Mop up chemo

I’m interested to know this as our oncologist seems adamant that my husband have all 8 cycles (he is T3N1aM0) and we’re worried about the increasing side effects. Did you have a CT to check the progress or did they just say you have had the best of the rounds and that should be enough? 

Hi SarahSerena, she said that the benefit from 4 rounds of capox is 15 % which reduces to between 1-2% for the next four rounds. That's based on 2 recent studies. If I stop now, I get a scan to see if there's any signs of cancer left. My tumor markers were at 5 when I started and are now 2.5, which she said were normal, not sure if that had anything to do with her advice?  They got wide margins during my surgery as well?  I'm just really struggling with what to do next?

 Best wishes

Michelle xx

Hi Rochelle19 and . There was a trial done a few years ago called the Scot trial that compared High risk stage 2 and stage 3 patients having capox for 6 months against those having it for 3 months. It was found that the benefit of 6 over 3 was negligible but the side effects from 6 were much higher so most oncologists now just recommend 3 months. I’ve attached a link to the report on the trial. SarahSerena - you could maybe ask the oncologist if there is a particular reason for your hubby having 8 and mention the side effects - my feet got worse after stopping and still feel like they’re permanently sunburnt 4 years on

https://www.thelancet.com/journals/lancet/article/PIIS1470-2045(18)30093-7/fulltext

Take care ladies

Karen x

Thank you so much! This is really interesting. My husband had cancer cells in 1 of 8 lymph nodes and perineural invasion present but CT & bloods all clear and no cancer in any of the removed intestine other than the tumour and 1 lymph node. I think we will watch the symptoms and maybe bring in this study at round 4 and have a discussion xxx 

Thank you for this Karen, it's really interesting and confirms what my oncologist said yesterday. There isn't a lot of difference in the figures is there? It's just the fear of thinking...have I done enough?? I've got a lot of thinking to do!

Many thanks

Michelle xxx

Hi Sarah..hope you don't mind me muscling in on this conversation..my hubby also had a sigmoid tumour removed via bowel resection in November and his final staging was T3N2bM0..he had 7 out of 22 nodes affected plus EMVI and PNI positive..he had clear margins following surgery and has started chemo today..but I noticed that your hubby also had the perineural invasion and to be honest I have been struggling to find many people with this appearing on their pathology report..I wondered what your oncologist has said as ours said its just another indicator that mop up chemo should he used but I am struggling to get past the fact it was in the nodes, blood vessels and nerves..it just seems so much more serious than just a couple of nodes which is what the PET scan indicated prior to surgery..but it is a moderately differentiated tumour so hoping that's one plus at least..

Hiya, my husbands tumor was also moderately differentiated (3cm). The oncologist advised 8 cycles of chemo and he’s done up to cycle 3 now. We are going to discuss stopping after cycle 4 as per the above research. If the oncologist has good reasons to continue we will of course take it onboard. Chemo has been tough on my husband and it’s a balance between killing stray cells and getting some long term damage. I think if he didn’t have PNI they may have suggested 4 cycles only, but this is something we will clarify when we talk to her. The PNI part is quite scary… the worry that cells have gone to his lungs or something and will surface later, but we have to think positive and that the chemo he’s had already will have had a huge impact! 

@sarahserena Thank you Sarah..yes the PNI and EMVI bit is scary..but the PET scan before surgery confirmed no spread and his surgery was a week later plus jus CEA levels are low so hoping they got it all out during surgery and that the chemo will kill any nasties..the nurse said her advice was to try and let the EMVI and PNI bit go as Tony had to have the chemo anyway due to the nodes and that no pathology report is perfect...

This is exactually what i was told and have read the report which confirms

my diagnosis T3 N1c M0

i start round 3 on friday 

Hi Sarah..hope hubby is doing well..I saw from.our chat that you were going to query 4 cycles over 8 in your hubby's case..I wondered how you had got on and whether he is continuing on for 8 cycles...my hubby has just started his 4th cycle and we are due to meet his oncologist at the end for a review..he high risk unfortunately having 9 out of 20 nodes affected with EMVI and PNI...although they got everything out with clear margins during surgery...