End of chemo not sure where to go next

Today is my final chemo treatment and only 7 more days of radiation. I am being treated by Texas Oncology in Rockwall. I’m back and forth on surgery and talking to several surgeons. I still have a few more weeks before I need to decide.

just pray hard, I'm still holding out, I hope the chemo did something, if not I open for radiation, hang in there.

I’ve been through it all, with wonderful results. I’d be happy to talk with you too. On whatever issues you want to address.

I'm not crazy about being replumbed, and it is not 100% cured but they can't do that so I'm just going for treatment and no surgery,

i’m very much in the minority here in terms of treatment but i did not have surgery either. did the chemo and radiation and just couldn’t bring myself to have the surgery. i had another negative ct scan today and i’m looking forward to celebrating the three year anniversary of the end of my treatment in october.

but it is important to remember that there was no way to predict my good outcome, or to predict what my future will look like. I think it is fair to say that going the whole hog – chemo, radiation, and surgery – is what the medical community regards as the best way to keep the odds in your favor. it’s a big decision.

had pet. shows nothing, and DNA blood test showed neg also, waiting on doctor consult as what to do next, I'm very hopeful.

I'm hopeful for you. There's no doubt that your treatments did a great job... but from the hundreds of my fellow patients I've talked to... there's little doubt it will return, even if you should be NED at this time. I'm not a fan of the surgery (I had mine in July 2020)... but I am a fan of living. Your treatments simply prepared your cancer to now be removed... I would be shocked if your tumor board did not strongly recommend surgery. I'm pretty much back to normal now. I'm 65.

All the best...

Gary

what kind of surgery did they do on you? thanks for the info

Standard "minimally invasive" Ivor Lewis esophagectomy. My biggest cut is maybe a 2 inch incision in my lower right side rib cage towards the back a touch. This is where they pulled out the chunk of esophagus.
I put minimally invasive in quotes because there is nothing minimum about this surgery. It's far more complex than open heart surgery... and only the most skilled surgeons can take this on. And there are a few ways this surgery is done. Does it matter really... maybe only if a patient has certain comorbidities that requires a certain approach to perform the esophagectomy. Otherwise what really matters is what method each surgeon is used to and is quite proficient with. And there will be at least two qualified surgeons in there with the patient... and many TV screens. Robotic assist is becoming more common... but not necessarily a must.

In my mind, there are 3 big hurdles to overcome post-op... to give the patient a great start towards a NED future.

The first is passing the leak test, usually about day 5 or so after the esophagectomy. The second is what post-op pathology shows... for the removed chunk of esophagus and for the 15 to 35 lymph nodes typically removed. Clear margins and clear lymph nodes is a good start... still not a guarantee, but a damn good start. And the third is not having any big complications post-op... like blood clots, heart issues, pneumonia, stroke, etc. Being sent home after 7 to 11 days... a good sign. Recovering from this big surgery takes a month or two... healing up your surgical wounds, getting heart and lungs back, starting to eat and digest and poop again, half decently. And it is this part of the post-op journey that is the most difficult... getting digestion working again... because the vagus nerve has been cut... and your body is lost trying to do what it has always done effortlessly. It takes a year (or two) for your body to rewire itself to get digestion somewhat back to normal. And no... you never quite get back to normal (not that I know what normal is supposed to look like for me at age 65)... but I'm pretty much back to normal. I eat what I want, and pretty good amounts too. I have very little reflux, tummy aches and ass explosions are few and far between now, and I also sleep normally again... lying flat with my head on a pillow or two. But during the first year post-op... you simply don't believe any of these things are coming... it's very depressing! But that's why I counsel so many around the world... I've seen all the bumps in the road we tend to see (there are many!), and I help my fellow patients along their journeys.

You have my cell if you should ever want to chat... or pop in on one of our twice-weekly free Zoom calls. And I have no agenda with my fellow patients... they make the call on their treatments, surgeries, etc. I simply help them with their decisions.

Be well,

Gary

What is it about the surgery you're apprehensive about? Health, age, quality of life? All are viable concerns. I chose surgery after chemoradiation for my stage 3, locally advanced esophageal cancer because it's the most successful treatment in my case for an actual cure and lower risk of recurrence. If you haven't already done so, have a thorough discussion with the surgeon. All of our situations are different and unique. I hope you explore all your alternatives and best wishes to you.