Some Colon Cancer Patients do not need Chemo

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http://www.medicinenet.com/script/main/art.asp?articlekey=89574


Not All Colon Cancer Patients Need Chemotherapy: Study
By Amanda Gardner
HealthDay Reporter

FRIDAY, May 16 (HealthDay News) — Colon cancer patients with a specific subset of the disease don't need to receive chemotherapy. In fact, not only does chemotherapy not benefit this group of patients, it may actually harm them, a new study found.
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"If you are found to have [this type of colon cancer], then you should not be treated with chemotherapy. Surgery alone would be standard treatment," said Daniel Sargent, lead author of the study and a professor of biostatistics at the Mayo Clinic in Rochester, Minn.

"In our data, patients who have [this type of cancer] who had surgery alone had a 93 percent survival at five years. In our study, chemotherapy actually lowered survival to 75 percent. So, we have a group of patients who can be spared the toxicity, the expense and the inconvenience of treatment and have a very good outcome even without any [chemotherapy] treatment," Sargent said.

The findings, presented Thursday at the American Society of Clinical Oncology annual meeting, in Chicago, confirm previous research and now give physicians a clearer roadmap for treatment, the study authors said.

About 15 percent of colon cancer tumors are known as deficient DNA mismatch repair (dMMR) tumors, because they have lost the ability to repair DNA damage. This particular type of tumor seems to be less aggressive than other forms of colon cancer, the researchers said.

A study published by the same group of researchers in 2003 in the New England Journal of Medicine also found that this subset of patients did not benefit from standard chemotherapy for colon cancer. Because the finding was so novel, the results needed confirmation before they could be incorporated into clinical practice. This new study offers that confirmation, the researchers said.

"We're talking about patients with early stage colon cancer. These are patients who sometimes get chemo and sometimes do not," Sargent said. "We have sought for a long time to try to determine if there was a way to predict which patients might benefit from chemo and which might not."

But, Sargent added, "we felt that in order to really recommend this in clinical practice, we needed to validate it."

The new study analyzed data from 1,027 patients in the United States as well as Canada, France and Italy who had participated in previous trials. Sixteen percent had dMMR.

"The goal was to validate that the 15 percent of patients who have defective mismatch repair did not receive any benefit from 5-FU therapy, and that is indeed exactly what we found," Sargent said.

"We now feel this is appropriately validated for clinical use," he added.

In fact, there is already a simple test for this type of cancer.

"The test is available and, in a patient with stage 2 disease being considered for treatment with chemotherapy, we think that this test would be useful," Sargent said.

One Year Anniversary - and a Toast!

"All Hail the TriLyte"

Why am I writing to you? Well, the reason is obvious. I am approaching the one year anniversary of my surgery - that is One Year N.E.D. No Evidence of Disease. A milestone for sure.

But let us not jump to early conclusions. With that date approaching, I am embarking on my annual colonoscopy - which will occur tomorrow morning. And this will help determine whether I indeed get the stamp of NED for the year. Yay!

So the process involved now, at this very instant, is the official drinking of the major laxatives to clean out my intestines. You missed it, a couple of hours ago, I celebrated the popping of the four laxative pills. I think they had the insignia of a skull and crossbones on them.. Anyways...

So if you will, let us raise our cups of TriLite (basically propylene glycol and water, with a so-called cherry flavor additive) and have a swig. It cleans you out real nice like. ooo weee!

Smile, as you step a little closer to the bathroom door.. And remember that its a small price to pay for early detection of a possible recurrence.



This isnt TriLyte, this is something I saw a few doors down from a bar called The Twisted Spoke, in Chicago.

So this is what I have been doing...

As you can see, there is some work going on.


Biking, Yoga, walking, lifting weights... Spring Cleaning...


My diet has been consistently healthy too. I have been getting back into things and in general bouncing back to my old self. And that is why there have been some weeks between posts.


Soon things should be back to normal. As this occurs, I will be posting here less frequently. It is time to get out and have some fun.

I promised my self that I would post a new blog entery and so here it goes.

First off, I was in to see my Oncologist again last Wednesday for a monthly examination. I am pleased to say that everything continues to be going well and I am disease free - N.E.D. The next appointment will be in three months.

