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This question was answered on Thu 20, Mar 2008 12:23am by Dr Heinrik M, MD

stage 3 colon cancer - chances of recurrence and treatment options


    
Asked by tcbryant (Male ) on Wed 19, Mar 2008 11:01pm

In July of 2007 my husband had a colon resection done with about 1.5 feet of his colon removed due to stage 4 colon cancer (sigmoid area). It had gotten thru the colon wall and into the venus artery. He finished chemo in January 2008. What are his chances of getting cancer again and how soon might he get it and if he gets it again how long do you estimate he will have?? I know this is a hard question but I really need a blunt answer if possible so I can prepare myself as much as possible. We are obtimistic but realistic. He still has bad neourapathy of the feed and hands & it is really hurting him. Any suggestions on medications the doctor might prescribe for him?

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Answer by Dr Heinrik M, MD  on Thu 20, Mar 2008 12:23am:

Hi, The risk for relapse is based on the extent of disease (there are subclassifications of stage 3, based on number of lymph nodes involved and variations on how deep were the layers of the bowel wall involved in the primary site), his age, the presence of other diseases like heart disease, hypertension, etc.). An estimate of disease recurring is a 5 year recurrence rate. This estimates the percentage of patients who get a relapse within 5 years. So that if there are 100 patients with cancer, and the recurrence rate is 50%, about 50 of the 100 patients would have cancer again within 5 years. Most relapses occur within the first 2-3 years. If he is about 60 years old without any other diseases, and with minimal involvement of lymph nodes (1-3 lymph nodes showed cancer): 5 year recurrence rate without any chemo is about 49%, with chemo this is reduced to 23% If he has more lymph nodes (more than 10 nodes showed cancer): 5 year recurrence rate or death without any chemo is about 96%, with chemo this is reduced to 67%. Bear in mind these are estimates that the disease has returned, not risk of death due to the disease. There is also an estimate of this, which you asked in your other post. The chances of getting pain would of course be a function of the recurrence rate. Cancer pain would also depend on the what structures the cancer may involve. For colon cancer, most of the metastasis would involve the liver, it is usually detectable before the pain occurs. Bone metastasis commonly has cancer pain, but colon cancer does not usually involve bone. Other sources of pain would be extension into the nerves near the primary site, local extension is typical for rectal cancer not for colon cancer. However way things go, if the cancer returns –pain would always be addressed so I don’t think this should distress you. The neuropathy is likely due to the chemotherapy (this is not cancer pain). It may be helpful to give Vitamin B supplements (if it is due to Fluorouracil - a drug commonly used in colon cancer), but if it is due to the Oxaliplatin, there is no specific therapy, however it is expected to improve with time. Best to avoid what triggers it, such as cold temperatures. If the cancer returns, average survival is about 2 years. Keep in mind though, that when the cancer returns and it is limited (say a single nodule in the liver only), there is a chance of cure with surgery which could provide a survival superior to the 2 year average. So if it comes back, a re-evaluation must be made to help you make the most appropriate decision.

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