Rectal Cancer Tumour

FormerMember over 5 years ago

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Got diagnosed 16th October 2019 for rectal cancer, went through chemo and radiotherapy for 25 days which terminated on the 20th December 2019 had a terrible time with diarrhotea and side effects, had a meeting with the surgeon on the 6th January 2020 where he went through all the possible things that could go wrong and what to be expected prior , during and after the operation. He organized for me to have a MRI, which i had yesterday and he set the date for the operation for the 7th February.

I am still suffering from excess visits to the toilet, pain and lack of sleep. he told me that all of the above was normal and would go away with time, he prescribed pain killers and sleeping tablets, the sleeping tablets are working really well and i am getting 8 to 9 hours of sleep as against 3 to 4 hours of interrupted sleep.

Yesterday evening at the MRI clinic they told me that the process would take about 15 minutes and it was to see what the tumour looked like compared to the one that was taken on the 31st October 2019. It would be used by the surgeon to guide him on where to cut.

The process took nearly 30 minutes and I had the distinct impression that the treatment was repetitive. Afterwards whilst waiting for the report and scan images the doctor in charge of the MRI center called us into his office. We were frozen with fright, he started by asking us if we wanted to speak in French or English, ( we live in France ) then he said i have really good news, they were unable to detect any trace of the tumour and the lymph nodes that had shown to be infected by the cancer had changed and now show no signs of infection.

At the same time he said that it does not mean that the cancer was gone, it just was not detectable by the MRI scan and it could exist at the cellular level.

We asked if that meant that I would not have surgery, he said that I had to discuss that with the surgeon.

The results will be sent to the surgeon.

Has anyone had similar experiences and if so what happened next.

Jogey over 5 years ago

Hi goslow,

This is great news as having a radiologically complete response which gets rid of the detectable cancer completely greatly improves your chances of long term survival as it is a sign of a favourable tumour biology. I had exactly the same experience and was diagnosed November 2018 with Stage 3 rectal cancer and which had not spread spread to distant organs but had spread to two lymph nodes. After radiotherapy there was no evidence of disease in the rectum or the lymph nodes. I was offered the choice of surgery or watch and wait, a monitoring program, whereby they operate if the tumour comes back and don't if it doesn't. I chose watch and wait. I am coming up to a year clear of cancer on 31/1/20 but have a CT scan on 26/1/20 so hopefully that will be ok.

To help you decide whether to do watch and wait or surgery the following research paper is very useful:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31078-X/fulltext

Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study

Published:June 23, 2018DOI:https://doi.org/10.1016/S0140-6736(18)31078-X

Summary

Background

The strategy of watch and wait (W&W) in patients with rectal cancer who achieve a complete clinical response (cCR) after neoadjuvant therapy is new and offers an opportunity for patients to avoid major resection surgery. However, evidence is based on small-to-moderate sized series from specialist centres. The International Watch & Wait Database (IWWD) aims to describe the outcome of the W&W strategy in a large-scale registry of pooled individual patient data. We report the results of a descriptive analysis after inclusion of more than 1000 patients in the registry.

Methods

Participating centres entered data in the registry through an online, highly secured, and encrypted research data server. Data included baseline characteristics, neoadjuvant therapy, imaging protocols, incidence of local regrowth and distant metastasis, and survival status. All patients with rectal cancer in whom the standard of care (total mesorectal excision surgery) was omitted after neoadjuvant therapy were eligible to be included in the IWWD. For the present analysis, we only selected patients with no signs of residual tumour at reassessment (a cCR). We analysed the proportion of patients with local regrowth, proportion of patients with distant metastases, 5-year overall survival, and 5-year disease-specific survival.

Findings

Between April 14, 2015, and June 30, 2017, we identified 1009 patients who received neoadjuvant treatment and were managed by W&W in the database from 47 participating institutes (15 countries). We included 880 (87%) patients with a cCR. Median follow-up time was 3·3 years (95% CI 3·1–3·6). The 2-year cumulative incidence of local regrowth was 25·2% (95% CI 22·2–28·5%), 88% of all local regrowth was diagnosed in the first 2 years, and 97% of local regrowth was located in the bowel wall. Distant metastasis were diagnosed in 71 (8%) of 880 patients. 5-year overall survival was 85% (95% CI 80·9–87·7%), and 5-year disease-specific survival was 94% (91–96%).

Interpretation

This dataset has the largest series of patients with rectal cancer treated with a W&W approach, consisting of approximately 50% data from previous cohort series and 50% unpublished data. Local regrowth occurs mostly in the first 2 years and in the bowel wall, emphasising the importance of endoscopic surveillance to ensure the option of deferred curative surgery. Local unsalvageable disease after W&W was rare.

Funding

European Registration of Cancer Care financed by European Society of Surgical Oncology, Champalimaud Foundation Lisbon, Bas Mulder Award granted by the Alpe d'Huzes Foundation and Dutch Cancer Society, and European Research Council Advanced Grant.

FormerMember over 5 years ago in reply to Jogey

I could not have asked for a better response. We both thank you. I like you have stage 3 ++ rectal cancer and like you it has not spread to distant organs, however it has pushed through into the abdomen and infected 1 to 13 lymph nodes, they are not certain as the oncologist said it could be just blistering.

I need to follow your results.

Jogey over 5 years ago in reply to FormerMember

This is an excellent video which explains the the situation medically very well from a top rectal cancer specialist in the United States https://youtu.be/8WqV-kqSQ5E

Take care