Newly diagnosed and really confused: Surgery vs Chemo + Radiation

@pliddle
Welcome to the club of esophageal cancer patients. I also had chemo and radiation which eliminated the cancer tumor without surgery. I had jtube also. I like your attitude and hope all goes well. Please let us know how it it going?
Don

Thanks; I will update as things go forward. I have viewed several times a YouTube vid of a study presentation before a Thoracic Physician group where a researcher assessed patient survival data for Stage 2 and 3 Esophageal cancer patients who underwent surgery or who declined. He concluded that those opting against surgical resolution had a 20% shorter survivor time than patients who declined. He was accompanied by a Mayo Clinic senior physician who commented on the quality vs. quantity aspects of patient survival criteria. There clearly is much food for thought in this issue.

@pliddle
Yes, I too studied the survival statistics for esophageal cancer patients. In the end I concluded the statistics are not all that helpful. You have to do some research, ask questions, listen to doctors, make decisions, and pray that all goes well. I will be interested to hear how you get on?
Don

Are the odds greatly improved with the surgery? My husband will be faced with this choice too, provided everything he’s currently about to do goes well. It seems like what the surgeon says he hopes as far as what he’d have to remove is a lot better than what the radiation oncologist is saying. The oncologist agrees with the surgeon. I guess the radiation guy isn’t the one doing the surgery, right? And everything is dependent upon what happens next, so my husband isn’t quite there yet.

@dave4144, welcome. It's your surgery anniversary month. I look forward to your reflection.

How are you doing now? What do you wish you had known? What thoughts do you have for anyone newly diagnosed with esophageal cancer?

Yes... surgery eligibility will be judged with the post treatment scan that shows everything has shrunk... and no distant spread. Local lymph nodes to the solid esophageal tumor are acceptable and don't necessarily make the patient stage 4. And yes... while anything we do... chemo, radiation, esophagectomy, immunotherapy... is not the cure for EC... it is doing a combination of these things that can get us to NED status. NED status is not the same as being cured either. But staying NED for 5 or more years... that is when they'll start saying we are cured. So only the passage of time (and living scan to scan) will tell us if we're cured or not. I'm in my 5th year post-op now... one scan to go in October... and they may cut me loose... no more monitoring. I'm starting to feel optimistic. And yes, of all the things we do, surgery is considered the cure (even though it is not). That's why everything else we do surrounds the surgery... first-line treatments are done in the neoadjuvant setting (before the esophagectomy)... and any treatments we do post-op are called adjuvant treatments. All of these things surround the Main Act... the esophagectomy. Post-op pathology is a big deal... where they examine everything removed during the esophagectomy under a microscope. This includes a close look at the removed esophagus as well as 15 to 40 lymph nodes. This will also dictate adjuvant treatments the patient may get. Be well.

You know how to reach me.

Gary

My surgeon told me that my best outcome would be due to having chemo, radiation and an Ivor Lewis esophogectomy. I was staged 3 locally advanced though. Anyway, you always can get a second opinion. Any responsible doctor would respect that. Good luck to you.

@dsh33782 Hi Don, it’s so encouraging to hear your scans are clear! My father (73) was diagnosed with esophageal squamous cell carcinoma on Jan 1st. He’s finishing up his initial chemoradiation (23 sessions/40 Gy) and we’re at a crossroads.

The doctors have given us two choices:

Esophagectomy (surgery) in 4-6 weeks.

Definitive Chemoradiation (continuing to 30 sessions/50+ Gy) with no surgery.

Since you went the non-surgical route, how has your recovery and quality of life been? Any long-term side effects from the higher radiation dose, and are you able to eat comfortably now? We’d love to hear your perspective as we weigh these options.

Thanks

Hello
I was diagnosed with esophageal cancer in November 2019
My treatment started with seven weeks of daily radiation and chemotherapy (Flofox, due to an allergic reaction to paclitaxel).
Restaging at the completion of chemo and radiation showed worrisome for metastatic disease, giving me a stage four diagnosis
On April 30, 2020 I underwent Ivor Lewis esophagectomy . They also removed a section of my posterior right seventh rib (was negative for carcinoma) and multiple lymph nodes (38 total ill showing no signs of carcinoma being seen).
In my specific case, starting with radiation and chemotherapy was the only option. Depending what CAT scans and PEC scans showed in a four to six week timeframe surgery was a possibility.
I know this whole process is a lot to remember but I believe that they told me in my specific case I had less than six months with no treatment. If I did chemo and radiation, possibly up to two years, but they strongly believe it would come back. I am now almost 6 years postop, still showing no signs of cancer(fingers crossed my skin in April goes well)
Wishing you the best of luck in your decisions,
Lori