Colorectal Cancer Staging and Treatment: A Patient's Journey

Malignant tumor of the descending colon?

Hello.
I would like to ask the doctor about my mother's recent issues.
1.
Due to long-term constipation, she was diagnosed with intestinal obstruction, and further examination revealed a tumor located 40 centimeters in the colon.
A biopsy indicated no cancer cells, and a PET scan reported stage II colon cancer, leading to her first colostomy.
2.
The doctor informed us that there was no metastasis and only the tumor needed to be removed, so she underwent minimally invasive surgery to remove 30 centimeters of the colon.
3.
During follow-up visits, the doctors stated that everything was normal and only monitoring was needed, and she was not prescribed chemotherapy.
However, after translating the biopsy report, we learned that it was advanced cancer with metastasis to the liver, lungs, and a small part of the spleen.
I would like to ask whether the advanced cancer pathology report refers to the portion of the colon that was surgically removed or the cancer stage of the entire body? If it pertains to the entire body, why did the doctors not inform us about subsequent treatments? Why was there no communication regarding the biopsy report results? And why was no oral chemotherapy prescribed during follow-up visits?

sophia chen, 40~49 year old female. Ask Date: 2016/05/27

Dr. Chen Jiaming reply Surgery

First of all, each individual's tumor treatment will have its specific circumstances.
You may need to accompany your mother to her outpatient appointment to confirm the questions you have raised one by one, rather than seeking advice from other doctors on this platform! The pathology report (what you refer to as the English slide report) requires a medical professional background to obtain appropriate information; messages translated by non-specialists are often fragmented and easily misunderstood.
The stage of a disease that the general public is familiar with is a multifaceted assessment result (such as the TNM staging system).
Even if colorectal cancer has metastasized to other sites, it does not equate to end-stage cancer (which generally implies a survival period of about a few months).
Patients with stage IV cancer can still have a good response if they receive appropriate treatment.
A typical pathology report will only present the depth of invasion of the colorectal tumor into the mucosa, indicated by the "T" stage, and the "N" stage representing local lymph node metastasis.
The "M" stage, which indicates whether there is metastasis, relies on other information, such as imaging studies (the PET scan you mentioned is one of them).
Based on the above considerations, you may have interpreted the "T" stage in the pathology report as the overall stage of the disease.
In summary, rather than excessive speculation, it is better to personally confirm the subsequent treatment plan (whether chemotherapy is recommended) and follow-up schedule with your mother's attending physician during the outpatient visit.
I hope this information is helpful.

Reply Date: 2016/05/27

More Info

I'm sorry to hear about your mother's situation. Understanding the complexities of colorectal cancer, especially when it comes to staging and treatment, can be quite challenging. Let's break down your questions and concerns regarding her diagnosis and treatment journey.

1. Understanding the Pathology Report: The pathology report you received indicates that there is a diagnosis of advanced cancer, which suggests that the cancer has progressed beyond the initial site of the tumor in the colon. When a report states that there is "stage IV" cancer, it typically means that the cancer has metastasized, or spread, to other organs such as the liver, lungs, or spleen. In your mother's case, it appears that the cancer was initially localized in the colon but later findings indicated that it had spread to other parts of her body.

2. Communication with Healthcare Providers: It's concerning that there seems to be a lack of communication regarding your mother's diagnosis and treatment options. Ideally, healthcare providers should discuss the results of pathology reports with patients and their families, especially when it involves a serious diagnosis like stage IV cancer. If the doctors did not inform you about the metastatic nature of the disease or the implications of the pathology report, it would be advisable to seek clarification from them. You have the right to understand your mother's condition fully, including the details of her diagnosis and the rationale behind the treatment plan.

3. Treatment Options: For stage IV colorectal cancer, treatment typically involves a combination of surgery, chemotherapy, and possibly targeted therapies or immunotherapy, depending on the specific characteristics of the cancer. The fact that your mother underwent surgery to remove a portion of her colon is a positive step, but further treatment may be necessary to address the metastatic disease. The absence of chemotherapy or other treatments post-surgery raises questions that should be addressed directly with her oncologist. It’s crucial to understand whether the medical team believes that additional treatment is necessary or if they are monitoring her condition closely.

4. Follow-Up and Monitoring: Regular follow-up appointments are essential in managing cancer. These visits allow the healthcare team to monitor for any signs of recurrence or progression of the disease. If your mother is not receiving chemotherapy or other treatments, it may be due to the medical team's assessment of her overall health, the extent of the disease, and the potential benefits versus risks of further treatment. However, if there is a concern about the cancer's progression, it is important to discuss this with her oncologist.

5. Seeking a Second Opinion: If you feel uncertain about the treatment plan or the information provided by your mother's healthcare team, seeking a second opinion from another oncologist can be beneficial. This can provide you with additional insights into her condition and potential treatment options.

In summary, the pathology report indicating stage IV cancer suggests that the disease has spread beyond the colon. It is essential to have open communication with her healthcare providers to clarify her diagnosis and treatment plan. If there are concerns about the adequacy of the information provided, consider seeking a second opinion to explore all available treatment options. Your mother's health and well-being are paramount, and understanding her condition is crucial for making informed decisions about her care.

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