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Gastroenterology (Expert Forum)
Prognosis for Local Recurrence
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Prognosis for Local Recurrence
by Concerned with Symptoms, May 30, 2003 12:00AM
Hi,
My mother was diagnosed with Colon Cancer in January 2003.
The details are as follows:
- She is 56 years old, otherwise healthy
- tumor was located in the sigmoid colon
- she underwent resection surgery and did not require a colestomy
- 20 lymph nodes were removed and examined and four regional
lymph nodes were positive.
In May 2003, her oncologist noticed a growth near the location of the surgery. As such, a colonoscopy and biopsy were performed. The results indicated that there was a malignancy in the scar tissue. As such, she requires additional resection
surgery. An MRI was performed and there was no indication at this point of recurrence in any major organs.
I have a few questions regarding the her current prognosis:
- Does the speed of this recurrence indicate that this cancer will spread to other parts of the body faster?
- The doctors have said that this is "still curable" is this the least likely scenario and should we be preparing ourselves for
worse news? Do you have any statistical data on what the survival rates for local recurrence cases are?
- Does the prognosis further worsen if the cancer has gone into the lymph nodes again?
Thank-you.
My mother was diagnosed with Colon Cancer in January 2003.
The details are as follows:
- She is 56 years old, otherwise healthy
- tumor was located in the sigmoid colon
- she underwent resection surgery and did not require a colestomy
- 20 lymph nodes were removed and examined and four regional
lymph nodes were positive.
In May 2003, her oncologist noticed a growth near the location of the surgery. As such, a colonoscopy and biopsy were performed. The results indicated that there was a malignancy in the scar tissue. As such, she requires additional resection
surgery. An MRI was performed and there was no indication at this point of recurrence in any major organs.
I have a few questions regarding the her current prognosis:
- Does the speed of this recurrence indicate that this cancer will spread to other parts of the body faster?
- The doctors have said that this is "still curable" is this the least likely scenario and should we be preparing ourselves for
worse news? Do you have any statistical data on what the survival rates for local recurrence cases are?
- Does the prognosis further worsen if the cancer has gone into the lymph nodes again?
Thank-you.
Doctor's Answer
by Kevin Pho, MD, May 31, 2003 12:00AM
, May 31, 2003 12:00AM
Hello - thanks for asking your question.
It is reassuring that there was no evidence of distant metastasis via the MRI scan. If the new growth is at the location of the prior surgery, it may simply reflect tumor cells that were not completely removed verses a new growth. Our surgical colleage (who will have more experience since I am not a surgeon) has concurred with this below.
If this is indeed a "new" local recurrence, a study I found has some survival rates. The incidence of local recurrence was 11% and 15.9% for Dukes B and C cancer respectively. Of these people, 28 of 35 people who underwent subsequent palliative therapy died within 9 months. 20 of 31 people who underwent subsequent radical surgery were alive after 30 months. This suggests that primary radical surgery is the treatment of choice when local recurrance of colon cancer is found.
Prognosis does indeed worsen when the cancer spreads to the lymph nodes.
Here is the study that was cited above:
http://www.icsglobal.org/publications/pdf/JanMar2002/630102000019.pdf
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
It is reassuring that there was no evidence of distant metastasis via the MRI scan. If the new growth is at the location of the prior surgery, it may simply reflect tumor cells that were not completely removed verses a new growth. Our surgical colleage (who will have more experience since I am not a surgeon) has concurred with this below.
If this is indeed a "new" local recurrence, a study I found has some survival rates. The incidence of local recurrence was 11% and 15.9% for Dukes B and C cancer respectively. Of these people, 28 of 35 people who underwent subsequent palliative therapy died within 9 months. 20 of 31 people who underwent subsequent radical surgery were alive after 30 months. This suggests that primary radical surgery is the treatment of choice when local recurrance of colon cancer is found.
Prognosis does indeed worsen when the cancer spreads to the lymph nodes.
Here is the study that was cited above:
http://www.icsglobal.org/publications/pdf/JanMar2002/630102000019.pdf
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Member Comments (1)
by surgeon, May 30, 2003 12:00AM
I'd assume she has been taking chemo therapy. Local recurrance is not quite as dire as distant recurrance: when it's at or near the original field, it could be due to some cells left from the time of the original surgery, rather than reflecting spread. So yes, cure is still possible. It's hard to put a number on the odds. Clearly, it's better when such things don't happen. But for now, one should stay optimistic and have careful followup and see what happens.
