Colorectal cancer Surgery: Watch and Wait

Posted by kiva @kiva, Sep 17 3:12pm

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

Interested in more discussions like this? Go to the Colorectal Cancer group.

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

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

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@kiva

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

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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?

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@colleenyoung

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?

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I’m unsure. The surgery is so life altering.
One could have the surgery and a cancer cell could still pop up somewhere.
The fear is waiting and if cancer spreads, there may not be a surgery choice.
The T4b is said to be scar tissue.
Yes, a second opinion would be helpful perhaps. But the surgeon and team have been great and there’s a strong trust for the surgeon.
Thank you for the response!

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After 8 weeks following a first biopsy, the surgeon is running all tests again. After being put under anesthesia for a second surgical biopsy, surgeon says he was “unable to get in far enough” to perform the biopsies. So we are waiting for the other test results like PET, MRI, etc.
The question, what what cause the difficulty for a surgeon getting in “far enough” for this surgical procedure?

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@kiva

After 8 weeks following a first biopsy, the surgeon is running all tests again. After being put under anesthesia for a second surgical biopsy, surgeon says he was “unable to get in far enough” to perform the biopsies. So we are waiting for the other test results like PET, MRI, etc.
The question, what what cause the difficulty for a surgeon getting in “far enough” for this surgical procedure?

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How unsettling. @kiva. I moved your question to your original discussion to keep you connected with @daledales and to also bring in @jalamc into this discussion.

– Colorectal cancer Surgery: Watch and Wait https://connect.mayoclinic.org/discussion/colorectal-cancer-surgery-watch-and-wait/

I cannot venture a guess as to what "far enough" means. I would continue to get clarification from your surgeon. How was the biopsy done – during a colonscopy?

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Muchas Gracias, seguimos conectados.

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@colleenyoung

How unsettling. @kiva. I moved your question to your original discussion to keep you connected with @daledales and to also bring in @jalamc into this discussion.

– Colorectal cancer Surgery: Watch and Wait https://connect.mayoclinic.org/discussion/colorectal-cancer-surgery-watch-and-wait/

I cannot venture a guess as to what "far enough" means. I would continue to get clarification from your surgeon. How was the biopsy done – during a colonscopy?

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Well, the “procedure” was supposed to be a surgical biopsy requiring anesthesia. In recovery, patient is told “no biopsies were done” because surgeon could not “get in far enough.”
Next step, look at PET scans to “determine” if the surgical biopsy is “tried again.” ?

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My first recent biopsy wasn’t able to get to liver lesion or other spot. Total waste. Went in for another one with different doctor. This is for recurrent colon cancer with metastasis to liver and omentus. Second doctor invented what he called a bowl. He designed it and printed it out on a 3d printer. I think it sort of flattens the area so it is easier to get to. It has holes inside the bowl for getting needle in. He was able to get samples of both area.

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