Further Excision to obtain clearer margins.

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Hi Guys 

  1. Hope everyone is feeling ok 

Just an update and a few questions to ask.

After my first excision the tumour fell into Stage 2  with no spread to Lymph Nodes or distant disease.

The clear margin was 0.2mm and the overall size of the excised tumour was 23mm. My surgeon said because the tumour had just fallen into stage 2 by only 3mm he recommended further excision to hopefully get clearer margins.

I had the surgery done on 26th January and as a result I now have a wound site that I could probably get the top of my finger in it’s that deep.

Has anybody else had a further excision to try for clearer margins?  Were the clear margins successful?

The pain is really bad as the wound is left open to heal in its own. I’m still waiting for the results.
I’ve researched the reoccurrence rates  for local excision and I must admit they don’t look great.

John

  • Hello John

    A warm welcome to the forum, although I am sorry to hear of your diagnosis.  we all understand what a worrying time it is for you, and I am also sorry to hear that you are in such pain.  I do hope they have given you some strong medication to help you cope, if not I would give the team a ring and ask - your wound is in a area where you can't avoid the 'traffic' as it were.

    There is one person on here who had excision of the tumour but then had further treatment,   and she is a mine of information (I hope you don't mind the tag Nicola).  There may have been others but I think perhaps excision only is a procedure suitable only for a minority although I am happy to be proved wrong.  

    I would avoid doctor Google if possible (believe me, we all know how difficult that is!) as a lot of the information on there is misleading or plain out-of-date. 

    I do hope that others will pick up on your post and give you more information.  What ever happens next, we are here to offer support should you need it.

    Irene xx

    John, I have just noticed this isn't your first post - sorry, I should have checked!

  • Hi John ( ),

    I think I’ve told you before that I had my tumour removed via local excision, I was stage 1 & I believe my tumour was approximately 2cms in diameter, so just a fraction away from stage 2! A 4mm clear margin was achieved on the majority of the excision but a small area only had a 1mm clear margin & I was advised that was cut off for further treatment, this if where our stories differ, I was referred to oncology & my oncologist offered me into the PLATO clinical trial. This involved 23 fractions of radiotherapy along with oral chemotherapy & was described to me as mop up treatment to get any stray cells.

    During my surgery my wound was stitched but my surgeon did warn me that because of the position of the wound it was a possibility that the stitches wouldn’t hold. I had my surgery on the Monday & sure enough the stitches burst on the Saturday evening which landed me in A&E bleeding! The Dr I saw in A&E said the wound would be best left open to heal from the inside out & like yours it was a substantial wound. I was having real difficulty going to the loo & it was incredibly painful so the A&E consultant advised that I stop taking the liquid morphine I’d been prescribed following my surgery & he prescribed Movicol (stool softeners) these helped immensely in easing the difficulty & pain when having bowel movements. Once my wound began to heal it resolved pretty quickly, I hope yours does too.

    I really hope your results come soon & they bring good news.

       thanks for the tag & of course I don’t mind. 

    Nicola 

  • Hi Nicola

    Im so sorry 

    You have replied to me in the past.

    I’m finding it difficult to navigate this site and  I thought I had to create a new thread to ask another question.

    It’s really strange that  Consultants have different criteria for further treatment. My initial clear margin was 0.2mm and the Tumour was 23mm at stage 2 and I was offered further excision ?

    I didn’t have stitches but the wound is quite wide,deep and painful. I am taking stool softeners which do help. Nurses are saying the wound will take 8 weeks to heal.

    Kind regards

    John

  • Hi John ( ),

    Seriously don’t worry & it’s fine to create another thread for a fresh question, it’s sometimes the best way to alert other users of the site to your queries. 

    Yes it’s a bit of a lottery as to the team you’re under & the hospital you’re directed to as to the treatment path taken. 

    The area of my tumour that had the 1mm clear margin opposed to the rest having 4mm was very close to the sphincter muscle & although it hadn’t begun to invade the muscle it was very close, my surgeon said he didn’t want to go any further as he didn’t want to risk leaving me with permanent incontinence as once that muscle is surgically damaged it rarely recovers. So maybe there was no other option for me than chemoradiotherapy whereas if there was the option of removing more healthy tissue without causing permanent damage for you maybe this contributed to the decision made by your surgeon? 

    Hang on in there, it is a very painful surgery & I would get to the point of almost passing out on the loo those first few days post surgery it was so, so painful but it was strangely less painful once the stitches had burst & as I said once my wound begun healing it closed pretty quickly so hopefully it’ll be the same case for you.

    Keep us updated on how you’re doing. Sending lots of healing thoughts your way. 

    Nicola 

  • Hi JayC, I have not had the same surgery as you but just wanted to jump in to let you know about the important of protein to aid healing. I had a very deep (7cm) post surgical wound in the same area as yours and the tissue viability team really kept going on about how important protein is for healing. I must say after I started taking the protein drinks they prescribed me it did seem to really speed up the healing. You can get them prescribed or buy them, they are called Fortisip Compact Protein if you are interested. I also ate a lot of chicken and salmon! Best of luck with the healing.

  • Hi Nicola

    Thanks you have just answered my question. The Consultant did say that there would be minimal damage to the Sphincter complex so it makes sense now. I think the consultant was also concerned that the clear margin depth was only 0.2mm.

    Nearly 3 weeks in the  wound site now looks twice the size with a noticeable deep hole.
    Obviously no stitches  and to be honest minimal bleeding .

    Does that hole disappear as the healing process progresses or will I be left with it?

    Not sure if I made the right decision as  I might just be delaying the Chemo/Radiotherepy treatment.

    Further update 14/02/24

    I received a phone call from the colorectal nurse who stated that the surgeon had taken another excision of tissue measuring 1.9cm wide by 0.7cm deep which  was clear of any cancer. I will now receive close Surveillance every 3 months with a high resolution Anoscopy  looking for any cancer cells.

    Must admit I had mixed emotions when I was given that news as I don’t  know if I’ve been incredibly lucky with this treatment.

    I also feel very guilty that other kind folk on this forum have been through far worse than I have and I am really truly sorry about that.

    I will staying on this forum because everyone is so brave and we are all in this together.

    Kind regards

    John

      

    Thanks for the advice.

    Kind regards

    John

  • Hi MrsKS

    Thank-you so much for your advice it’s really appreciated. I will make sure I get plenty of protein to sort this wound out.

    Kind regards

    John

  • John

    Please don't feel guilty, we are all delighted for you.  Sending gentle healing wishes

    Irene x

  • Hi John ( ),

    I can only speak from my own experience but my wound site filled in completely. There’s obviously a scar there but I can’t feel it at all. You’ve had 2 surgeries pretty close together so you may take a little longer to heal than I did. 

    That’s great news that the margins were bigger this time & clear & it sounds as though your team are going to be keeping a really close eye on things. 

    Please never feel guilty about your journey compared to others we’re all here for the same reason unfortunately & our aim is to support each other through this diagnosis regardless of treatment paths etc. 

    Once again I’m pleased to hear your good news & I hope you notice a difference with your wound really soon. Please keep us updated on how you’re doing. 

    Nicola 

  • John hoping for speedy healing of your wound. Take care. 

    Andrea