An update on life after rectal cancer treatment, positive ctDNA, KRAS G12C, and the uncertainty of what comes next.

I’ve decided that this cancer journey is a lot like a rollercoaster ride. Except it’s not the fun kind.

Nobody is screaming with delight, I certainly didn’t buy a ticket, and I’d really like to speak to whoever is operating this thing.

Just when you think you’re getting somewhere, there’s another unexpected stop, an S-curve, or one of those ridiculously long corners where you can’t see a darn thing ahead of you. And occasionally, there’s a giant boulder sitting smack in the middle of the tracks.

It’s a wild ride, full of surprises, uncertainty, and moments when you’re pretty sure the entire contraption was assembled by someone who had absolutely no business building rollercoasters.

And yet, here I am. Still positive, still hopeful, and still very much a realist.

For me, information is everything. The more data I have, the better my brain can process what’s happening. I don’t necessarily need someone to tell me everything is going to be okay. I need to understand what we’re dealing with, what the possibilities are, and what we can do about them.

The good, the bad, the ugly. Give me all of it.

My brain is much happier when it has the whole picture, even when that picture isn’t particularly pretty.

A Little Background for Anyone New Here

In August 2025, at 51 years old, I was diagnosed with locally advanced, very low rectal cancer, initially staged as Stage IIIC.

My treatment plan involved something called total neoadjuvant therapy (TNT), which means receiving chemotherapy and radiation before surgery.

I completed chemoradiation in November 2025, followed by seven cycles of FOLFOX chemotherapy, finishing in February 2026.

And let me tell you, chemotherapy was no walk in the park. Of everything I’ve been through, it has been the hardest part.

On August 18, 2026, I underwent an open low anterior resection (LAR) with total mesorectal excision (TME). In simpler terms, my surgeon removed the section of rectum containing the cancer, along with surrounding tissue and lymph nodes.

Because my tumor was so low, I have less than an inch of rectum remaining. My colon was connected very close to my anus, and I was given a temporary loop ileostomy to allow everything to heal.

Enter Flo.

We’ll get back to her.

My surgical pathology brought both encouraging and concerning news.

The good news? My surgeon achieved clear margins, meaning no cancer was found at the edges of the removed tissue.

The not-so-good news? Despite months of chemotherapy and radiation, there was still viable cancer in the rectal wall, and four of the twelve lymph nodes removed contained cancer.

My final post-treatment pathology was ypT3N2a.

For anyone unfamiliar with those letters and numbers, the yp means the staging is based on tissue examined after preoperative treatment. The T3 means the cancer had extended through the muscular wall of the rectum into surrounding tissue, and N2a means four to six regional lymph nodes contained cancer.

It was a reminder that even after completing an aggressive treatment plan, cancer doesn’t always follow the script.

The Blood Test That Keeps Me Asking Questions

One of the tools my oncology team is using is Signatera, a personalized circulating tumor DNA (ctDNA) blood test.

It looks for tiny fragments of DNA associated with my particular tumor circulating in my bloodstream.

The idea is that even when imaging cannot identify cancer, a positive ctDNA result may suggest that microscopic cancer remains somewhere in the body.

Before surgery, my Signatera had gone from undetectable to positive.

After surgery, it increased substantially.

My first postoperative result was 8.75 MTM/mL, and the next was 8.00.

Now, I want to make something clear for anyone reading this who is also navigating positive ctDNA: a positive result does not tell us where cancer is located, how much visible disease is present, or exactly what will happen next.

And those numbers are not a cancer stage or a direct measurement of tumor size.

But persistent positive ctDNA after treatment is concerning because studies have associated it with a higher risk of recurrence.

For me, it’s information I don’t want to ignore.

Which brings us to my PET scan.

The PET Scan: Clear! Well, Not So Fast.

My recent PET scan initially brought some very encouraging news.

During my appointment with my oncologist, who is retiring at the end of this year, the preliminary interpretation looked clear!

Wonderful news, right?

Well, hold on to your hats.

The final report arrived, and BAM.

