The thoughts of surgeons and colorectal cancer specialists on all aspects of the disease. These thoughts are not medical advice and should not be construed as such. Information within this blog should not substitute for your own judgement and that of your physician. Email to cancerdocs@mac.com if there is something you would like to hear about.
Thursday, June 2, 2011
Topics of Interest
This blog has been somewhat inactive due to responsibilities of the authors. We are looking to begin adding new content and would like to have our readers input.
Please add comments to this post regarding topics you would like to hear about and we will try to answer your questions.
In April of 2011, I had a 4cm rectal mass removed. Pathology showed that 1.5cm of the mass was moderately differentiated adenocarcinoma with 1.2mm margin and no lymphovascular invasion. I went to John's Hopkins and Sloan Kettering for opinions. Both said that if i did not have further surgery there was 15 to 20% chance of recurrence. Surgery would improve those odds by 10 to 12%. Ive had ct, mri, PET, CEA and endorectal ultrasound. All came back negative. Im due for another colonoscopy and MRI next month. Are you familiar with any cases similiar to what I've described, and if so, their outcomes?
When you say removed, are you talking about transanal excision? The recurrence rates that you are speaking of sound like those for a T2N0 cancer following transanal excision. Is that the case? Radical resection of the rectum is the gold standard in this setting, however, adjuvant chemoradiation therapy has been used to reduce the risk of local recurrence instead of radical resection. This is not considered equivalent to radical resection. My read of the data is that chemo radiation reduces recurrence risk by about half compared to transanal excision alone in this setting. I expect local recurrence rates of 4-6% following radical resection for a T2N0 adenocarcinoma in my practice.
Yes, transanal excision of a T1 lesion with 1.2 mm margin. I decided against the radical resection due to long term quality of life issues. CT,MRI,transanal ultrasound, CEA were all negative. I understand that staging is uncertain due to lack of node harvesting, but mine appears to be T1NO. Do you have patients with a profile similiar to mine, and what is your take on recurrence in this instance?
I don't use transanal excision unless patients refuse radical surgery or are too sick to undergo major surgery. I have a number of patients treated by transanal excision with T1N0 rectal cancer. In my practice, recurrence is low, however, I combine transanal excision with adjuvant chemoradiation therapy in most cases. The gold standard for cancer control remains radical resection as it is the best cancer operation.
My husband was diagnosed with Stage 3 2b rectal cancer last June. He has has a resection, radiation and chemo and straight chemo. The CT in March showed nothing. He is having pain in the sacral area now. We have his repeat colonoscopy in a week. If the cancer spread to the bone in the area, will the colonoscopy find a possible tumor in that area? We were planning to let the surgeon know when we arrive of his pain, but should we discuss it prior to make sure they can take a look if the colonocopy won't find it? I have read enough now to know it can spread to the sacral or pelvic area and am really nervous for him.
Kim, cancer recurrence is certainly of concern when there is pain following cancer treatment and it is good that you are getting it evaluated and communicating this information to your doctors. Cancer recurrence isn't the only cause of such pain, however. We frequently see that patients with a history of radiation treatment begin to have chronic pain in the sacrum and pelvic bones due to "radiation osteitis" which just mean bone inflammation. Evidence of this can often be seen on imaging studies. I wish you the best with your husbands cancer treatment.
6 comments:
In April of 2011, I had a 4cm rectal mass removed. Pathology showed that 1.5cm of the mass was moderately differentiated adenocarcinoma with 1.2mm margin and no lymphovascular invasion.
I went to John's Hopkins and Sloan Kettering for opinions. Both said that if i did not have further surgery there was 15 to 20% chance of recurrence. Surgery would improve those odds by 10 to 12%.
Ive had ct, mri, PET, CEA and endorectal ultrasound. All came back negative. Im due for another colonoscopy and MRI next month.
Are you familiar with any cases similiar to what I've described, and if so, their outcomes?
When you say removed, are you talking about transanal excision? The recurrence rates that you are speaking of sound like those for a T2N0 cancer following transanal excision. Is that the case?
Radical resection of the rectum is the gold standard in this setting, however, adjuvant chemoradiation therapy has been used to reduce the risk of local recurrence instead of radical resection. This is not considered equivalent to radical resection. My read of the data is that chemo radiation reduces recurrence risk by about half compared to transanal excision alone in this setting. I expect local recurrence rates of 4-6% following radical resection for a T2N0 adenocarcinoma in my practice.
Yes, transanal excision of a T1 lesion with 1.2 mm margin. I decided against the radical resection due to long term quality of life issues. CT,MRI,transanal ultrasound, CEA were all negative. I understand that staging is uncertain due to lack of node harvesting, but mine appears to be T1NO. Do you have patients with a profile similiar to mine, and what is your take on recurrence in this instance?
I don't use transanal excision unless patients refuse radical surgery or are too sick to undergo major surgery. I have a number of patients treated by transanal excision with T1N0 rectal cancer. In my practice, recurrence is low, however, I combine transanal excision with adjuvant chemoradiation therapy in most cases.
The gold standard for cancer control remains radical resection as it is the best cancer operation.
My husband was diagnosed with Stage 3 2b rectal cancer last June. He has has a resection, radiation and chemo and straight chemo. The CT in March showed nothing. He is having pain in the sacral area now. We have his repeat colonoscopy in a week. If the cancer spread to the bone in the area, will the colonoscopy find a possible tumor in that area? We were planning to let the surgeon know when we arrive of his pain, but should we discuss it prior to make sure they can take a look if the colonocopy won't find it? I have read enough now to know it can spread to the sacral or pelvic area and am really nervous for him.
Kim, cancer recurrence is certainly of concern when there is pain following cancer treatment and it is good that you are getting it evaluated and communicating this information to your doctors.
Cancer recurrence isn't the only cause of such pain, however. We frequently see that patients with a history of radiation treatment begin to have chronic pain in the sacrum and pelvic bones due to "radiation osteitis" which just mean bone inflammation. Evidence of this can often be seen on imaging studies. I wish you the best with your husbands cancer treatment.
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