Staging
People often ask what 'stage' my cancer is. I'm stage 3a, but there's a really wide variance between different stage 3 colon cancers, so it's worth exploring the details.After my surgery, pathology reports revealed the following info:
- My primary tumor is 17mm x 15mm x 3mm. Think of a stack of 2-3 dimes. So, it's pretty small.
- The surgeon removed 14 lymph nodes around the area. 1 showed cancer.
- That cancer in my lymph node was 6mm (diamater of #2 pencil).
So, pathology reports will use the TNM staging system.
- T for primary tumor stage. T can be 1 through 4b. (this is often noted as pT for primary tumor)
- N for lymph nodes. N can be N0 through N2b
- M for metastasis(spread to other organs). M and can be M0 through M1c.
For me, I'm T1 (my primary tumor is small, and didn't spread through the colon wall). N1a (only a single regional lymph node impacted). M0 (no evidence of spread to other organs via pathology, CT scans, or visual inspection during surgery).
So, this has me at the lowest risk stage 3 category, stage 3a (pT1 N1a).
More details about staging colon cancer here. Cancer.net Link
Tumor Marker
There's a blood test that is a diagnostic tool in monitoring cancer. It's called CEA (CarcinoEmbryonic Antigen). Anything under 3.0 is considered normal (no cancer). [for smokers, anything under 5.0 is normal).
Before surgery, my CEA was 1.1 (that's good).
After surgery it was 0.9 (a bit better, I guess, but as long as it's under 3.0, doc is happy).
Prognoisis
To be honest, I haven't asked my oncologist to give me a prognosis. If I did, I'm sure she'd give me some 5 year survival percentage. But the way my brain works, I know I'd be uncomfortable with it. Let's say she said 90%. In my brain, I'd hear I have a 10% percent chance of being dead within 5 years. So, at this point, I haven't asked that question of her. I may at some point. But I have done some research...
Colon cancer is tough. Even when you think you've got it beat, it can come back some time later, and show up as a new tumor in a remote organ (it seems to prefer liver or lungs first) or a new tumor in the colon, etc... I know I will have CT scans, scopes, and blood tests done regularly for the rest of my life, and the long days waiting for lab results that follows.
Colon cancer is tough. Even when you think you've got it beat, it can come back some time later, and show up as a new tumor in a remote organ (it seems to prefer liver or lungs first) or a new tumor in the colon, etc... I know I will have CT scans, scopes, and blood tests done regularly for the rest of my life, and the long days waiting for lab results that follows.
However, there are some good reasons to be optimistic. There are studies that indicate that Stage 3a that are pT1 N1a single lymph node patients are a unique category, and if they have a low CEA number and have enough (>12) lymph nodes harvested during surgery, predicts a more favorable overall survival prognosis. Normal pre-operative CEA levels also predicted much lower risk of tumor recurrence. National Institute of Health Link
This study supports the same notion. BiomedCentral Link, stating that survival rates are as high as 92.6% for T1 N1a patients.
The two studies above have some indication that pT1 N1a patients may not benefit much from chemotherapy because the survivability rates don't improve much for us(it's already pretty good). This study indicates less chemo (3 months vs 6 months) may be just as good. Cancer.gov link
I discussed this with my oncologist, and she said she was familiar with these studies, but admits that I'm a rare patient. T1 N1a is an unusual combination. So, she is comfortable dropping the most toxic of the 3 drugs after 3 months.
Ok, this is drifting into the chemo topic, so I'll end here and post about chemotherapy next.