One single lymph node in my left pelvis, along the internal iliac vessels, lit up on the scan and was described as suspicious for cancer.

There’s our boulder.

The node measures approximately 1.1 centimeters, with an SUV of 5.0. SUV is a measurement of how much of the radioactive glucose tracer an area takes up during a PET scan. Increased uptake can be associated with cancer, although inflammation and other conditions can also cause it.

What makes this particular node concerning is that it has grown compared with my earlier MRI, and I have persistently positive ctDNA.

It hasn’t been confirmed by biopsy, but the combination certainly warrants attention.

The encouraging part is that my PET scan did not identify any definite cancer spread to my liver, lungs, or other distant organs.

That’s a pretty big deal, and I’m absolutely counting it as a win.

Why One Lymph Node Isn’t Necessarily a Simple Problem

Here’s something I’ve learned while researching all of this.

Not all pelvic lymph nodes are removed during a standard rectal cancer operation.

During a total mesorectal excision, the surgeon removes the rectum and the surrounding fatty tissue containing many of the regional lymph nodes. However, lymph nodes along the internal iliac vessels sit farther out in the lateral pelvis, outside the usual TME surgical field.

In some parts of the world, particularly Japan, surgeons more routinely consider removing certain lateral pelvic lymph nodes in patients with low rectal cancer.

In the United States, the approach has historically been different, with greater reliance on chemotherapy and radiation, and selective use of lateral pelvic lymph node dissection.

The procedure is called lateral pelvic lymph node dissection (LPLND).

What makes my situation more complicated is that I’ve already undergone an open LAR, had pelvic radiation, and have a very low surgical connection that we certainly don’t want to compromise.

Operating in an area that’s already been treated and surgically altered can be more difficult because of scar tissue and changes to the normal anatomy.

And there are important nerves and blood vessels in that part of the pelvis.

But here’s something I find encouraging: internal iliac lymph nodes are generally classified as regional lymph nodes in rectal cancer, rather than automatically being considered distant metastatic disease.

That distinction matters.

It doesn’t guarantee that surgery is possible or that removing this node would eliminate all remaining cancer. My positive ctDNA means we also have to consider the possibility of microscopic disease elsewhere.

But if this truly is an isolated, removable area of persistent cancer, I want to understand whether surgery could offer meaningful benefit.

Ideally, I’d like to evict this little troublemaker sooner rather than later.

And Then There’s My Tumor’s Genetic Personality

My tumor genomic testing also came back, giving us a better understanding of the biology of my cancer.

One of the most important findings was a mutation called KRAS G12C.

KRAS is a gene involved in signaling pathways that tell cells when to grow and divide. Certain mutations can cause those signals to remain active, contributing to cancer growth.

KRAS G12C is relatively uncommon in colorectal cancer, occurring in only a small percentage of cases.

Historically, KRAS-mutated colorectal cancers have been more challenging to treat with certain targeted medications.

Not exactly the genetic lottery ticket I was hoping to win.

BUT, and this is an important but, science has made some remarkable progress.

There are now targeted treatment combinations specifically developed for KRAS G12C-mutated colorectal cancer, including therapies that block the mutant KRAS protein alongside another growth-signaling pathway.

These treatments are currently used in particular advanced or metastatic treatment settings, and they are not automatically appropriate for someone in my situation.

I may never need them. And I certainly hope I don’t.

But knowing that they exist is encouraging.

My tumor is also microsatellite stable (MSS), which matters because it influences which immunotherapy approaches are likely to be effective.

This is why genomic testing is so valuable. It doesn’t necessarily hand you an immediate solution, but it gives your oncology team more information about which treatments might be useful now or in the future.

I want every possible tool in the toolbox.

Sometimes Your Gut Knows Before You Do

This coming Friday, October 23, I have a consultation with a gastrointestinal oncologist at OHSU Knight Cancer Institute in Portland.

Here’s the interesting part: I called and arranged this appointment weeks ago, before I knew my genomic results or what the PET scan would reveal.

