month gap
...he did have alternative drugs to use if he suffered a recurrence
The drawbacks were that we were told once oxaliplatin is used beyond certain doses the body will become oxali-resistant.
The side effects of oxali can be hard to deal with if you are not proactive againt them
Husband is a stage 4. As Alison and others have said there is maybe another chemo option for you.
If you decide not to take up the chemo, please ensure you have a good grasp of how the doctors are going to monitor your condition. Dont let them go for the cheapest options and make them work hard for you. Make sure you get them to look at the whole of your body if poss, not just inside your colon and blood tests.
Hey all thank you so much for all of your replies. It truly is a tough decision, I go for a second opinion on Monday, and then I will try and decide. I am VERY happy about the diagnosis. I am ecstatic about the lymph nodes and all of the other positives. My main struggle is mentally, and will I go crazy wondering about everything if I don't have chemo. As for chemo. The first doc said about oxaliplatin, and I hear that has a lot of side effects, cold intolerance, neuropathy, possible infertility. So I just don't know if I want to subject my body to such potential overkill.
Again thanks all for all your input and great responses. Its great to have a sounding board.
I will report only what my father's medical ongologist said to him (he is responsible for developing and protocoling the FOLFOX 4 regiment and works very closey w/ DeGramont... The 5fu/Leucovorin regiment is a maximum 2 % absolute benefit. He said if it were him he wouldn't do it! The FOLOFOX 4 regiment...Oxaliplatin/5fu/lecouvorin has an absolute effect of 8-12% depending on staging. The oral form of chemo, against colon cancer in my opinion is nearly useless.
Chemo kills up to 85% of present cancer cells! It is all about odds, risks, statistics. I think the best way that was explained to us was an analogy to buying insurance. If you don't know that cancer cells are present (ie microscopic) you take the therapy (like insurance) to increase your coverage. They may not even be there at all. There is no medical test available today that can detect microscopic cells.
I haven't had cancer so I don't want to attempt to say I can empathize. But I watched my dad go through it and the only way to describe the "heavy" regiments is pure hell. BUT you do it if you have a high reoccurance risk. With stage II the reoccurance risk is what 10-15% if it has not preforated? I would wait and see too! Talk with the most knowledgeable doctors you can and do your research. Unfortunately, as someone said there is no guarantee either way. But I have to think we have to er on the side of positive. There's a better chance that it won't occur than that it will.