Talk Cancer

Question:

Last week I had a flex. sig. and the surgeon took three tissue samples to biopsy. I had the sig. because my most recent CT scan shows thickening at the anastamosis, as well as enlargement of lymph nodes. The surgeon didn’t find any signs of recurrence during the sig. and the biopsy came back negative. Both the surgeon and the onc., however, are concerned because they think the cancer is there, but that the wrong tissue was biopsied. Surgeon said it wasn’t possible, during the sig., to positively identify the area concerning them. The surgeon is suggesting a (I think I have this right) a guided imaging needle biopsy, the idea being to pinpoint and biopsy precisely the tissue that’s raising the red flags. I’m also getting another CT scan in two weeks, to see if there’s been any change since the scan in Feb. Am also having another CEA test. (also, we’re doing a bone scan, to see if the continuing back pain I’m experiencing is metastasis to the bone). So I asked the surgeon what he suggests we do if the results continue to be "ambiguous" and don’t tell us with certainty that there is cancer at the anastamosis or not. He suggests that we be aggressive and remove my rectum. He’s worried that the cancer (if it’s there, though we can’t "see" it right now) will grow through the bowel wall, possibly making the recurrence inoperable. That’s a big decision to make. I’d hate to wake up from major surgery, facing a colostomy, only to hear, "whoops. We didn’t find any cancer, after all." At the same time, I don’t want to air on the side of caution, with bad results. One of the things I need to talk to my onc. about is how closely I could be monitored if I decided to put off surgery until there was clear evidence the cancer was back. Anyway, no need to make a decision until we get another CT scan and this other biopsy. Hopefully those tests will give some clarity to the situation. Steph, would a PET scan be of any help in determining if the cancer is back? Is there anything else you’d suggest we do? TIA, Michele

Response:

– Hide quoted text — Show quoted text – Last week I had a flex. sig. and the surgeon took three tissue samples to biopsy. I had the sig. because my most recent CT scan shows thickening at the anastamosis, as well as enlargement of lymph nodes. The surgeon didn’t find any signs of recurrence during the sig. and the biopsy came back negative. Both the surgeon and the onc., however, are concerned because they think the cancer is there, but that the wrong tissue was biopsied. Surgeon said it wasn’t possible, during the sig., to positively identify the area concerning them. The surgeon is suggesting a (I think I have this right) a guided imaging needle biopsy, the idea being to pinpoint and biopsy precisely the tissue that’s raising the red flags. I’m also getting another CT scan in two weeks, to see if there’s been any change since the scan in Feb. Am also having another CEA test. (also, we’re doing a bone scan, to see if the continuing back pain I’m experiencing is metastasis to the bone). So I asked the surgeon what he suggests we do if the results continue to be "ambiguous" and don’t tell us with certainty that there is cancer at the anastamosis or not. He suggests that we be aggressive and remove my rectum. He’s worried that the cancer (if it’s there, though we can’t "see" it right now) will grow through the bowel wall, possibly making the recurrence inoperable. That’s a big decision to make. I’d hate to wake up from major surgery, facing a colostomy, only to hear, "whoops. We didn’t find any cancer, after all." At the same time, I don’t want to air on the side of caution, with bad results. One of the things I need to talk to my onc. about is how closely I could be monitored if I decided to put off surgery until there was clear evidence the cancer was back. Anyway, no need to make a decision until we get another CT scan and this other biopsy. Hopefully those tests will give some clarity to the situation. Steph, would a PET scan be of any help in determining if the cancer is back? Is there anything else you’d suggest we do? TIA, Michele

A PET may well be useful, but it isn’t foolproof. The CT guided biopsy is the right next step. Problem with biopsies is that a positive biopsy generally proves that there is a recurrence, but a negative biopsy does not prove that there is not a recurrence. The surgeon may be able to tell more at surgery, and the pathologists may be able to help with a frozen section, before he proceeds with an abdominoperineal resection, but the surgeon has to do what he thinks best at the time of surgery, otherwise his hands are tied

Response:

<snip A PET may well be useful, but it isn’t foolproof.

