“Doctor, my eyes, tell me what you see…”

Monday, 11/22/10

I met with the radiation oncologist to discuss my case. He reviewed all of the scans including the MRI that was performed on Saturday. We talked about the differences between colon and rectal cancer. He mentioned the same things that my oncologist had told me and added that the lymphatic drainage is different for the two types of cancer. The lymph fluid from the colon drains into the mesenteric lymph nodes while the lymph fluid from the rectum drains into the pelvic lymph nodes. He went on to say that there would only be two reasons for performing radiation prior to surgery.

1.     If the tumor was low in the rectum, i.e. closer to the anus it would be more difficult for the surgeon to remove and radiation would help shrink the size of the mass making it easier to resect. The same would also apply to cases where the tumor exhibited extension into the pelvic area, which can be seen in advanced stages of the disease.

2.     If the lymph nodes appeared to be involved.

He said that based on the MRI, the majority of my tumor appeared to be in the distal end of the sigmoid colon with a slight dip downward into the rectum and there didn’t appear to be any extension of the tumor into the pelvis. The lymph nodes were clear on the CT & PET scans and measurements taken from the MRI determined the lymph nodes were about 6 mm in diameter, which was within normal limits. Therefore, I didn’t need radiation and chemo prior to surgery. This was great news!

I told him that I was worried about the long-term effects of radiation exposure, e.g. chronic gastroenteritis, bladder or prostate cancer. In years past, radiation was administered using a relatively broad path and other organs could be affected. He said that radiation treatment had changed quite a bit just in the last five years and new technologies had been developed like intensity-modulated radiation therapy (IMRT), which uses a much smaller beam. Target areas can be painted with surgical-like precision, thus avoiding other organs. He went on to say that while I didn’t need radiation or chemo before surgery we would have to wait for the pathology report on the lymph nodes harvested from surgery to see if I needed post-surgical treatment. If any nodes were positive I might need to have IMRT, but we would cross that bridge after surgery.

He said he imagined the past few weeks must have been frustrating since there seemed to be no answers, just more questions. He assured me that all of the tests were necessary to piece together a picture of what was really going on and the MRI was the last piece in the puzzle. It felt great to finally have some concrete answers and a game plan for treatment. My fears regarding radiation had been alleviated and things were looking up. Thanksgiving was just a few days away and I had much to be thankful for this year.