Wednesday, November 21, 2007

An Unwanted Journey: Day 0726 - Marginal Highlights

If you've followed this unwanted journey thread for the past two years, you'll know that there is very little I consider off limits. Whether it's radiation proctitis, chemotherapy blues, post-surgical complications, enduring neuropathy, or even the clinical value of optimism - I've reflected on them all.

More recently, I've avoided writing about some of the material arriving in my Inbox from Google Alerts - typical stuff related to diet and cancer, vitamin D, grape extract, coffee, etc. Frankly, it gets a little tedious and predictable.

But in a week, I'll be having another colonoscopy, almost two years to the day from my diagnosis. I'm not really nervous, but it's on my mind. Today, something arrived in my Inbox about prognostication for those who have undergone anterior resection surgery for advanced rectal carcinoma; in other words, something specifically about me.

Researchers looking at 201 cases with locally advanced rectal cancer analyzed the circumferential margin involvement (CRM) in the excised tumors of the patients. This is a technical measure which looks at whether any malignancy is found in the margin of the tumor.

What most rectal carcinoma survivors fear is local recurrence, meaning another instance of rectal carcinoma in roughly the same region as where it was originally found. Local recurrence is very bad news.

CRM is the acronym for circumferential margin. If the CRM showed no evidence of malignancy, then only 8% suffered local recurrence, whereas 43% of those with CRM involvement had a local recurrence.

It gets even a little more detailed. Those of us who have had anterior resection surgery either had radiation therapy before surgery or combination radiation and chemotherapy. In both cases, the surgical oncologists are hoping for a regression of the tumor before surgery. This makes it easier to do the surgery as well as to get a good CRM for the pathologist who will examine the tumor.

This study indicates that the amount of tumor regression doesn't seem to correlate with prognostic factors. In other words, regression alone doesn't seem to matter much as far as your survival is concerned. But having a free CRM does matter a great deal.

As I get closer to my follow up colonoscopy, the worst possible news would be evidence of local recurrence. What I anticipate is a completely benign result. My surgeon always gives me bad news quickly and directly, so as long as I don't hear from him until my scheduled follow consultation a couple weeks later, I'll be a happy man.

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