1. I had rectal cancer in May of 2005. The tumor had started to grown out of my rectum. The pain was so fierce I wanted to drive my car off the freeway. When I went to meet the radiolist he said to me,that I was wasting my time by doing the chemo/radiation prior to my surgery. That no amount of radiation would shrink a tumor of that size. I could hardly have a bowel movement. But my oncologist said she wanted to try to save some of my rectum. So I did 5 weeks of chem/radiation. The tumor shrunk really fast. So fast I thought it was a sign not to have the surgery. Which would be a permanted removal of the rectum. I went to many doctors for a second opion about the surgery. All of them said have the surgery. Better to be safe than sorry. I was only 42. The though of wearing the bag for the rest of my life didn't appeal to me. Nor did dieing of cancer. But I felt that the cancer was gone. So I passed on the surgery. I go to the doctors every 3 months for a check up so far so good. I was kicked into earlie menopause. I end up gaining 50lbs . No trying to lose the weight. I would reccomend the the chemo/radi as treatment. Even though the radiation weakens your bowels. Mine havn't return to normal yet.

Posted at 8:35PM on Sep 16th 2006 by Arlene

2. Surgery is generally used if it can cure the cancer. It is most useful in cancers that have not spread. Even if the cancer has spread to only one area or is small, then it may be possible to remove it completely with surgery. It is likely that surgical skill is a more important determinant of prognosis than the aggressive nature of the cancer or its stage at diagnosis.

Some surgeons view chemotherapy as a remedy for "bad" surgery. Chemotherapy just isn't good enough to make up for surgical mistakes (e.g. failure to get good margins, tumor spills during surgery, etc.). The most important prognostic factor is the surgeon!

Most good surgeons would explain that the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive, and that the removal of lymph nodes at the time of surgery may additionally contribute to a better outcome.

Surgery is an integral part of the multimodality treatment of many cancers. The line of reasoning frequently used to explain the value of surgery includes five points:

1. Surgery is thought to remove resistant clones of tumor cells and thus decrease the likelihood of the early onset of drug resistance (if one was going to have chemo).

2. The removal of large masses likely to be associated with poorly vascularized areas of tumor improves the probability of delivering adequate drug doses to the remaining cancer cells (if there are any).

3. The higher growth fraction in better vascularized small masses enhanced the effect of chemotherapy.

4. Smaller masses require fewer cycles of chemotherapy and thus decreased the likelihood of drug resistance.

5. Removal of bulky disease enhances the immune system.

Posted at 5:49PM on Sep 17th 2006 by Gregory D. Pawelski