Rectal Cancer - Hospital Recommendation

I had a transanal resection when we thought the polyp I had was pre-cancerous. The post op biopsy revealed positive margins (rectal cancer). My surgeon at the time and the oncologist said no new surgery because of closeness to the sphincter and because at eyesight there is nothing left to see. So I had radiotherapy.
8 months after the RT, when looking for a second opinion on how to fix the rectovaginal fistula it had provoked, my current surgeon was a different opinion. He said they should have operated again and taken a wait and see attitude in relation to radiotherapy. A third oncologist who is also a surgeon was of the same opinion.
So, @mrt2024 , if you can take a second opinion, do so before taking a final decision about your treatment.

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Today, we finally had the opportunity to meet with the oncologist. We addressed all the questions lingering in our minds. Unfortunately, there is also a tumor detected on my father's right kidney. The report indicates it as "suspicious," raising concerns about a second primary cancer. It is not related to colorectal cancer. It is kidney renal cancer. I asked whether it was definitive, and if not, how we would determine it. The response was that a biopsy isn't conducted for that; there's a 90% chance that it is cancer. Therefore, we proceed with treatment as if it were cancer, but it's also necessary to consult a urologist. The cancer is classified as stage 1.

Despite the situation, I'm trying to stay optimistic, considering the 93% treatability rate I found online.

Regarding the rectal cancer, it's classified as stage 3. The oncologist mentioned a treatment success rate of over 70% if we opt for chemotherapy, radiotherapy, and surgery. There's no invasion of the anal sphincter, and due to the tumor's location, a temporary colostomy will be required, no permanent one, which is another bright side for us. He added, without chemotherapy and surgery, the success rate drops to 50%. My father is inclined towards pursuing all treatment options.

Once we've consulted the urologist and radiation oncologist, a treatment plan will be determined—whether to begin with chemotherapy followed by radiotherapy and then surgery, or to initiate radiotherapy with low-dose chemotherapy followed by surgery.

We were contemplating seeking a second opinion. The oncologist assured us that we have time; the rectal cancer's current stage won't suddenly progress to stage 4. However, we're hesitant to delay appointments with another set of specialists—urologist, radiation oncologist, and medical oncologist—to make a decision. It's a challenging decision to make. Additionally, I'm uncertain whether we need to consult all four doctors for a second opinion or just one. If only one, which specialist should it be? Another surgeon or a medical oncologist? We have another appointment scheduled with my father's surgeon on Thursday, and I'll inquire about his perspective then.

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Having another tumor elsewhere makes quite a difference. Do ask all the questions you can think of. You can consult https://fightcolorectalcancer.org/facing-colorectal-cancer/diagnosis-and-treatment/know-your-treatment-options/; it might help you define your questions.

There is a surgery that avoids a temporary colostomy. You could ask if it's an option for your dad. It's called a two-stage Turnbull-Cutait pullthrough (with coloanal anastomosis).

Also important is to maintain a positive attitude, trusting that you're getting the best care available to you.

Sending a big hug.

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Thanks a lot. I didn't know that option. I'll definitely ask that option to the surgeon tomorrow.

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Today, we finally had the opportunity to meet with the oncologist. We addressed all the questions lingering in our minds. Unfortunately, there is also a tumor detected on my father's right kidney. The report indicates it as "suspicious," raising concerns about a second primary cancer. It is not related to colorectal cancer. It is kidney renal cancer. I asked whether it was definitive, and if not, how we would determine it. The response was that a biopsy isn't conducted for that; there's a 90% chance that it is cancer. Therefore, we proceed with treatment as if it were cancer, but it's also necessary to consult a urologist. The cancer is classified as stage 1.

Despite the situation, I'm trying to stay optimistic, considering the 93% treatability rate I found online.

Regarding the rectal cancer, it's classified as stage 3. The oncologist mentioned a treatment success rate of over 70% if we opt for chemotherapy, radiotherapy, and surgery. There's no invasion of the anal sphincter, and due to the tumor's location, a temporary colostomy will be required, no permanent one, which is another bright side for us. He added, without chemotherapy and surgery, the success rate drops to 50%. My father is inclined towards pursuing all treatment options.

