Hi All,

First time posting to the forum so hopefully I'm submitting in the right section; just after some advice and input really.

My father has recently undergone a right hemi-colectomy following a diagnosis of stage 2 bowel cancer. His operation according the surgeon went well, it was done laproscopically and his recovery seems to be going ok.

He received a phone call from his surgeon today saying the report from histology has come back; during his surgery I believe they removed approximately 30 lymph nodes, and the report states that 3 of them were detected has having cancer present. As a result the surgeon suggested he would benefit from chemotherapy and has sent the appropriate referall, now currently waiting on an appointment to discuss how to move foward.

A number of things obviously rush into my head, and I was wondering if other's might be able to offer their opinions and experience to help me.

(As a point to note; I am currently a practising nurse but have never worked in oncology, and despite caring for numerous patients with cancer I still feel I am woefully ignornant on many things cancer related. Hence my posting here on the forum.)

My father is approximately 75 years old, of slim build, with his only PMH being a TIA (approx 4yrs ago) and A.F (currently on bisoprolol and Epixaban (or one of the equivalents etc), he also takes Atorvastatin at night, and I believe since his cancer surgery is now on lanzoprazole as well.

His quality of life prior to his cancer diagnosis and operation was fine; he was fully independent and mobile, enjoying his retirement with my mum; happily garderning, cooking, going for regular walks etc.

Following surgery he was obviously limited for a little while; reduced mobility, abdominal pain, low mood etc. Gladly to say though that over the past few weeks these have improved - his pain has reduced, he is far more mobile, mood much better and he's getting back to doing most of his normal activities (just limiting any strenous activities or heavy lifting etc).

Then upon receiving the news from his surgeon regarding his lymph nodes kind of was a kick in the teeth to the positivity I felt about his recovery.

My gut, knee-*** reaction is that I'd rather he NOT undergo chemotherapy or radiotherapy. My rationale for this being that although obviously they have benefits in reducing cancers (citing a greating effectiveness on cancer cells with their higher rate of cell replicaiton and division etc) they are still limited by the pharmacological prinicples that the chemo/radiotherapy itself will inevitably profilerate to a great deal of "healthy/non-cancer" cells and inevitably do damage to them.

The undercurrent for my feeling primarily revolves around his A.F. Working in ICU its clear to me that the heart, lungs, brain are the most significant organs, closely followed by kidneys, liver etc.

My main concern is his quality of life. I fear that in trying to eliminate some residual cancer that may be in the lymphatic system the treatment will end up exacerbating or worsening his cardiac function, and ultimately it may have a profound effect on his quality of life.

Speaking to many patient's in ICU the overall feedback I got from oncology patients is that surgery was far and away the preferred method of treatment, and that radiotherapy and chemotherapy was a largely displeasurable experience, with many patient's saying that had to stop or refused to continue due to the range of side-effects the therapies entailed.

I can appreciate the surgeons recommendation, as I imagine; although only 3 of 30 lymph nodes showed signs of cancer, that this could be a precursor for cancerous spread through the lympathic system?

My main desire is to optimise my father's quality of life for however long we have him around for.

My partner is also a nurse and she has had some experience in oncology, and suggested to me it depends on what type of treatment they recommend for my father and for the duration etc. She said she'd be less concerned if he only had a one - three course dose of treament, as opposed to prolonged long term therapy.

Doctors would say his A.F is well controlled, and his blood pressure is stable. But my father does report chest pain at times, particularly after finishing his daily walk, and is aware that is exercise tolerance is limited by his heart.

In addition, the fact that only 3 out of 30 lymphnodes returned a positive cancer result also makes me wonder about the risk/benefit of therapy. Could it be that the 3 lymphnodes that tested positive were in close proximity to the primary tumour in his intestine? And the other 27 lympnodes were more distal from the tumour and thus healthier?

And if 3 lymph nodes were detected as cancerous - what is the usual time frame for lymphatic cancer to spread? Is it most often a gradual process, or can it be rapid and severe?

I know this post contains a lot of questions and queries, and I appreciate in biology nothing is ever clear-cut black/white straightforward, but obviously I love my father and want to have him around for as long as possible, with the best quality of life.

I felt like the removal of a stage 2 bowel cancer would be the end of it. His staging CT didn't show any proflieration to any other areas, and I honestly thought it would - find cancer, surgically remove it, keep calm and carry on.

The whole lymphnode finding just threw a spanner in the works. And part of me is worried that in my desire to protect my dad from any further deteriation in his health from adjunctive therapies (chemo/radio) that I might be putting other parts of his health at risk.

Are my concerns vaild?

I can't see how chemo or radio would help my fathers cardiac condition in anyway, and I'm worried it will potentially worsen it, to the point that any post-surgical therapies would lead to a deterioation is his energy and quality of life, or at worst might exacerbate or bring about a cardiac event.

To anyone who reads this post or provides feedback; I am deeply grateful.

At the end of my day - it's my father's life, and he will choose to do whatever he deems fit, which I totally respect.

I'd just be interested in other people's thoughts/experiences - particuarly from a clinical point of view.

Thanks again in advance,

Kind regards,

Mark