u/Sad-Base-9220

Hey everyone,

I’ve got T2NxM0 rectal cancer about 4 cm from the anal verge and 1cm to the sphincter. The tumor is 6cm long and 2cm thick. My doctor is recommending TNT (chemo + radiation + surgery), and I get to choose the order.

Option 1 is 28 days of radiation first, then 9 cycles of FOLFOX, then surgery if needed. Option 2 is chemo first, then radiation, then surgery.

I’m mainly trying to avoid a permanent colostomy.

What I’m unsure about is this: if I do radiation first, surgery could end up being like 18–20 weeks later, and I’m worried that long waiting after radiation is done might make sphincter-sparing surgery harder because of fibrosis. With chemo first, surgery happens sooner after radiation done (like 8–12 weeks), but maybe the tumor shrink isn’t as strong.

Has anyone actually had surgery 18-20 weeks after radiation in a TNT plan, and did that timing affect outcomes or sphincter preservation?

Appreciate any real-world experience 🙏

Hi guys. I’m about to start 5 and half weeks of radiation and oral chemo followed by 9 cycle of Folfox.

My tumor is low rectal T2NxM0. It’s 6cm long and 2 cm thick. circular. 4cm from anal verge and 0.9cm from sphincter (from MRI 4weeks ago)

The goal is to achieve a complete clinical response (eradicated) at the end if not hopefully the treatment shrink the tumor enough for sphincter preserving surgery

Not sure if a complete response is achievable due to the size but hopefully at least it will shrink enough for surgery to avoid a permanent bag. wish me luck!

I met with Onc today. They wanna do 9 rounds of Folfox. I am T1/T2 low rectal. Two 5mm indeterminate lymph nodes. No distant spread. They said either 9 rounds of folfox followed by 5 1/2 weeks radiation or starting with 5 1/2 weeks of radiation followed by 9 rounds of Folfox. Isn’t 9 rounds too much for my staging? I am also in a debate with sequence. I understand radiation first help shrink the tumor best. but followed by 9 rounds of Folfox means waiting for 18 + weeks for surgery after radiation is done. I heard best surgery window is week 10-16 after radiation is done. Should I choose chemo first then radiation so after radiation I have the perfect window for surgery without waiting for 18+ weeks? Also is 9 rounds fixated or they would evaluate during the course maybe after 4 rounds to see if I needed more?

Hey guys. My low rectal cancer was staged at T2NxM0 on April 15’s MRI. I met with Radiation Onc today he ordered PET scan on next Friday to look at some indeterminate 5mm lymph nodes. Before that he would discuss with my chemo Onc on the sequence of radiation with chemo first or Chemo first. He said both are acceptable. I heard radiation first has an advantage on maximizing tumor shrinkage however he said he usually do chemo first then radiation. I forgot to ask him why. I will meet with my chemo Onc next Wednesday to find out their decision on the sequence. I think chemo first may start the treatment sooner while radiation first needs to take an extra 2 weeks for mapping and simulation. However researches always say radiation first helps shrinking the tumor best so sphincter preservation will become more possible later during surgery. I am hesitant about what sequence is better.

Hi guys. I just got my ctDNA test result. It’s 34MTM/ml. I don’t have any treatment yet. I am T1/2NxM0. N stage indeterminat due to couple of 5mm lateral lymph nodes. What does this ctDNA number mean to my diagnosis. Does it mean the lymph nodes are more than like to be positive or the tumor is already in my blood circulation just not showing any spread yet ? Please help.

Hi guys. How far is your tumor from anal verge? Were/are you able to keep your anus or you had/have to have a permanent bag? I would like to know because mine is 4cm and I want to see if there is anyone in similar situation and how did you end up with ? Feel free to share. Thanks

Hi guys. New rectal cancer patient here. I found out I had rectal cancer in a colonoscopy on March 11, biopsy result confirmed in March 18 then CT found no spread on March 27th. Waited for 2 weeks for MRI until April 14th. Just got staging at T1/2NxM0 last week. Consultation with Oncologist next week to discuss about treatment plan, most likely chemo radiation first. Looks like the treatment will not start until 2 months after initial diagnosis. Is this delay or normal?

Hi guys. T2NxM0 low rectal cancer. N stage indeterminate because of couple of 5mm lateral lymph nodes. They are located outside the mesorectal fascia in the pelvis. The nearby lymph nodes inside mesorectal fascia are all clean. MRI can’t tell they are spread or not. The standard TME surgery does not include the removal of these lymph nodes. Procedure to remove them are very risky due to the location. If they are spread , local reoccurence rates would be way higher. Anyone got experience with this?