Doctor said all margins were good, but still needs immunotherapy. Why?

Posted by dorenemonchil @dorenemonchil, Feb 23 1:44am

My husband 71 years old has esphogeal cancer. Treatment of chemo, immunotherapy and radiation followed by surgery to remove tumor and esphogus . After surgery the Doctor told me that he removed the tumor and 1 lymphnode and the all margins looked good. To me those words meant that he had gotten all of the cancer. We went to see his oncologists two days ago and he tells us that they did not get all the cancer. That there is more in other lymphnodes but he does not know how much and that Bill will need to come in for immunotherapy every two weeks for 1 year. Also after surgery we find out that the doctor removed his gallbladder . We had no knowledge this may happen . We will see the surgeon on the 27th. I am not complaining I am shocked and confused.The reason for removing his gall bladder, could it be that it had cancer and if other lymphnodes have cancer why not remove them ? I almost feel as if we are being told only so much . As everyone here knows being told you or someone you love has cancer is devastating. It turns your world upside down. The only way for us to make the best choices for my husband is by having total honesty from everyone involved in his care . Even if it will be hard for us to hear it's what has to happen . What does clear margins mean and did his gallbladder possibly have cancer so it was removed.

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Not sure how many lymph nodes were removed during original surgery. A few years ago, lymph nodes in the neck kept lighting up, they were biopsied and diagnosed as follicular lymphoma. We were told not to worry about that at this point. The scan this summer showed something near the esophagus. That was biopsied and found to be esophageal cancer in lymph nodes very near the esophagus. After the brutal chemo regime was adjusted,( by the way, there is lactose in capecitabine and that really added to the chemo nightmare as my husband is lactose intolerant).The original chemo was oxaliplatin once a week and cape for 14 days on and 1 week off. That was stopped after 2 horrible cycles and changed to cape 2 x a day everyday. Now he takes a lactase tablet with his twice daily capecitabine. Since the cancerous lymph nodes seem to be the only site and are not in the same field as the previous radiation, the oncologist wanted to try radiation to get rid of the cancer and then get off the chemo.


There are reasons for doing more treatments, even with clean post-op pathology. I have seen this before, but in stage 1 patients who went straight to surgery, where the tumor was a bit deeper into the esophageal layers than was thought going into surgery. There are studies in Asia (where most patients who are not stage 4) go straight to surgery, then they do adjuvant treatments... (they don't do any neoadjuvant treatments first).

Anyways... I still find it strange only 1 lymph node was removed during his esophagectomy... are you certain of this? And removing his gall bladder also seems odd... was this not discussed as an option prior to his surgery? Did he have gallstones? But I'm sure he'll do just fine without his gallbladder... as bile will continue to drip into his intestines straight from his liver.

But it is concerning he did not complete his neoadjuvant CROSS protocol treatments (if that is what he did)... due to side effects. I'll assume his chemo regimen is going to change now... to Folfox or something. And yes, now that he is post-op, it will be harder on him... they will have to watch him very closely.

All the best.


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Yes I am positive that only one lymph node was removed. No one talked to us about his gall bladder before surgery. I would think that removing it without consent would be a risky thing for a doctor to do . The Doctor did tell us that he would be watched very close. Exactly as you said .

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