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    Old 08-20-2006, 01:56 PM   #1
    marcessna's Avatar
    Join Date: Jun 2003
    Location: Ocala,FL, USA
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    marcessna HB User
    Wife with Rectal cancer, surgery questions

    Hi everyone. My heartfelt to all that are dealing with this disease. My wife is 39 and was diagnosed as a Stage II, T3,NO,MO about three months ago. Her tumor is about 7cm above the rectal opening. It is very mobile and can be moved around. She had an endorectal ultrasound (sp) about a month ago and they said no lymph node involvement but it was in the rectal wall. It is an outward tumor posterior. She had chemo for 6 weeks and radiation 28 times. Last week the surgeon checked her and her tumor has been very responsive. He said it has almost shrunk to nothing. Here is our question. Originally we were told that we would have to have the full surgery, resection, ostomy(with reversal) etc. Now they are telling us we could as another option now have the surgery just to remove the tumor and sorrounding tissue rectally. We are not sure is that safe..will they get all the tumor? Is there still a risk just because they didn't see it in the lymph nodes that it was still there. The surgeon said the radition that they did on her pelvic area should have killed all of it. In addition, she will be doing 6 months of FOLFOX with oxilyplatin (sp) after due to her age. Does anyone have some guidance. We just are afraid if we don't do the full surgery the risk is too high.
    Thanks and God bless....Marc

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    Old 08-21-2006, 02:03 PM   #2
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    Re: Wife with Rectal cancer, surgery questions

    This IS an option available to rectal cancer patients with State I 0r II cancer. Originally it recieved great debate in the medical literature, but I believe is becomming a little more acceptable. Especially depending on HOW they plan to remove the tumor. One of the criteria is it has to be within reach of the surgeon's instruments, and there should be no nodal involvement.

    Do a search for Transanal Excision or Trans rectal excision of rectal tumor. There is also a technique where they can make an incision in the perineum and come up behind the rectum in order to remove some tissue and nodes to test for spread (mets).

    Personally, I would be much more inclined to recommend this procedure if it were you, Marc, that were suffering. Men have MUCH smaller pelvises to get into to transect and reattach tissue. Also, there are MANY nerves that run around the rectum that are responsible for sexual functioning and urination. Men have a much greater chance of erectile dysfunction...etc, as well as urination difficulties as do women... though women may experience a slower time emptying the bladder, typically, her chance of NOT being able to pee (as I have suffered) is much greater for a male patient. This is REALLY A TOUGH CALL. If she were stage 3 there would be no question for me, I would say go with Abdominal resection... If she were stage 1, no question, go for a Transrectal excision.

    I don't AT ALL intend to sound sexist... that's not it at all. It is simply a matter of anatomy. You could argue statistics though too... She did receive radiation, the surgeon is correct, and she will receive adjuvant chemo... All this evens out a Stage 2 to have the SAME CHANCE OF RECURRENCE for TRE versus a more traditional abdominal resection approach. Also, there are chances of nicking/nerves, and increased complication rates by her going through an abdominal resection which is MAJOR PELVIC/ABDOMINAL surgery.

    You two need to look at the studies and decide for yourselves. If you are looking for someone to give his/her opinion--I am somebody who has been through an abdominal approach, I would have chosen the transrectal approach had I been eligible, and had my surgeon suggested it though. Unfortunately I was a 3C with extensive nodal involvement, and could not go with the Trans Rectal Excision. If I were your wife I would do the Trans Rectal Approach, but be darn sure that this surgeon specialize in colorectal surgery utilizing the Trans rectal approach, and has done MANY of these procedures before. There is nothing wrong with sitting down with him/her and asking for numbers.


    PS I'M SORRY. I hope you didn't read this before I edited my post... colostomy bag troubles... I didn't have time to proof, and just posted it!
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    Last edited by CancerDad; 08-21-2006 at 04:08 PM.

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