Esophageal Cancer: Surgery Or Not?

Posted by rickho @rickho, Feb 19, 2024

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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s6819103 | @s6819103 | Jul 22 1:43pm

In reply to @earle "And past research shows it conveys little if any survival advantage..." + (show)

Has anyone opted out of surgrey and had a reoccurence? Where did they go from there?

s6819103 | @s6819103 | Jul 22 2:01pm

In reply to @earle "Yes. FWIW, my hometown oncologist says he would do exactly what I've done. My ex-wife died..." + (show)

How long have your scans showed clear since ending chemo?

earle | @earle | Jul 22 6:02pm

In reply to @s6819103 "How long have your scans showed clear since ending chemo?" + (show)

I'm only out of chemoradiation two months, with extensive inflammation, so there's no way I'll show "clear." I did show a dramatic drop in score. My point is that surgery is no guarantee. My ex-wife showed clear after chemoradiation + surgery and it still reoccurred...

kmordan | @kmordan | Jul 22 7:45pm

In reply to @earle "And past research shows it conveys little if any survival advantage..." + (show)

I think and respect everyone’s situation is unique. Research specific to our situation, reflects a greater percentage for survival past the various data found.

I wish the best wishes, whatever a person chooses for them.

God bless

s6819103 | @s6819103 | Jul 23 12:02pm

In reply to @earle "I'm only out of chemoradiation two months, with extensive inflammation, so there's no way I'll show..." + (show)

He's only out 2 months as well and shows no signs but wondering if he opts out of surgrey and it comes back will they still do surgrey at that point? Or chemo again? Wondering if this happened to anyone. I think he wants to take his chances going without since the surgrey is so hard.

earle | @earle | Jul 23 1:35pm

In reply to @s6819103 "He's only out 2 months as well and shows no signs but wondering if he opts..." + (show)

I asked that same question down at MD Anderson. The answer was less than satisfying. They said that it depended on where the reoccurrence was located, plus absence of any spread, whether local or metastatic. As I've said before, two main factors in my case were age, 86 later this year, and having watched my ex-wife go through with the surgery. Had I been younger, I might have considered it. The possible extension of life span/QoL in my case just made the tradeoff obvious. I've just left a meeting where one of the attendees has had a brush with cancer and he's far younger than I. He observed that cancer doctors were like all other specialties - they're determined you're going to die of something else first - "not on my watch." I had to laugh, particularly at my age... 🙂

geoff123 | @geoff123 | Jul 23 8:14pm

It’s a gamble. It’s major surgery with QoL issues for the remainder of your life but, according to my surgeon (in Australia), it confers a fourfold increase in the survival rate. It’s of course good to have a very positive response to chemo / radiotherapy, but PET scans are not sensitive to small groups of surviving cancer cells that are likely to cause a future relapse. I was told that, despite having a very good post chemo PET scan result, if I did not have the surgery, I’d likely lose it as an option. Post surgery, they couldn’t find any living cancer cells in the resected tissue, so it may not have been necessary. Your age may well be a major factor in deciding for or against surgery. Best wishes either way.

melbnorcal53 | @melbnorcal53 | Aug 2 9:32am

In reply to @56899t52 "I could have had the surgery (Stage 2-3 squamous cell) after the chemoradiation, but I chose..." + (show)

Hi
I was diagnosed last night. I have a cruise planned in three weeks with my son before he heads to boot camp. So many unknowns and questions about going on cruise. I appreciate this post.

56899t52 | @56899t52 | Aug 2 2:22pm

In reply to @56899t52 "I could have had the surgery (Stage 2-3 squamous cell) after the chemoradiation, but I chose..." + (show)

Still EC cancer free! Going on a cruise of the Norwegian fjords August 15. Next PET scan is mid September. Chemoradiation was finished November 2022 and I am so grateful for the healthy and active months since then. Turning 74 in September.

geoff123 | @geoff123 | Aug 3 8:26pm

Hello to all, I had chemo x5 and radiation therapy x23 early 2024 resulting in a very good PET scan result. My surgeon here in Tasmania is very experienced in Ivor Lewis esophagectomies and told me that - 10% survival rate for those who opt out of surgery, PET scans are not sensitive enough to pick up individual surviving cancer cells that may cause a recurrence, if surgery is declined and a relapse occurs, surgery is often no longer an option due to the “unstable” nature of the relapsed tumour - tends to go for lungs, liver and / or bones. I had the surgery in May 2024 and have been feeling pretty good for several months now - minor improvements are still happening. Pathology results from the resected tissue showed no surviving cancer cells. It may well be that for me, surgery was not needed. Unfortunately, I had to have it to get reliable pathology results.
Improvements in treatment and outcomes are happening very rapidly which means it’s a good idea to exercise great care if Googling information re the cancer or treatments or survival statistics. The stakes are very high for the cancer patient and their family and friends and many of us suffer from an information overload at a very stressful time.
Wishing you all the best with your decision and treatment. Geoff