[Question] Math/medical question.

[Dave]

Okay, so the oncology (cancer) doctor came in last night to speak with the family. What will follow will be a paraphrasing of what he told us. I want to hear your thoughts as my sister just does not get it!

My father had Stage 3A (even though none of the biopsied lymph nodes showed cancerous, which I thought was a prereq for Stage 3) colon cancer. In effect the cancer had started to eat through the lining but had not yet penetrated. Essentially the fall which broke his hip also saved his life as they discovered this cancer which was nearly through the wall and into the lymph nodes.

In these cases the percentages break down as follows:

30-35% return in 5 years cancer free.
50% never return for various reasons unrelated to the diagnosis of cancer.
15-20% return in 5 years with a recurrence of the cancer.

There are treatments - chemotherapy - that can fight this recurrence. There is oral medication, IV infusion or a mix of both oral medicine and IV infusion. But since this is chemotherapy, how healthy he is will determine the aggressiveness of the treatments we choose, if any.


Okay, so here's where my sister and I differ.

She says: There's a 15-20% chance of the cancer coming back. That's not high enough to worry about. Even if he's healthy enough for the treatments we should probably stay away from the aggressive one as it has detrimental effects.

I say: There's a 30-40% chance of the cancer coming back within 5 years. If he's healthy enough we should certainly look into the more aggressive treatments, if that's what dad wants.

Am I wrong?

 

[Hylian]

Personally if I was in your place I would be wanting to go ahead and at least look at the treatments if for no other reason than to try and help the chances of your dad not having the cancer come back. But of course that all hinges on whether your dad is going to be physically and mentally well enough to handle the treatments. But I always want to know all of my options before hand and take every precaution I can.

 

[gargoyle_eva]

roughly working back from your age, and therfore your dads age, i can gather he is in the 60-80 bracket. Chemo at that age will rock him bad. but will also rock the cancer. My grandad at early 60's found early stage cancer, got chemo and a year later is almost back to normal. and by normal i mean crazy amounts of excercise with the kids, climbing on roofs to run cables and other such nonsense. he still gets tired easy from treatment, and has a bit of hairloss. He has stopped riding motorbikes because he lost the energy for a while and just never got back into it. Assuming a few years on to that for your dad, he would alrady be in the almost retired not doing anything hard stage of his life. Chemo will set him back, but not a huge amount. In the long run it will mean an extra few years with your kids.
That is worth the world. I would gladly give anything for a few more precious moments with my great grandparents, this is the option for years. If i had to choose I would say go the chemo. But i would also ask what he wanted. You guys may have power of attorney but he still has enough left in him to at least have a sya in his future.

Just my 2 aussie cents....so about 1 american cent

 

[blotsfan]

I'm nothing close to a doctor, but I think I would go for the agressive treatment. Better to suffer now but give a greater chance to not getting cancer again down the road.

 

[CrimsonSoul]

I would do everything in my power as long as he can handle it to make sure it never comes back

 

[Mathias]

Aggressive treatment now. Before metastasis. And make sure all the cancerous cells are destroyed from the chemo.

15-20% of the PEOPLE that come back have cancer AFTER treatment. It's not odds per say, but statistics of what has been seen. All in all the re-occurrence of cancer will vary from person to person. But your sisters being a moron if she thinks a light spanking will make it go away. It might and it might not. The more aggressive treatments have a better chance of killing off all the cancerous cells.


I'd say that aggressively going after something like colon cancer is very important, as your odds of survival are dramatically increased the earlier you catch and treat it. In your dad's case, it hasn't invaded his lymphatic system so I'd say to consult with the doctor, and if he gives the go, do the aggressive treatment.

And did he already have the tumor removed? If so, a couple months of aggressive chemo is faaarrrr better than what your sister is suggesting.

 

[Dave]

Tumor and part of his colon have already been removed. Right now with his COPD and oxygen he isn't healthy enough for the aggressive right now.

But does anyone else see where I'm getting my numbers of 30-40% recurrence? Please tell me that I'm not off base here.

 

[drifter]

I'd agree the odds could be higher, but I'm not seeing how you got those numbers, Dave.

 

[Mathias]

I have no clue where you're getting your numbers. I want to make sure I understand them too. Those percentages are people after 5 years of treatment or diagnosis without treatment?

 

[Dave]

I have no clue where you're getting your numbers. I want to make sure I understand them too. Those percentages are people after 5 years of treatment or diagnosis without treatment?

Yes. But when the doctor was talking about returning people he brought up the "100 people" who were seen by doctors. Of those, 50 never were seen again. So the percentages are based on FIFTY people, not ONE HUNDRED! So instead of 15-20% having a recurrence, it's 30-40%. The 50 who were never seen again don't figure in to the equation.

THAT'S what I can't get through to my sister. The doctor didn't say 15-20% of the people reexamined.

 

[evilmike]

Tumor and part of his colon have already been removed. Right now with his COPD and oxygen he isn't healthy enough for the aggressive right now.

But does anyone else see where I'm getting my numbers of 30-40% recurrence? Please tell me that I'm not off base here.

Basically, of every 100 original patients, 15 to 20 of them have relapses. But since only 50 people report back, the final percentage is 15/50 = 30% to 20/50 = 40%. Makes perfect sense.

 

[netsirk]

I suppose that I would directly clarify with your dad's oncologist to confirm the current survival percentages for treatment/non-treatment groups - I bet that you're right about the math situation, and the doctor was trying to make it simpler by referring to people rather than percentages, but if those numbers are going to significantly influence decision making, they should be explicitly clarified by the expert.

also, I would imagine that histopathology is being performed on the tumor; this may help to further identify the risk of metastasis (based on the appearance of the cancerous cells) that is not yet grossly appreciable; if in fact there is stage IIIa colon cancer, it can involve up to 3 lymph nodes OR be invasive through the layers of the bowel wall up to the tissue surrounding the lymph nodes (but not yet involving the nodes themselves).
there is a wealth of good information available online about this type of cancer that can be pretty helpful - the NIH website is pretty informative without being overwhelming: http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page2#Keypoint12

also, there are several pretty recent articles available about the benefits of chemotherapy for this stage of tumor; I've only skimmed the following manuscripts (which are targeted at medical professionals, be forewarned!) but this one suggests that chemotherapy is less often pursued (for whatever reason) in older patients or those with other concurrent disease, though within their (arguably limited) study population, patients receiving chemotherapy were likely to live longer: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989633/?tool=pubmed. another (abstract only, not a full article) discusses that some of the newer chemotherapy regimens for stage 3 colon cancer may not confer as much benefit in patients >70 years old than in those <70 years old: http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=65&abstractID=34878. however, your dad's oncologist will have the most recent information about all of these options!

sorry for the wall of text - good luck with everything!

disclaimer: I'm neither an oncologist nor a physician (I'm a veterinarian!)

 

[Siska]

Much depends on his age and health otherwise. As well as how aggressive the cancer he's got is. Would you reasonably expect him to be alive and physically active 5 years from now if all this hadn't happened? If your father is 80 years old and had a hard time moving about before, then chemo might actually shorten his life on top of making him feel even less energetic. In that case it might be better to just cross your fingers and hope it doesn't come back without chemo, or at least wont come back fast enough for it to really matter. There is also the problem with the broken hip. Chemotherapy will slow down the healing of that, with some extra added risks.

Of course there are also different types of chemotherapy. Some are more physically draining than others