Once we've consulted the urologist and radiation oncologist, a treatment plan will be determined—whether to begin with chemotherapy followed by radiotherapy and then surgery, or to initiate radiotherapy with low-dose chemotherapy followed by surgery.

We were contemplating seeking a second opinion. The oncologist assured us that we have time; the rectal cancer's current stage won't suddenly progress to stage 4. However, we're hesitant to delay appointments with another set of specialists—urologist, radiation oncologist, and medical oncologist—to make a decision. It's a challenging decision to make. Additionally, I'm uncertain whether we need to consult all four doctors for a second opinion or just one. If only one, which specialist should it be? Another surgeon or a medical oncologist? We have another appointment scheduled with my father's surgeon on Thursday, and I'll inquire about his perspective then.

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I'd like to bring @dsh33782 (Don) into this discussion. Don didn't have rectal cancer, but rather inoperable esophageal cancer that was successfully treated with chemotherapy and radiation. Shortly after treatment for esophageal cancer, kidney lesions were discovered and shown to be cancerous - a second primary cancer. He was successfully treated for renal cancer too. I may be getting some of the details or timeline wrong. Don, please correct anything I mis-represented.

@mrt2024, I'm sharing Don's story hoping to offer you and your father hope. I know it's a lot to absorb and deal with, not one but two cancers. I'm sure your dad is grateful to have you by his side. Keep asking questions of the cancer care team. And if we can help with first-hand experiences, we will.

Regarding how many specialists to consult for a second opinion, is it possible that they will confer together? This is sometimes referred to as a tumor board where all team members discuss the case together. They do this a many cancer centers, including Mayo Clinic.

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This was the surgery I had to preserve my sphincter and avoid a colostomy at the same time. Should it be an option for your dad and should you, your dad and the doctors decide to go for it, feel free to contact me for a patient's view of what it is like.

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I'd like to bring @dsh33782 (Don) into this discussion. Don didn't have rectal cancer, but rather inoperable esophageal cancer that was successfully treated with chemotherapy and radiation. Shortly after treatment for esophageal cancer, kidney lesions were discovered and shown to be cancerous - a second primary cancer. He was successfully treated for renal cancer too. I may be getting some of the details or timeline wrong. Don, please correct anything I mis-represented.

@mrt2024, I'm sharing Don's story hoping to offer you and your father hope. I know it's a lot to absorb and deal with, not one but two cancers. I'm sure your dad is grateful to have you by his side. Keep asking questions of the cancer care team. And if we can help with first-hand experiences, we will.

Regarding how many specialists to consult for a second opinion, is it possible that they will confer together? This is sometimes referred to as a tumor board where all team members discuss the case together. They do this a many cancer centers, including Mayo Clinic.

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I am going to ask to doctor pros and cons if this procedure applicable to my father. I would like to hear if you had unexpected challenges or complications during your recovery period.

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It's truly overwhelming to absorb everything. I'm grateful that I'm not facing this alone; my three sisters and mom are all here to support my father. My father seems okay if he is not pretending. That's a relief. However, my oldest sister's pessimism weighs heavily on us. Despite my efforts to share survival statistics and details with her, she remains unconvinced. We make an effort to maintain a cheerful atmosphere around my father, but her attitude makes it challenging.

I'm trying to understand her feelings, but we all need strength to cope. Our conversations have prompted me to delve into the possibility of recurrence. Questions flood my mind: Will it return, and when? The odds of recurrence within five years are around 28%. Is it inevitable? He is 66 now. If it recurs in a decade or earlier, could it metastasize? Will he endure chemotherapy and surgeries again? Will his suffering be severe?

Even though it is difficult, I don't want to dwell on these uncertainties, I want to focus on the present. I hope for his successful treatment with minimal side effects and complications. However, maintaining optimism can sometimes be challenging.

My mother is another worry. At 76, we fear the toll this ordeal might take on her. She's currently unaware of the kidney cancer diagnosis. We've decided not to tell her until after the surgery.

@dsh33782 Thank you for sharing that. Our appointment with the urologist is this Friday. We don't know yet which treatment will be the first, rectal or kidney cancer. It is stage 1 and I don't know if it is gonna be partial nephrectomy or full nephrectomy. Unfortunately, my father also has stage 3 kidney disease. He has been on pill for about 6 years. Is there anything in your mind that I should ask to the doctor?

Thank you both.

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