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Old 10-13-2006, 01:28 PM   #1
besteele
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1st post

Hi everyone - This is my 1st post and to let you know I have been following this board for the last month and a half ever since I was diagnosed with rectal cancer. I find great comfort in reading from this health board.
This is my situation as I know it - my tumer is in the lower rectum just in reach of my surgeons finger, the test I have had are a sigmoidoscope to take a biopsy, a cat scan that showed my liver is normal,the abdomen is unremarkarkable, scans into the pelvis reveal eccentric thickening of the wall of the rectum along the distal half with a suspect lymph node in the prescral zone.
My surgeon wants to do the following - 5 days of radiation followed by surgery the following week . the surgery would include giving me a permanet colostomy.
I have a good friend that thinks I should get a second opion about the colostomy and I"am not sure if this treatment is the right way to go. The second treatment would be to have 6 weeks radiation and 6 weeks chemo.
I am not quite sure what to do at this point, so if you have any thoughts please let me know.

 
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Old 10-13-2006, 01:59 PM   #2
CancerDad
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Re: 1st post

Hi and welcome to the board. I am sorry for your diagnosis, but I am glad you found us. We all have experience and knowledge to share with you and support you as you go through this journey.

A week worth of radiation, and then surgery the following week is NOT standard in the treatment of rectal cancer. Nor is 6 weeks radiation followed by 6 weeks of chemo. Radiation is documented in studies to give better results when given WITH chemo usually for the first and last weeks of treatment. However, this DOES NOT mean that you have a bad radiation oncologist or oncologist.-- I just wanted to point out the norm. Maybe there are circumstances with your tumor that warrant this regimen.

I have a few questions... Did they tell you what stage you are, or exactly how big the tumor is? Also, how far has it grown into the rectal wall? Did they tell you what the differentiation of the tumor is-- poorly, moderate, or well-differentiated (histology from the biopsy/pathology report)? Lastly, what agent was your oncologist planning to use if you went the route of radiation and chemotherapy? The standard is 5FU and Leucovorin, although the oral agent Xeloda IS starting to become the norm.

I'm SORRY if I sound like I'm beating you up with questions!!! I'm just curious so we can all try to help and support you better!!!

Lastly, I just want to encourage you to get a second or even a third opinion on how best to handle your situation and whether a colostomy is necessary.

Warm Regards,
CancerDad
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Old 10-13-2006, 02:32 PM   #3
besteele
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Re: 1st post

Thanks for your reply - I will try to answer most of your questions.
First to correct myself the 2nd treatment option would be 6weeks radiation combined with chemo followed by an operation.
The tumor size as I remember correctly from the catscan is 17mm in thickness from the bowel wall - I believe surgeon said it is fairly small.
Surgeon from feeling tumor doesn't think it has grown outside the rectal wall.
The differentaition of the tumor I have not been told.
Stage 3 is what the surgeon thinks it is.
I have not talked to anyone in respect to any angents that would be used.
I am meeting with my surgeon in 2 weeks - and need to prepare a list of questions.

Thanks again for your concern

 
Old 10-14-2006, 05:52 AM   #4
gocatsgo
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Re: 1st post

Have you had a transanal ultrasound? This will help the staging.

I think that the 5 days of rads followed by surgery is a from a NEW study. Google it to see. They tried to offer that to me as well. I think they are doing it in Europe now - maybe Norway, Netherlands or something. A study I just read the other day suggests it MAY become a new standard of care. My radiation oncologist was not willing to do it last year because I was 32 and she was not sure of the Long term effects based on the studies done at that time. Looks like there may be some new data to consider... Try googling the study and see what you think...I believe it was published just in September, and I forget which journal it was in.

Right now most people get the 6 weeks of chemoradiation followed by surgery six weeks later...

Good luck!
Cats

 
Old 10-14-2006, 09:24 AM   #5
Jeni61
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Re: 1st post

Hello, welcome to our group, there are lots of knowledgeable folks here.

I also have rectal cancer, and had 6 weeks of radiation with the first and last weeks also having chemo.

My surgery is coming up on November 13th.

I have never heard or encountered a 5 day radiation regimen, but maybe your dr believes your case is such that that is fine.

