Re: Question for and others

[Guest guest]

> Hello,

> I tried to send this message 2 other times but had some technical

> difficulty

----- This thing is awkward, but it does allow you to delete a post,

which I did, double posted for some reason!!

> I was

> concerned that my husband's CEA had risen since his original

> surgery, but my brother-in-law said not to worry because the tests

> were done at 2 different facilities with 2 different types of

> equipment. He said it is like " comparing apples to oranges " .

----- Very well may be. Our local doc. did a cea one week after the

tues that OSU did one. OSU Cea read 3.7 and a week later, Clev read

3.4 so I don't know what to tell you here, heard cea is in error 1/3rd

of the time too.

>I am

> anxious to hear your opinion on treatment options.

---Sorry, this can't do as a new kid on the block, haven't much exp.

to be offering to others along your line of needs.

HOwever, the last post I had put up, there is a co. that will do

testing on cancer cells, to see prior, which types of chemo will work

best. Wondered if anyone had ever had that done?

It is hard to cut thru the " jungle out there " and trial and error

sometimes looks to be the norm. when it sure shouldn't be.

Always the Best, Betty

[Guest guest]

Hi Donna,

I know its hard to help feeling nervous as the surgery

approaches...but try not to dwell too much on " what ifs " situations.

No reason to assume ANYTHING " unexpected bad " is going to happen,

just take this one day at a time!

First, please get an oncologist at the !!! This doctor will

know the surgeon and work with him. It is VERY important to find a

doctor you feel comfortable with to bounce questions off of...you

should NOT make decisions without thouroughly discussing with a

qualified oncologist who is directly handling your husband's case.

As other posters have said, chemo is indeed a " trial and error " sort

of thing...however, I did notice a very good trial at The which

your husband would I think be qualified for...it is

http://www.jamesline.com/output/content/CCCsite/ccc/Protocols/gas2.htm

Protocol ID: NSABP CI-66 (last one on the page)

You can get more info on this at the NCI webpage...here is a link but

you will have to COPY it into your browser rather than click on it

because Yahoo splits long links!

http://www.nci.nih.gov/clinicaltrials/view_clinicaltrials.aspx?

version=healthprofessional & cdrid=69011

Phase II Study of Hepatic Arterial Infusion With Floxuridine and

Dexamethasone Followed By Systemic Therapy With Oxaliplatin and

Capecitabine in Patients With Surgically Resected Liver Metastases

from Primary Colorectal Carcinoma

It is a very good trial (my opinion!) as these things go...combines

systemic therapy with HAI pump...uses Oxaliplatin + Xeloda, which has

had high tumor response rate - see for example

http://groups.yahoo.com/group/experimentalandunconventional/messages

post #841

[snip]

The combination of capecitabine (Xeloda) and oxaliplatin (Eloxatin),

or XELOX, is an effective and safe approach to the treatment of

advanced colorectal cancer, with the potential advantage of

convenience over standard combination regimens

You probably should at least consider this trial, along with the

other things you mentioned! The high preoperative CEA (in the

hundreds, right?) and the large tumor size are " bad " prognostic

indicators...there is probably more " hidden " disease in the

liver...the HAI MIGHT be able to help level the playing field, so to

speak...

<<The surgeon who did the colon surgery said he was certain he got

all of the tumor and got good borders but still mentioned a follow-up

with radiation>>

*********************************************************************

WARNING - - VIEWPOINT - the following is a personal opinion and

should NOT be taken as " medical advice " . I am NOT a doctor, have

ZERO medical training! YOU MUST DISCUSS THIS WITH A RADIATION

ONCOLOGIST - USE THE FOLLOWING ONLY AS A STARTING POINT FOR

DISCUSSION WITH A DOCTOR!!!

*********************************************************************

I have occasionally heard of individuals with COLON cancer (as

opposed to RECTAL cancer) getting radiation...however this does not

appear to be standard practice from all I can tell. Your husband has

COLON cancer, not rectal cancer, right?

According to the COLON cancer PDQ

http://www.nci.nih.gov/cancerinfo/pdq/treatment/colon/healthprofession

al/

(COPY link into browser!)

For stage III COLON cancer:

[snip]

" Improved local control with postoperative radiation therapy has been

suggested in patients with adherence or fixation to adjacent

structures.[1] An Intergroup trial designed to explore the role of

adjuvant combined chemotherapy and radiation therapy compared with

post-operative chemotherapy alone for selected patients with stage II

and III colon cancer was closed early because of low accrual.

