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Thread: Stage 3A Rectal Cancer, stage 1 2007

  1. #1
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    Stage 3A Rectal Cancer, stage 1 2007

    I am a 56 year old man. 6 years ago, after a routine colostomy, I was diagnosed with stage 1 rectal cancer. The adeno carcinoma was removed trans-anally, and no chemo or radiation was required. All of my follow up colonostomies were negative for cancer. Recently, while a urologist was looking for traces of blood in my urine, a CT scan was ordered that showed a 2 cm soft tissue mass outside of the rectum, near where the prior tissue was removed. A Pet scan was ordered and the tumor glowed with cancer, a biopsy confirmed the cancer. I am now stage 3A with a cancerous tumor of one lymph node adjacent to the rectum.

    The first Dr. originally recommended a colostomy bag, then said a resection of the rectum followed by a second surgery to remove the temporary colostomy bag. The 2nd Dr. recommended a removal of the complete rectum, surrounding fat tissue, and lymph nodes, then attaching the colon to the anus, followed by a second surgery to remove the temporary colostomy bag. He went on to say that bowel movement would never be the same as with a rectum, and that sexual disfunction could include no erection or ejaculation if nerves were damaged. Chemo and radiation would be done before the surgery to shrink the tumor and kill the cancer.

    Has anyone heard of a better way to treat this stage of rectal cancer?

  2. #2
    Moderator Top User esk2poo's Avatar
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    Activeman,
    Sorry to hear of the recurrence. My tumor was in the colon so I did not wake up with the bag. I am sure our experts in that area will be along to chime in soon. Glad to see you already got a second opinion. It is my understanding with rectal cancer, they do the chemo and radiation before surgery to shrink the tumor so that there is less collateral damage during the surgery. I guess the use of the tools is pretty important to you or you wouldn't have mentioned it. There are always chances things can go wrong with surgeries but they have to tell you beforehand. Personall, I have been happily married for 19 years with 2 wonderful children. I actually told my surgeon to take everything out while he was in there. I did not want it coming back to anything else. I told him to take the spleen, gall bladder, testicles, and whatever else I really didn't need. As long as I could be around a little longer, I could find other things to keep my wife happy like money.
    Ironically, I am now scheduled for 2/28 to have the gall bladder removed and to repair the hernia from last years colon surgery. If they would have taken it last year, would have been done. I hope they can shrink everything down with the neo-adjuvant treatments so there are no major issues with the surgery. There are also many on here that have a great life with the bag and others who wished they never had the reversal because of control issues. With this damned disease, I've just taken on the mantra it is what it is and try not to let things get to me too much. Of course easier said than done.
    Good luck,
    Allen
    Stage 3B Colon cancer 8/23/2011
    Resection 9/15/11
    Folfox starts 10/31/11
    Dehydration,blood clots, numerous hospitalization due to complications
    Gall bladder/ hernia repair, 4/2013
    Melanoma sole of right foot 2010
    Clean scans so far.
    12/14/14 that little puppy in my avatar went to heaven

  3. #3
    Moderator Top User Fourlegsgood's Avatar
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    Hi activenan,

    Sorry to hear that lightning has struck twice in the same place for you.

    My tumour was low down in the rectum and I had a resection with no bag. Over the months since the operation my bowel movements have more or less returned to normal despite having little rectum left.

    I may be being thick (often am) but I'm sort of struggling to see what the difference is with what is suggested by the two surgeons. Whichever one does it they would normally remove all the adjacent lymph glands and tissue. Does it come down to how much of the rectum each if them would take out? If so the thing is that each if them could change their mind anyway when they are in there. It is very difficult to decide exactly how much will need to come out before they actually eyeball the little menace.

    On the subject of nerve damage and possible effect on night time activities I think there is always a risk of that with surgery such as this and in that area. It's a risk but doesn't always happen and for sure it's not a reason to decide against surgery. In my pre op chat with my surgeon just before the operation I said to cut away until he was happy he had taken out enough.

