Friday, November 19, 2010

Heads it’s colon, tails it’s rectal


Friday, 11/19/10
I met with my oncologist and we talked about the results from the PET scan. There did not appear to be any increased metabolic activity in the liver, lungs or elsewhere, which was good. However, the origin of the tumor was still in question. He thought that it may be a colon tumor that had a slight extension down into the rectum rather than a true rectal tumor.  The distinction was important because colon and rectal cancers are treated differently.

Typical treatment for rectal cancer
1.     Neoadjuvant therapy consisting of radiation & chemo using 5-Fluorouracil (5-FU)
2.     Surgical removal of the tumor
3.     Follow up chemo using FOLFOX (Folinic acid, 5-FU & Oxaliplatin)

Radiation is used in rectal cancer to help shrink the size of the tumor making it easier for the surgeon to remove. This is especially true in advanced cases of the disease where the tumor has penetrated the rectum and extended into the pelvis. In addition, clear margins (unaffected areas of normal tissue lying adjacent to the tumor) can be difficult to obtain if the tumor is low in the rectum near the anus.

Typical treatment for colon cancer
1.     Surgical removal of the tumor
2.     Follow up chemo using FOLFOX (Folinic acid, 5-FU & Oxaliplatin)

Radiation carried with it a certain amount of risk depending upon how the treatment was performed and the size of the area being treated, e.g. chronic gastroenteritis if portions of small bowel were in the path of the beam and increased risk of bladder or prostate cancer in the future. Rectal tumors not treated with radiation had a higher chance of recurrence.

The CT scan had provided basic anatomical detail and the PET scan had characterized metabolic activity, but more information was needed to pinpoint the location. There were two options, endoscopic ultrasound, which isn’t currently available in Fort Collins or MRI. He scheduled an MRI for the next morning and was referring me to a radiation oncologist who would interpret the results and determine if radiation treatment was necessary.

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