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Underwent a right hemi colectomy to remove a malignant tumour. What does the biopsy result suggest?

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Oncologist, Radiation
Practicing since : 1989
Answered : 8 Questions
My father underwent a right hemi colectomy on XXXXXXX 29th to remove a malignant tumor. The summary of the biopsy report is:
Specimen type: right hemicolectomy
Specimen length: 985 mm
Tumour site: cecum
Tumour configuration: infiltrative, ulcerating
Tumour size: 55mm (addl dimensions 35 x 50 mm)
Histologic type: adenocarcinoma
Histologic grade: Low grade (well to moderately differentiated) (though before in the same report under 'opinion' it says moderately differentiated adenocarcinoma)
Pathologic staging: Primary tumour. pT3a/b: tumour invades through the muscularis propria into the subserosa or the nonperitonealized pericolic or perirectal soft tissues, invades 5mm or less beyond the border of the muscularis propria
Regional lymph nodes: pN0, no regional lymph node metastasis. Bumber examined 10. Number involved 0.
Distant metastsais: pMX cannot be assessed

Margins: proximal, distal, mesenteric, unresolved by invasive carnioma.

Lymphatic invasion, absent

Venous invasion, absent

Perineural invasion, absent

Intratumoral/peritumoural lymphocytic response, none

Other details that might be significant are that the tumour had caused a near complete obstruction, and my father's sister also had colon cancer and died from it more than ten years ago.

I would like your advice on whether he will need chemotherapy or not. My father is very reluctant to have chemotherapy done. And we, his children, are very scared of a recurrence, but given his gae (76 years) can't see him suffer the side effects of chemotherapy or cancer recurrence. Can you tell us your opinion please?
Posted Thu, 16 Aug 2012 in Cancer
Answered by Dr. J. Krueger 16 hours later

I am sorry to hear your father has colon cancer.

The good news is that all lymph nodes are normal (no cancer in all 10 lymph nodes).
This gives him a good prognosis. Most patients are cured with just surgery; 90 out of 100 are cured.

I do not recommend chemotherapy.
I do not recommend radiation therapy.
I do not recommend any special vitamins or herbs.
Most likely your father will live many years cancer-free.

Hope I answered your query let me know if you have any specific questions.
Above answer was peer-reviewed by
Follow-up: Underwent a right hemi colectomy to remove a malignant tumour. What does the biopsy result suggest? 2 hours later
Thank you very much for your answer, it has provided much relief!

My father's oncologist, who we had to XXXXXXX in secret yesterday because my father (he's a doctor himself) refused to go, has recommended chemotherapy based on there being less than 12 lymph nodes removed and the tumour having caused a near total obstruction. He's suggesting oral chemotherapy. He has also suggested a PET scan to make sure there are no tumours anywhere else in his body.

I know this might be difficult for you to answer, but do you think there is anything in his argument for chemotherapy? If we decide against chemotherapy based on your advice, which appeals to us greatly, is there anything we should do to monitor the situation to make sure there is no recurrence?

I would highly appreciate your advice.
Answered by Dr. J. Krueger 16 hours later
Thanks for writing back.
Your oncologist brings up two reasons which might suggest the need for chemotherapy.

Your father had 10 lymph nodes removed. Oncologists like to see at least 12 removed to be sure the patient is truly without spread to the lymph nodes. I personally feel 10 is an adequate sample so I would not worry about this.

Complete bowel obstruction is an indication for chemotherapy, but your father had near total obstruction, not total obstruction. So I do not feel strongly that chemo is indicated, but there are many chemo experts that would agree with your father's oncologist.

The oncologist is suggesting an oral chemo, probably Xeloda. Xeloda is generally well tolerated by patients (mild side effects), so if your father decides he wants chemo, he would probably find that taking Xeloda is fairly easy.

A PET scan is a very good test to look for spread of cancer. It is an easy test for the patient. If your father canot afford a PET scan then substitute a CT scan of the chest/abdomen/pelvis with contrast injection.

Whether or not your father has chemo, he should visit his oncologist every 4-6 months for a check-up.
Hope that helps
Above answer was peer-reviewed by
Follow-up: Underwent a right hemi colectomy to remove a malignant tumour. What does the biopsy result suggest? 2 days later
Thank you Dr, Kreuger. I have discussed your advice with my father. The oncologist we consulted here, though he suggested chemotherapy, I noticed he has written in his notes that adjuvant chemotherapy would prevent recurrence 'theoretically speaking'. This, to me suggests, that even he has doubts about its actual benefit - it is not a categorical recommendation to have chemotherapy.

Taking into consideration your advice and that chemotherapy side effects might adversely affect the good recovery my father is making at the moment, and also the fact that my father feels he is fine and is reluctant to consider any further treatment, we have decided against chemotherapy.

Thank you for your advice. I am grateful to you for your help and am hopeful my father will remain well for many years, as you say.

Best wishes
Answered by Dr. J. Krueger 3 hours later

You should commend yourself for actively researching treatment options for your father. Delivering chemotherapy for his stage of cancer is controversial, some oncologists recommend chemo, others do not.

You and your father have discussed the pros and cons of chemo. You all have come to the conclusion that the indications for chemo are marginal, and that the side effects outweigh the benefits. You have made a very reasonable decision.

I wish your father many years of good health!

Dr. Krueger
Above answer was peer-reviewed by
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