    Nick
    Age 1/2 way to 120 plus 1. Symptom of blood in stools May 2011. Colonoscopy June 2011 confirmed rectal cancer. CT scan June 2011 showed no spread to other organs. Anterior resection July 2011 plus 50% bowel removed due to thickening observed during operation. Biopsy confirmed stage 2 in rectum only. Completed 8 cycles of precautionary capecitabine (4600mg Xeloda). Returned to horse riding 6 weeks post op, jumping 2weeks later and first competition 2 weeks after that. July 2012 - CT scan clear. June 2014 - CT scan clear. December 2014 - Colonoscopy clear. July 2017 - 6 year CT scan clear.

  4. #4
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    Thanks for you response, please follow my case.

  5. #5
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    Thanks Nick, and Allen, as I am just starting this forum and need to be polite.

    My first Dr. did not explain much, as you gathered, it was the 2nd Dr. that gave me most of the information about the surgery and subsequent issues. I have a meeting with my Family Dr. on 2/13 and will be asking those questions of him. I was hoping that they could just take the tumor as it is localized in the one lymph node. I see you have stage 2, could this be why you were able to keep part of your rectum? Thanks for your response.

  6. #6
    Moderator Top User Fourlegsgood's Avatar
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    You bet we will. Please keep us updated.

    I'm not sure how much of my rectum I have. Not a lot. As far as I can tell there was just enough to join the colon back up to it and still get clear margins. As you will have read, they took out half of my colon as well. That's why I say that they have to make decisions once they are in there.

    I was lucky because I was offered the person that I was told was the top guy and I just went with what he said and he made the decisions once the operation was underway.

    My operation and how much they removed would have been the same whether stage 2 or 3 because they didn't know which stage it was until the biopsy results on the removed lymph glands.

    Nick
    Last edited by Fourlegsgood; 02-12-2013 at 09:03 PM.
    Age 1/2 way to 120 plus 1. Symptom of blood in stools May 2011. Colonoscopy June 2011 confirmed rectal cancer. CT scan June 2011 showed no spread to other organs. Anterior resection July 2011 plus 50% bowel removed due to thickening observed during operation. Biopsy confirmed stage 2 in rectum only. Completed 8 cycles of precautionary capecitabine (4600mg Xeloda). Returned to horse riding 6 weeks post op, jumping 2weeks later and first competition 2 weeks after that. July 2012 - CT scan clear. June 2014 - CT scan clear. December 2014 - Colonoscopy clear. July 2017 - 6 year CT scan clear.

  7. #7
    Hi Active man. Not sure what doctors/specialists you have seen but highly recommend you see both an oncologist and a colon and rectal surgeon before determining your treatment. It takes awhile to get all the scans, tests and exams but it's necessary to determine best course of treatment. I really hate to hear stories of recurrence. Please keep us updated on your progress.
    Deb f53
    Diag at 49 RCa 5-4-12
    28 rounds Xeloda+radiation 5-12 to 7-12
    Lovely month of normalcy in August
    LAR + temp ileo 9-5-12
    Stage IIIa T2, N1
    FOLFOX 10-16-12 x 12 rounds for 6 months
    Round 12 completed 4-4-13--YAY!
    NED 4-12-13 CT Scan
    Ileo reversal 4-19-13; contracted c-diff--went into toxic shock; 2nd surgery 4-22-13;
    Hospital release 4-30-13
    7-13 to 9-13 Joined LIVESTRONG program at YMCA
    NED 8-13 Breast and cervical biopsies (due to abnormalities)
    NED 9-20-13 Colonoscopy
    American Cancer Society 9-21-13 Relay for Life Event
    NED 4-10-14 CT scan
    NED 1-13-15 CT scan
    NED Dec 2015 Colonoscopy
    NED Feb 2016 CT scan

  8. #8
    By the way, a resection of the rectum is today's standard treatment for rectal cancer and don't think at this stage a removal of just the lymph node would be considered an option. Ask doc to see NCCN guidelines (or you can log in online to see treatment standards but it is fairly technical). nccn.org