Acupuncture takes care of most of the neuropathy for most of the week and every week I see lasting improvements in that area. I know it is helping because this week I cancelled my appointment and can feel the difference.

The other good news is that I have been gaining weight slowly but steadily too. Im really only 5 lbs lighter than I used to be at this point.

Winter has been hanging around a little more than I would like. Its the middle of April here and it snowed last night. This is sort of a good metaphor for the uncertain times that Im going thru right now.

Recovering well

Has it been 7-8 weeks since I finished chemo already?  Time flies and I am happy to say that I have been recovering nicely.  I have been back at work full-time for a while now.  My appetite is way up and I have been going out on the weekends and am on a decent workout schedule too. 

The Erbitux rash has cleared up and there are some remnants but nothing to get excited about.  I do have to limit my exposure to the sun this summer though.  Sunscreen and a wide brimmed hat were recommended by the doctor. That wont be stopping me from having fun though.  

My weight has been climbing back to normal too.  I have a ways to go.  Met with a nutritionist at Northwestern and she told me that I need to eat 2,500 calories a day in order to gain one pound a week. That means I get to eat like a pig for another 10 weeks.  (sigh)

I have been lifting heavier and heavier weights, attending a pretty challenging Yoga class, and still doing acupuncture weekly too.

I go my hair cut and lo and behold it is no longer curly. It is straight now. Told my barber to style it differently and suddenly started getting all kinds of complements.  Really that is fun, and I am starting to get flirty again.  

I feel pretty good these days.  Lots of energy.  As a matter of fact I feel so good, that sometimes I wonder  if I am "overdoing it" and need to purposely take it easy and rest a little more.  Well probably I dont want to drive myself too hard just yet.  But even the memory of going thru chemo, feeling yucky, etc.  is fading fast, yet I still have the subcutaneous port in my chest (which I dont even feel really)  

On the flip-side, what lingering effects I do still have is the dreaded neuropathy I was trying so hard to avoid.  I have that and it is not good.  My fingers and feet oscillate between being either numb, or sensitive and tingly.  My fingertips are very tender and the fingers themselves are, at times, weak and clumsy.  Because of this, activities like typing, playing the guitar, and writing are somewhat diminished.  This neuropathy will take the longest to go away, anywhere from months to years, and I would say that it represents a significant source of distress for me.  Acupuncture, B-100 tablets, and L-Glutamine capsules is the therapy that seems to get mentioned the most and that is what I am doing.  It should improve much over time, but there are plenty of survivors out there who, years later, continue to have neuropathy.  I will be very happy when I am able to play the guitar like before and am dedicated to making it happen.

So...

well.. 

I did not get the 12th round of chemo.  My Oncologist said that I had enough.  Even though all I felt was weakness, I guess it was a serious event that sent me to the hospital.  Getting dehyrated from the chemo was the tip of the iceberg because the chemo stays in you for a while and it would have continued to dehydrate me unless I was receiving fluids and being monitored 24/7.  I found out that my White blood cell count was only 500, where 4,300 is the very bottom of the normal range.  I also lost weight until I was only 118 pounds.  

While in the hospital I had some tests done.  An ultrasound of the liver came back totally clean.  Also a chest x-ray and blood test came back saying there was no evidence of disease.  Further examinations also came back great.  

Three weeks later, I was at my primary physician's office and got another chest x-ray because I had a bad chest cold and was coughing a lot.  That is all gone now..

My schedule now will be to meet with my Oncologist every month for the next 6 months, then every two months for the first year, then every three months, etc.  to be evaluated.  I will have a yearly colonoscopy now for the next 5 years.  

Other than that I am free to walk the planet.  I am to limit my alcohol intake to only 2 drinks a day and should avoid red meat, and should eat a lot fish, and fruits & vegetables and other nutritious foods.  I should really cut back on sugars too.

I have been building my strength slowly and feeling better.

Getting Back to Normal

Whew...

I was hospitalized for 6 days and have been home now for over a week. I have been recovering still and have had an at-home nurse come in three times to administer m0re fluids.

It was determined that the cause of this was a reaction to the chemo. I guess the toxicity of the chemo grew to a high level in my system and my body decided it had enough.

At the height of this dehydration, I weighed only 118 Lbs. A week and 1/2 later, I've already gained 10 lbs back.

