We met with Dr. Maloney Patel - a rectal-colon surgeon - on Friday, and she told us what we already suspected: with any carcinoid tumor over 2 cm - a right hemicolectomy must be performed.The procedure consists of removing the part of the colon that was closest to the carcinoid and re-attaching it to the small intestines. The lymph nodes in this general area will also be removed and biopsied. The results of the biopsy will help determine staging for the cancer.
The great news is, in Dr. Maloney's own words, this surgery is exactly "her bag" and she is specifically trained to do this particular surgery laparoscopically. Also, she can do the entire procedure in one shot - initially, we thought it was a two-step process and I'd need a colostomy bag. (YES!!! no colostomy bag!!) I am also planning to go to Sloan-Kettering for a second opinion, but all the literature we have read indicates this is pretty much what has to be done.
The only potentially "bad" news that we got is that my appendix was attached to my abdomen wall, and had to be cut away. It may have been just scar tissue and inflammation from the tumor that caused the attachment, or it could mean that the tumor broke through the appendix wall and started spreading to the surrounding tissues (Stage III).
Because my cancer is rare, Dr. Maloney is going to present my cancer to the Tumor Board at RWJ. The Tumor Board is an interdisciplinary monthly conference about diagnosis and therapy for recently diagnosed cancer patients. The participants include members of the medical staff (oncologists, pathologists, surgeons, internists), nursing, nutrition, pharmacy, social services, hospice and community outreach. The purpose of the Tumor Board is to facilitate clinical, radiological, and pathological findings. The input of all specialties is encouraged. Recent advances in cancer diagnosis and therapeutics are also presented.
Barring something unusual from the Tumor Board or Sloan-Kettering, I am planning to go forward with the next surgery on June 8, 2010.
1st June I had a right hemicolectomy. 8/22 lymph nodes affected, clean ends at astomosis - apparently no further metastases. Started chemo 5 days ago - Oxaliplatin + Xeloda - on 3-week cycle regimen - side affects - many and not good. Very supportive wife and family - taking mild exercise and eating OK. Bowels OK, but feeling dreadful. Seeing surgeon again on Thursday.
ReplyDeletePatrick - I'm so sorry that you are feeling terrible. I think there are different opinions as to what works re carcinoids and chemo; my understanding is that chemo is not a great choice...but perhaps since your lymph nodes came back positive, they want to be very aggressive. I might try to get a second opinion re your 3-cycle regimen - The Carcinoid Cancer Foundation has some links to experts on their website. I'll keep you and your family in my prayers. Good luck on Thursday.
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