    Actually they have guidelines for patients which I am looking at now. Much easier to follow!
    Deb f53
    Diag at 49 RCa 5-4-12
    28 rounds Xeloda+radiation 5-12 to 7-12
    Lovely month of normalcy in August
    LAR + temp ileo 9-5-12
    Stage IIIa T2, N1
    FOLFOX 10-16-12 x 12 rounds for 6 months
    Round 12 completed 4-4-13--YAY!
    NED 4-12-13 CT Scan
    Ileo reversal 4-19-13; contracted c-diff--went into toxic shock; 2nd surgery 4-22-13;
    Hospital release 4-30-13
    7-13 to 9-13 Joined LIVESTRONG program at YMCA
    NED 8-13 Breast and cervical biopsies (due to abnormalities)
    NED 9-20-13 Colonoscopy
    American Cancer Society 9-21-13 Relay for Life Event
    NED 4-10-14 CT scan
    NED 1-13-15 CT scan
    NED Dec 2015 Colonoscopy
    NED Feb 2016 CT scan

  9. #9
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    Thanks Deb,
    I appreciate the information. I noticed that your condition was similar to mine. What did they remove? You must be getting close to the reversal. I have been to UCSF and Stanford for colorectal consult, met with Radiologist and Oncologist locally. Maybe start Chemo and Radiation next week then surgery in about 6 weeks.
    Stage 1 rectal cancer 5/07, age 50
    Transanal removal with clear margins
    No Chemo and no Radiation.
    Stage 3A rectal cancer 12/12 in one lymph node adjacent to rectum, age 56
    3/12 started 28 days of Xeloda (3000mg) and Radiation.
    6/13 LAR at UCSF, home after 6 days with ileostomy.
    8/13 start 12 rounds of oxaliplatin Flourouracil cocktail. Completed 2/14.
    2/27/14 Take down of ileostomy, home after two days. One tough night after 5 days to restart bowls, now feeling quite well with minimal issues.
    4/14 Okay blood work, 5/14 Clear PET scan, 6/14 Clear colonostomy. Meeting with Oncologist to see if they can remove port.
    7/14 Port removed, looking to go topless in a month or so. Fiber therapy after lunch and appreciate a little personal time about an hour after my big meal of the day, which can have me walking to the restroom two to three times in the next hour.

  10. #10
    They removed nearly all of my rectum and sigmoid colon--total about 20 cm and 6 lymph nodes. Just left enough rectum to reattach to the descending colon. That procedure is called a low anterior resection (LAR). I don't feel like I'm missing any parts but may feel differently after reconnect, which I hope will happen late April/early May. I had 28 rounds of Xeloda (chemo in pill form) and radiation-- took 5.5 weeks, then waited another month for therapy to continue working, then had the surgery. However, the therapy was effective and tumor was almost completely gone, and the surgeon said it could disappear completely but the odds of non recurrence was 60% and with surgery 85%. Was a no brainer even though I dreaded the ileostomy bag.
    Deb f53
    Diag at 49 RCa 5-4-12
    28 rounds Xeloda+radiation 5-12 to 7-12
    Lovely month of normalcy in August
    LAR + temp ileo 9-5-12
    Stage IIIa T2, N1
    FOLFOX 10-16-12 x 12 rounds for 6 months
    Round 12 completed 4-4-13--YAY!
    NED 4-12-13 CT Scan
    Ileo reversal 4-19-13; contracted c-diff--went into toxic shock; 2nd surgery 4-22-13;
    Hospital release 4-30-13
    7-13 to 9-13 Joined LIVESTRONG program at YMCA
    NED 8-13 Breast and cervical biopsies (due to abnormalities)
    NED 9-20-13 Colonoscopy
    American Cancer Society 9-21-13 Relay for Life Event
    NED 4-10-14 CT scan
    NED 1-13-15 CT scan
    NED Dec 2015 Colonoscopy
    NED Feb 2016 CT scan

 

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