Feeling much better, my appetite has returned, and a lot of my energy has returned too.

Now I am feeling like creating some new music.

Resting up and drinking chicken soup today.  On Tuesday I will meet with my 

Oncologist to be evaluated.  At that point I will find out whether they recommend a 12th round of chemo, or if it is too toxic.

Bump in the road

Like all things, sometimes there are bumps in the road that must be dealt with. I practically sailed through the first 10 rounds of chemo (they say), but it didnt work that way for the 11th. -So close to the end -

But I am writing to you in the hospital now. Somehow yet to be determined... I either caught a bug, took too many antibiotics, or from the chemo itself, my GI tract had a reversal of fortune, and over the course of 10 days, I became extremely dehydrated. and worn out and weak. I have not really eaten anything in 5 days because I couldnt keep it in me. Kinda gross to talk about, but somewhat typical of chemo. I lost almost 20 lbs in 2 weeks.

This sudden change of events scared me and I went into the Onc office two days in a row to get fluids - 3 liters in all, but it wasnt enough. So they told me to check into the hospital. Im in the hopsital now getting fluids and they are doing some tests to rule out what this is exactly and get me back on my feet. I only had one round of chemo left after this and want to get it too. But there is talk that they might end it now. Or really lower the dose.

The good news is that my stomach is finally settling down and eventhough the real test will be when I can eat something and everything is fine, but I feel good about things now.
I should be out of here in a dayh or two

the computer im using at the hospital _ the keyboard really sux so please excuse the typos and i will fix er up as soon as im fixed up>

more later

YAY -

Just a quick note to say that I have only 2 big treatments left now. Should be done by the beginning of February.

Acupuncture

(So you guessed it - I got a stunt double, a Gibbon, if you will, to pose for an acupuncture photo.)

Today is a little over 4 days since the start of my 8th round of chemo. I'm starting to bounce back from it, although we had our first big snow storm here and now the neuropathy occurs more often and more easily rears its head. The cold snow on the ground gives me painful tingling in the feet. Bad noooze. But liveable - for 8 more weeks.
Luckily I am getting acupuncture on my hands and feet to counter its total effects.

Acupuncture is a medical treatment that is 5000 years old.

For many weeks now I have been going to see Dr. Lee, a Doctor of Chinese Medicine, to treat the neuropathy that usually accompanies the chemo that I'm on. The Oxaliplatin causes extreme tingling in the hands and feet, and also causes an extreme pain reaction to cold temperatures. There are days when I don't want go into the refrigerator to get anything because it is too cold. Luckily, the acupuncture makes this reaction short-lived and temporary. (There are many reports of this neuropathy setting in and lasting for an undetermined number of months and even years after chemo ends. That fear has been a big issue for me all along.) I get the neuropathy for minutes at a time, or only when touching something cold, but only during the week of chemo. Other than that it goes away. And I hope it stays away.

Let me tell you, yes that is my hand. If you have never done it before, the needles don't hurt at all. And I usually fall asleep or at least into a relaxed state when they are applied. They stay in for 30 minutes at a time and I only go once a week. But it works.

Other acupuncture that I have done at the same time has alternated between different points on my neck and head, for a boost to my immune system when needed, or the stomach, for an increase in energy. Some of the points are for the liver as well (Those points are located on my feet and called Liver 3.) I had some needles in my knees once which promote circulation.

There is much to say about the theory and science behind acupuncture. I learned a little about it. This much I know just from reading here and there... It has been shown to be beneficial for many ailments. How it works however is not entirely known. Basically the needles act as a stimulus to influence physiological functioning of the body. There is an energy flowing throughout the body called Qi. When the flow of this energy is blocked, insufficient, or otherwise suppressed, then illness can occur. Qi travels throughout the body in channels, and at specific points, these channels come up to the surface of the skin, where acupuncture needles can access them. The acupuncture restores the flow.

Acupuncture raises various hormones and white blood cell counts, although it is not known how this occurs. It is also known to successfully treat a variety of diseases, illness, and injury. So far it has worked for me and the neuropathy that is associated with Oxaliplatin.

Dr Lee is at Chinese Healing Art, 1854 Clavey Rd, Highland Park, IL. Tel: 847-831-1609.