Rectal Cancer - Hospital Recommendation

I completely agree with Paul! And the radiation will make him so much more vulnerable. I was in the same situation, and I had five short courses of radiation to shrink the tumor as much as possible before surgery. Three weeks after surgery I started my chemo, no more radiation.

If only making a decision could be this easy. There is a lot of information out there.
"If... those patients can skip radiation."
"If...those patient can skip surgery, but... watch and wait..."
"micrometastasis, TNT, adjuvant, neoadjuvant..."

What I know so far is that relying solely on surgery decreases the 5-year survival rate. Lymph node involvement is a concern, and without shrinking the tumor, surgery becomes difficult and poses a risk for recurrence. On the other hand, even the colorectal surgeon did not recommend undergoing surgery before trying other therapies.

There is 20%-30% chance we may skip surgery if there is a complete response. Do we want to skip the surgery? We are not sure because it brings its own risks.

It is really difficult to know what option is the best.

You had radiation>surgery> chemo. This is the thing I want to understand. Which one is the best approach? Followings are what we were told so far:

Radiation( more than regular one) > Chemo > Surgery (If no complete response)

Chemo> Radiation> Surgery ( If no complete response)

Chemoradiation> Surgery

My surgeon went to the tumor board at MUSC in Charleston with my case.I had T3N2 (stage 3) colorectal tumor with lymph node involvement.
Everyone agreed my tumor wouldn’t shrink to nothing no matter how much radiation and chemo. So prior to surgery I had just enough radiation to shrink the tumor and make the margins easier. She removed 26 lymph nodes - 16 were cancerous. That’s why after the surgery the chemotherapy with FOLFOX was recommended.
Maybe someone with earlier stage cancer and a smaller tumor would benefit from neoadjunct therapy. I did not.

My father's is T3dN2 rectal tumor, stage 3. On the report it says 4 or more suspicious regional lymph nodes. We have never asked, and we were never told how much the tumor will shrink, if we go with chemo first, or go with the other options. It seems this is going to be my first question once we meet the oncologist again.

Thank you.

Good plan. Have you spoken with the surgeon yet? Do you have a great one? Do they report to a tumor board to get multiple input for what treatment and protocol to go with?
That should be your next conversation. Not another with the oncologist. The surgeon will make all of this so much clearer!

We were looking for another surgeon to get a second opinion, and whoever we asked, we were given the same name: our surgeon. I believe he is good. I think all of them talk with each other because whenever we visit one of them, they mention discussions between each other. I'm not sure if this is called a tumor board. We met with the surgeon again after meeting the medical oncologist, and the surgeon said, 'You will not see me for a year.' Also, he was the first person mentioning about avoiding surgery if there is a complete response. He said chemo and radiation are necessary.

The medical oncologist did not inform us of the plan during our initial meeting. It was our first visit, and the focus was on addressing the kidney cancer issue, and to give us some general information about treatment of rectal cancer. He or they recommended kidney surgery as the initial step, allowing time for healing before deciding on subsequent steps. Following the kidney surgery, we consulted with a radiation oncologist, which left us feeling confused. We plan to meet with the medical oncologist soon to discuss the next steps.

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