Let us know how you proceed.

jeni

 
Old 10-14-2006, 09:24 AM   #6
Jeni61
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Re: 1st post

Hello, welcome to our group, there are lots of knowledgeable folks here.

I also have rectal cancer, and had 6 weeks of radiation with the first and last weeks also having chemo.

My surgery is coming up on November 13th.

I have never heard or encountered a 5 day radiation regimen, but maybe your dr believes your case is such that that is fine.

Let us know how you proceed.

jeni

 
Old 10-14-2006, 10:51 AM   #7
CancerDad
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Re: 1st post

Hi Bestelle:

Thanks for the info. That makes more sense if they are offering you the newer route or what is known as the "gold standard" for treatment of Rectal Cancer. Thanks Cats for bringing it up--Cats is right... they have evaluated a 5 day course of rads, however, to my knowledge it has NOT been compared in a head to head study against the standard regimen. The whole shortened course of radiation comes from the Swedish Rectal Cancer Trial which reveals conflicting data. This intensive short course radiation approach has not been available so far to my knowledge in the States due to the conflicting reports regarding its higher toxicity levels and lack of sphincter preservation.

There MAY be newer data available recently, but I go to a lot of colorectal and oncology conferences, and this has NOT been brought up as a possible revision in treatment protocol due to any benefit. Again though, it may be offered based on a brand new study proving better efficacy.

I think the thing you need to consider is the possibility of reconnection and a return to "semi-normal" functioning. Is the tumor too low to re-connect? Will this surgeon use the TME approach (which HAS been proven to now be the best procedure for sparing nerves and other morbidity), or is s/he planning on not even trying to reconnect you? You can shrink the tumor even more by getting radiation, which gives the surgeon more room to reconnect while still obtaining proper margins, and as previous posters have said, chemoradiation DOES improve your chances of not having a local recurrence, or mets to the pelvic area.

We can post a list of questions for you to ask, but I would DEFINITELY make certain you are meeting with Board Certified Colorectal Surgeons... and get at least a couple of opinions.

Everyone here will lend support however we can. How are you holding up?

Warm Regards,
CancerDad
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Old 10-14-2006, 01:47 PM   #8
besteele
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Re: 1st post

Thank you again for your response. I'am holding up very well thankyou for asking. I just want to move onto the next step in the process.My surgeon that I'am using is a general surgeon and has done this surgery before - how often I don't know but I will ask.Were I live in Canada the protocol seems a little bit different. I'am working with a team of people at a cancer hospital who works with the general surgeon.My understanding is the team of doctors at the cancer clinic will make the final call based on their evaluation.
I have been reading alot about this disease and what I have found about short course preoperative radiotherapy is it is only used for cancers that appear as though they will be fairly easy to remove.
The only thought I have is if there is a lymph node envolved do I want to wait 5-6 weeks after surgery to start chemo.

THANKS FOR YOUR CONTINUED SUPPORT

 
Old 10-15-2006, 07:14 AM   #9
ktee_uk
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Re: 1st post

Hi Besteele

Sorry you are visiting the boards due to your diagnosis. I hope you find them usefull as the folks here all try to help as much as possible.

Regarding the radiotherapy protocol....... I read an article by Doc Thomas Stuttaford in The Times on Friday 13th ( !! ) (im from the UK ) which supports yours and jennis comments. I cant post a link to it but it is easily googled but remember it's the UK Times. Article was named "Lateral thinking" and went into detail about the lateral spread into the mesorectal compartment of rectal area, etc.

Anyhow, the article talked about the fact that the British Medical Journal had published the results of a Medical Research Council survey that studied 1,350 patients with rectal cancer who have been treated in the UK, Canada, South Africa and New Zealand. The trial was designed to show the results of treating the lateral spread of the cancer, which could first be assessed with MRI scanning of the pelvis. The patients were given five daily treatments of radiotherapy before surgery. The effects were then compared to a matched group given the traditional regime of surgery followed by radiotherapy, combined with drugs over a five-week period.

The results showed that the first group had reduced recurrence rate and increased survival rate, although i am sure there is more to read into those statistics...... statistics being what they are.

One of the points raised was that the use of MRI scanning and reading the results correctly against the health of the patient can lead to different combinations of how much, how often and at what point a patient may or may not receive radiotherapy.

There is also another trial due to be published later this year called "Mercury".

What do you think CDad?

 
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