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Esophageal Cancer: Surgery Or Not?
I just completed my 8 Chemo and 28 radiation treatments with a follow up Pet Scan. My wife and I were excited with the images when compared to the 1st pet scan that showed cancer in the lower 3rd of the esophagus as well as in a couple of limpnodes located in the area. Our radiologist showed us the images and said it showed absolutely nothing now. We felt a EGD with a biopsy would be the next logical step but the surgeon who would be performing the surgery really wasn't receptive to it. She is probably the best in our area and performs a high volume of these surgeries annually. Her comment being "Even if the test comes back clear, the cancer returns 50 % of the time". So now I'm in the position of trying to make a decision to go with the surgery or not. I'm 70 years old, in good health. I'm just struggling with what I should do. I know it's not a easy surgery or recovery. I'm not afraid of the fight, I just don't know if I need to make it
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Yes. He has the cross protocol. They never gave staging. Said that would come later after surgrey. Initial scan didn't show anywhere else but esophagus was so full that they could barley get a pediatric scope down him. Oncologist said he responded to treatment very well. He should be getting scope in the next week to give more update.
Even though my post-chemo/radiation sessions showed no detectable cancer cells, I still had the esophagectomy necessary to allow oral nutrition due to positioning of the original tumor.
Can you explain further on the positioning? Mine was one third of the way down, stage III, confined to the esophagus. I underwent chemoradiation and I'm only two months out, but I show dramatic shrinkage and a drop in SUV score from 14.7 to 7. They feel most of the return is from late-onset esophagitis and my score will drop to normal. I'll be 86 in a few months and decided against surgery. My ex-wife died from EC, although hers was adeno and mine is squamous, about a third of the way down. After seeing her misery with the surgery and the long rehab, and how little time I have left in any case, I made my decision. Hence, my question about your positioning...
He has no problem eating and drinking now. What is an SUV score?
My tumor was low, blocking the stomach entrance. Yours is higher, so the problem might not exist.
An SUV score is the amount of fluorescence the contrast medium gives off in a PET scan. The dye is basically sugar laced with a radioactive agent. Since cancer cells, and unfortunately inflamed cells, require more glucose ("avid"), it's an indirect measure of cancer cells. As I said, in my case, I still have considerable inflammation, which blurs the picture. Normal is 0-2.5. I should explain I'm going to MD Anderson, although I earlier went through Mayo for lymphedema following problematic PAD surgery...
We had the same scenario and our surgeon explained the same. They also inducted that chemo and radiation do not guarantee that all cancer cells are eliminated. With the high rate of reoccurrence, the only way to confirm is surgery.
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1 ReactionAnd past research shows it conveys little if any survival advantage...
I believe you are saying that the various scans show no cancer, but to be absolutely sure surgery is the option. But the surgery doesn’t really improve your existing situation therefore why do it. Am I correct?
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1 ReactionYes. FWIW, my hometown oncologist says he would do exactly what I've done. My ex-wife died with esophageal cancer, although hers was adeno and down at the juncture, whereas mine is squamous and a third of the way down. After seeing what the surgery did to her and the long rehab, plus effect of QoL, it was an easy decision for me. I'll be 86 later this year, so that affects the decision. If I were, say, 50, I might decide differently...
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