<nodding I understand that. If the guided biopsy results are ambiguous, though, I’m going to ask the onc. if we can do a PET scan. I’d just like some assurance (if at all possible) of presence of cancer before choosing surgery. The CT guided biopsy is the right next step. Problem with biopsies is that a positive biopsy generally proves that there is a recurrence, but a negative biopsy does not prove that there is not a recurrence.

Yes, it’s a weird situation for me right now. Essentially we’re trying to prove I have cancer, since we can’t prove I don’t. The surgeon may be able to tell more at surgery, and the pathologists may be able to help with a frozen section, before he proceeds with an abdominoperineal resection, but the surgeon has to do what he thinks best at the time of surgery, otherwise his hands are tied

I trust my surgeon, and appreciate the fact that he wants to be aggressive. I also appreciate that he’s not pushing an immediate choice down my throat. So, we’ll wait and see what the next set of tests show. Michele, admiring the snow on her flowers this morning

Response:

– Hide quoted text — Show quoted text -Last week I had a flex. sig. and the surgeon took three tissue samples to biopsy. I had the sig. because my most recent CT scan shows thickening at the anastamosis, as well as enlargement of lymph nodes. The surgeon didn’t find any signs of recurrence during the sig. and the biopsy came back negative. Both the surgeon and the onc., however, are concerned because they think the cancer is there, but that the wrong tissue was biopsied. Surgeon said it wasn’t possible, during the sig., to positively identify the area concerning them. [snip] So I asked the surgeon what he suggests we do if the results continue to be "ambiguous" and don’t tell us with certainty that there is cancer at the anastamosis or not. He suggests that we be aggressive and remove my rectum. He’s worried that the cancer (if it’s there, though we can’t "see" it right now) will grow through the bowel wall, possibly making the recurrence inoperable. That’s a big decision to make. I’d hate to wake up from major surgery, facing a colostomy, only to hear, "whoops. We didn’t find any cancer, after all." At the same time, I don’t want to air on the side of caution, with bad results. One of the things I need to talk to my onc. about is how closely I could be monitored if I decided to put off surgery until there was clear evidence the cancer was back. Anyway, no need to make a decision until we get another CT scan and this other biopsy. Hopefully those tests will give some clarity to the situation.

Colostomy is a big thing to face up to; on the basis of my very limited experience (of other people), women seem to take it harder than do men. It may be related to the more delicate sensibilities of women – it certainly isn’t to do with lack of courage. (I’m not brave, but I know a number of men who are even bigger chickens than I am. I can only think of one or two women of my acquaintance who are less brave than me. I scream when the medics do a needle biopsy on me. Most women don’t make nearly as much fuss). Back in my flying days, a (male) colleague had to have a colostomy. He certainly made the best of it. If you were rude to him, he’d bide his time, then empty his colostomy bag into your pocket. And he’d brag about his lack of rectum: "Other people reckon they’ve done some flying, but how many of them can *really* claim to have flown their a**e off?" In contrast, a female friend could not come to terms with her colostomy and eventually, at great hazard, had her rectum re-built. In spite of the constant risk of complications, and a lot more discomfort, she was a lot happier with the rebuild. In your case, you’ll cope if it happens. A lot of us are still gritting our teeth on your behalf and hoping it *won’t* happen … — Replace "nospam" by/with "mould" in e-mail address. "Red sky at night means it went off alright." – Old nuclear weapons testers’ aphorism. John Osborne, fighting a rearguard action against the triumph of image over function from the beleaguered Castle Despair (home to Henry the hairy German shepherd)

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<snip Colostomy is a big thing to face up to; on the basis of my very limited experience (of other people), women seem to take it harder than do men.

It’s not the colostomy so much as the idea of major abdominal surgery once again, the recovery time, time off work, etc. Though the thought of a colostomy does not fill me with joy, I think I can get used to it. <snip In your case, you’ll cope if it happens. A lot of us are still gritting our teeth on your behalf and hoping it *won’t* happen …

Thanks, John. It helps to hear this . Michele

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