Welcome George.
I don't know the answer to your question.
Let's see if there's comments from others.
J

Hello George,
It's my understanding that the lymph tissue, that had the microscopic cancer
cells" in it was removed.  I would have thought that would have been
followed by judicious RT, but you've since told us she had her limit (of
RT), with the anal cancer treatment.

I understand, that there's a worry that more microscopic cells may have
escaped elsewhere into her body.  But I have to explain something to you.
Around the 3rd or 4th regimen of chemo (no matter what chemo /name/brand),
the cancer cells become "chemo resistant", so if your wife had more chemo
now or after her APR, that would have been her 2nd regimen and well on her
way to "chemo resistance".   So then if more cells escaped the 2nd regimen,
and more tumors grew, the 3rd regimen would have been next to useless and
toxic to her.   So, in my non-expert understanding, it's best now just to
wait it out and hope for the best that they got it all.  Should more tumor
occur, surgery may still be possible or chemo to shrink one or more tumors
for palliation. (which would still be effective ..ie not chemo-resistant).

So while, it's somewhat nerve-wracking to wonder if there's more microscopic
cells in her body, at this time, it's better to not have chemo until and IF
something appears.  There's others here, with various types of cancers,
wondering if and when "the other shoe will drop".  I and Steph encourage
such patients to get on with their lives and worry as little as possible.
While we're worrying about this issue, we miss out on a lot of living.

That web page I posted to you, also mentions "Abdominoperineal resection is
reserved for patients who have persistent or recurrent disease following
combined chemo-radiotherapy, or as primary therapy for patients with large
tumours that have destroyed the anal sphincter."  and
"A proportion of patients will have persistence of or development of
inguinal metastases following chemotherapy and radiotherapy  If this is the
only site of additional disease, inguinal node dissection is usually
recommended which may be combined with further radiotherapy. Surgical and
radiation approaches for paravertebral nodal disease are not routinely
recommended, due to anatomic location and associated technical complexity."
[end quote]

Under :"follow up" sectin it says
"They should be seen as follows:
   *      First two years - every six- eight weeks
  *      Third year - every six months
  *      Fourth and fifth years – annually [end quote]

I think Steph's away for a few weeks. I would appreciate if you posted again
when you see his name appear on the newsgroup, tell him the story and ask
him what frequency and follow up tests should be done. I would feel more
comfortable if you did that.  Then you can compare to what you've been told
at your end (from her experts).
I wish you well and hope to see you later, after Steph's reappeared.

If you wish to check elsewhere you could try the ACOR list under "colon" and
see what their opinions are, but don't forget if they suggest chemo, about
chemo-resistance. Not everyone knows about it.  The list is here and click
on the list name to subscribe. http://www.acor.org/mlists/mlists.html

Best wishes,

J
PS Hang on to this as well
http://www.acor.org/news/whatsnew.html?item_id=5268
or you might wish to discuss this with her doctors, in case. and may she
keep her liver in good shape in the meantime.

Steph,
Too late to bother having RT and/or chemo now?  The surgery was December.
J