Something in my gut told me it was time to get another set of very specialized eyes on everything.

Turns out, intuition can be a pretty useful tool.

I’m incredibly glad I made that call.

OHSU is an NCI-designated comprehensive cancer center, and my hope is that this oncologist and I are a great fit.

I want a team that looks at the entire picture: my original diagnosis, response to TNT, surgical pathology, ctDNA trends, imaging, genomic testing, and the available options.

And I want a multidisciplinary discussion that includes an experienced colorectal surgeon.

My biggest hope right now is that the suspicious internal iliac lymph node can be surgically removed.

I’ve been researching lateral pelvic lymph node dissection, including the experience of surgeons at major cancer centers. It’s a specialized procedure, particularly when performed after someone has already undergone rectal cancer surgery.

Whether I’m a candidate remains to be seen.

And if surgery isn’t the best option, I want to understand why and what alternatives might offer the greatest benefit.

I’m not opposed to more chemotherapy if there’s good evidence it could help. But having already experienced how difficult chemotherapy can be, I don’t want to repeat it simply because we feel we need to do something.

I want a plan grounded in the best available evidence for my particular situation.

Flo Apparently Isn’t Ready to Retire

For those of you who haven’t been formally introduced, Flo is my temporary loop ileostomy.

She’s been accompanying me everywhere since August, and while I appreciate her service, I was really hoping to send her into retirement sometime in the next month or so.

Apparently, Flo has other plans.

Because my rectal cancer was so low, I have very little rectum remaining. Once my ileostomy is reversed, I’m at risk of developing Low Anterior Resection Syndrome (LARS).

LARS can involve frequent bowel movements, urgency, clustering, difficulty emptying, and sometimes incontinence. It happens because removing much of the rectum changes the body’s normal ability to store and control stool.

Some people improve significantly with time, while others experience longer-term challenges.

I don’t know exactly what my experience will look like.

But the thought of simultaneously adjusting to a brand-new bowel routine while potentially undergoing more chemotherapy or another pelvic surgery?

No, thank you.

So for now, Flo stays.

She’s probably thrilled.

This isn’t necessarily a setback. It’s a practical decision to avoid introducing another major adjustment while we figure out what treatment, if any, comes next.

Hopeful, Realistic, and Still Asking Questions

I suppose that’s where things stand today.

Not necessarily a step backward, but not quite a step forward either.

More like hanging upside down on a slightly sketchy rollercoaster, somewhere in the middle of the ride, wondering how long until the next turn and whether anyone has checked the bolts lately.

I know there are no guarantees.

I know that clear surgical margins don’t always mean every cancer cell is gone. I know that a positive ctDNA result is concerning. I know that even if this suspicious lymph node is removed, there could still be microscopic disease elsewhere.

But I also know that my imaging hasn’t identified definite distant organ metastases. There may be a surgical option for the lymph node. There are targeted treatments for my particular KRAS mutation in certain settings. And I’m about to meet with a team that specializes in gastrointestinal cancers.

All of those things can be true at the same time.

I don’t believe being hopeful requires ignoring the difficult information.

And being realistic doesn’t mean giving up hope.

For me, understanding the possibilities, even the ones I’d rather not think about, makes the uncertainty a little easier to live with.

So I’m still here. Still learning, still asking questions, still finding reasons to be hopeful, and still determined to make the best decisions I can with the information available.

If you’re reading this because you’re navigating your own rectal cancer diagnosis, treatment, surgery, or a frightening test result, I hope something in my experience helps you feel a little less alone in all the uncertainty.

Our situations may be different, but I suspect we understand some of the same twists and turns.

For now, I’m rolling with the punches, holding on tight, and trying to enjoy the occasional stretch of straight track.

And if someone could kindly point me toward the exit of this particular amusement park, I’d be most appreciative. ♥︎

---

I’m sharing my personal experience as a rectal cancer patient and former registered nurse, not offering medical advice. Cancer treatment is highly individualized, and the information here reflects my understanding of my diagnosis and treatment options as of October 2026.