Colorectal cancer Surgery: Watch and Wait

Posted by kiva @kiva, Sep 17, 2022

A 30 year old female patient, stage III and T4b with colorectal cancer (cancer cells also in vagina) has neoadjuvant chemo to shrink the tumor for surgery. The treatment didn’t work. Additional chemo and radiation therapy was given for about 2-3 months to stall growth to prepare for surgery.
Biopsies and PET scans now show no cancer cells.
The surgeon is recommending WW - watch and wait for 6 weeks…stressing the surgery is life altering and she is “so young.” Surgeon says he will do the surgery if she wants, but pushes for waiting.
Has anyone ever been advised to take this approach? Is it possible she could be “cancer free.”
Biopsies also show the cancer cells have turned “mucinous” according to the surgeon, but he states there are no cancer cells. Can this be?
Thanks in advance

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Colleen Young, Connect Director | @colleenyoung | Sep 24, 2022

In reply to @kiva "What a thoughtful and helpful response. Thank you so much!" + (show)

Hi Kiva, I agree that @daledales' experience and post is really helpful. How are you feeling about the watch and wait approach? Have you considered getting a second opinion to feel confident in the approach?

kiva | @kiva | Sep 19, 2022

What a thoughtful and helpful response. Thank you so much!

billbills | @daledales | Sep 18, 2022

Waiting for 6 weeks after chemo to have surgery can be a common approach.

I was stage III rectal cancer. I had chemo and radiation. I achieved complete pathlogical complete response (pCR). I am on a watch and wait protocol. I have alternating CT and PET scans every 6 months, along with blood tests and CEA, 3 months physical exams, yearly colonscopies. 1 1/2 years no issues. I did not have surgery. For me, this approach was a great solution. I also recently had a ctDNA test blood test to look for residual cancer, it was negative. This test is still new and not covered by many insurance policies.

Memorial Sloan Kettering has been leading the effort on watch and wait.

Read, develop questions, talk to several medical professionals, read some more, and make a decision that is right for you. No guarantees with any approach but statistics can lead you to an informed choice, it may not work out but at least you took an informed path. Risk and rewards should be balanced in any decision. Good luck.

Attached is some reading material, you may need to register to read, but it is free information.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422545/
https://www.nejm.org/doi/full/10.1056/NEJMoa2200075
https://pubmed.ncbi.nlm.nih.gov/32561971/
https://www.mskcc.org/news/how-watch-and-wait-approach-may-help-people-rectal-cancer-preserve-their-quality-life