However, preliminary results, published only in abstract form, have

not suggested a survival advantage from routine postoperative

adjuvant radiation therapy in this subgroup of patients. "

[stop snip]

For stage III COLON NOT RECTAL cancer, assuming the tumor did

NOT " break thru " the bowel, I don't think MOST radiation oncologists

would do radiation because it could have considerable toxicity with

pretty questionable efficacy.

Therefore, it would seem to me that for stage IV, assuming the tumor

did not break thru the bowel, the radiation would offer no benefit

either.

In stage IV, even if the tumor did break thru the bowel, there is a

MUCH higher chance of NONLOCAL metastatic recurrance than LOCALIZED

recurrence at the site of the primary. Radiation could only help

prevent LOCALIZED recurrence anyway. Therefore, the benefits of

radiation would probably be LESS than the benefits in stage III

(assuming these even exist!). Be careful!

Radiation may have considerable toxicity - moreso to the intestines

than to most other parts of the body. It can cause bowel obstruction

YEARS after it is given due to scarring in the intestines...it might

also cause lactose intolerance to develop, or possibly absorption

problems if the beams hit the small intestines. YOU SHOULD RESEARCH

THIS! I would ask a LOT of questions before doing it, carefully

studying the possible side effects/probability of those side effects

happening versus probability of localized recurrence prevention.

********************************************************************

But the above is just MY GUT FEELING, DO NOT MAKE ANY DECISIONS OFF

OF THIS BECAUSE I AM NOT A DOCTOR AND AM NOT QUALIFIED TO GIVE

MEDICAL ADVICE!!!! You need to talk to a RADIATION ONCOLOGIST at the

for advice as to the benefits and drawbacks of radiation for

your husband's particular case!

*********************************************************************

<<I also want to ask about Tagamet. My brother-in-law said that

it is not used routinely because study results have not been

conclusive, but I say if it won't hurt, why not try?>>

He is correct in that there have been no large, randomized trials

proving its effectiveness for stage III. Before the trial that I

mentioned in another post, there were several other trials which did

not seem to indicate nearly so strong an effect....in fact, I think

some of them showed no difference in therapy arms. So its hard to

tell what is going on without LARGE clinical trials. But like you

say, what exactly is there to lose? There ARE some possible side

effects for longer term use, but one could always stop taking it

should those start to appear....seemed to be reversable from what the

package insert says....

You should discuss this with the new oncologist as well, to make sure

he/she has no objections!

<<I was concerned that my husband's CEA had risen since his original

surgery, but my brother-in-law said not to worry because the tests

were done at 2 different facilities with 2 different types of

equipment. He said it is like " comparing apples to oranges " .>>

Hard to say...I guess a " huge " rise might indicate some sort of

increase, even if different labs were used (although obviously much

more inaccurate interpretation because of this). But why worry about

CEA prior to surgery anyway? Wouldn't increasing CEA be irrelevant

until AFTER surgery, when you hope it goes to 0 because they got all

the tumor?

Hope this helps...hang in there, things will work out!

Best Wishes,

> Hello,

> I tried to send this message 2 other times but had some technical

> difficulty so, here goes again. I am trying to get all my

> information in order so that if things do not go well next week I

> will know my options. The closer the surgery gets the more nervous

I

> get. As I said before, I am afraid of more bad news. We also don't

> have a medical oncologist at this time because we dismissed the

> previous one because he was not aggressive at all. He wanted to

> do " status quo " and wasn't even in favor of surgery when it was

> presented by our surgeon as an option! My brother-in-law recommends

> chemo post op to " mop up " any remaining microscopic disease. Here

is

> what looks reasonable to me after reading for several days...

> Xeloda, and oxaliplatin or Xeloda, leucovorin, and Camptosar. In

> addition, I will ask for the CEA vaccine if it can be done in

> conjunction with the chemo. The surgeon who did the colon surgery

> said he was certain he got all of the tumor and got good borders

but

> still mentioned a follow-up with radiation. My brother-in-law did

> not seem to think that was warranted at this time. I also want to

> ask about Tagamet. My brother-in-law said that it is not used

> routinely because study results have not been conclusive, but I say

> if it won't hurt, why not try? What do you think? Does this sound

> like a reasonable course? Is there anything I am missing? I was

> concerned that my husband's CEA had risen since his original

> surgery, but my brother-in-law said not to worry because the tests

> were done at 2 different facilities with 2 different types of

> equipment. He said it is like " comparing apples to oranges " . I am

> anxious to hear your opinion on treatment options.

>

> Donna M.