Hoping for thoughts on my decision to forego the surgery for cancer

Posted by shboston @shboston, Jul 31 1:43pm

Gastro biopsy shows 3 cm squamous tumor mid chest. Surgeon says CT shows nothing to suggest surgery is not an option, but we need PET still.

However I am seventy-five years old. The surgery is hard on a body and from this forum I understand that life after surgery can be difficult to say the least.

Here is the mail I sent to my surgeon. Please add your opinions

I'm deciding against surgery. Working through the stats it doesn't make sense for someone my age. Recovery from the surgery can take years and that recovery is severely compromised by the treatment.

I'm seventy-five; I don't want my remaining years to be a misery. We're looking at a year or so of pain and disgusting discomfort with an uncertain outcome. That doesn't make sense. I understand that chemo/radiation in some cases eradicates the cancer and in others reduces it. Given that Dr < > tells me that only half the patients with esophagectomy survive -- and I know that of that half many are miserable -- I don't see surgery making a good break for me. The odds with chemo/radiation may not be much better but the consequences of failure are less devastating.

We don't heal quickly and well at my age, and quality of life is my primary concern. With the surgery, it's likely I'll be nearly eighty before I 'recover' and that recovery does not look like an easy life for an eighty-year old man.

So how do we proceed? Please advise.

Interested in more discussions like this? Go to the Esophageal Cancer Support Group.

I wish I could be more helpful but I'm totally at sea with the Canadian system. My son lived there and was in love with it. OTOH, an old friend whose daughter lived there blamed her death from cancer on the system, because of the long delay in treatment. As I've posted before, I forewent surgery, but that more based on age than anything else. I'll be 86 later this year and the tumor was contained in the esophagus, so I decided to roll the dice. I hope you can find some answers and I'll be thinking and praying about you...

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Spot on! I made the same decision, based on exactly the same factors, except I'm 85. I've been through Mayo for a different condition, but I chose MD Anderson for my EC. For one thing, all MDA does is treat cancers. My initial meeting was with my MD team - a surgeon, a medical oncologist and a radiation oncologist, as a group. I had already made my mind up at that point and explained my attitude to the surgeon. He was very gracious and said that he understood my reasoning and that my decision was, for me, an informed and best decision. (My ex-wife, still a friend, also had EC and had surgery at Johns-Hopkins, so I'd had the opportunity to observe her aftermath. She was 77 at the time.) That was the last I saw of him. I know you've made a difficult decision, having been there, and I wish us both the best of luck...

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Profile picture for earle @earle

I wish I could be more helpful but I'm totally at sea with the Canadian system. My son lived there and was in love with it. OTOH, an old friend whose daughter lived there blamed her death from cancer on the system, because of the long delay in treatment. As I've posted before, I forewent surgery, but that more based on age than anything else. I'll be 86 later this year and the tumor was contained in the esophagus, so I decided to roll the dice. I hope you can find some answers and I'll be thinking and praying about you...

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The 'Canadian' system is really a motley collection of provincial systems that are federally funded. The governments of some provinces want to replace the public system with a more US-type private system. These pro-private projects are, of course, very well funded by private interests.

Sorry for the rant, this may not be the best place for it, but I feel bound to add the necessary nuance to discussions of the 'Canadian' health care system.

Thanks for your response.

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Profile picture for earle @earle

Spot on! I made the same decision, based on exactly the same factors, except I'm 85. I've been through Mayo for a different condition, but I chose MD Anderson for my EC. For one thing, all MDA does is treat cancers. My initial meeting was with my MD team - a surgeon, a medical oncologist and a radiation oncologist, as a group. I had already made my mind up at that point and explained my attitude to the surgeon. He was very gracious and said that he understood my reasoning and that my decision was, for me, an informed and best decision. (My ex-wife, still a friend, also had EC and had surgery at Johns-Hopkins, so I'd had the opportunity to observe her aftermath. She was 77 at the time.) That was the last I saw of him. I know you've made a difficult decision, having been there, and I wish us both the best of luck...

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Please say more about your ex-wife's 'aftermath'

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Only YOU, your family, and care team can decide how to fight on. At 75 it's a hard call for sure. I went through an open Ivor Lewis, "esophagectomy" at the age of 57, I'm now 67 and living a good but changed life. Eating is still my nemesis, but 60+ endoscopies to eliminate the 16 months of wall socket feedings was worth it to KeepSuckin'Air at 57.
What ever your very personal decisions on how to fight on, I wish YOU and your family peace and strength.
10yearDave.

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Profile picture for shboston @shboston

Please say more about your ex-wife's 'aftermath'

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Well, even though she's now deceased, I feel some compunction in providing too much detail, in the interest of her right of privacy. However, her cancer was adeno, right at the GE junction, so the surgery had to be the most radical of these types. She continued to have regurgitation issues and never really came to terms with the multiple small meals per day...

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Profile picture for pennyr1965 @pennyr1965

I'm knew here just found out squamous eosphogus tumor 6 weeks ago. Go for pet scan Monday booked for results a week tomorrow. No idea of stage or if any spread. I've been bombard with doctors. I found the oncologist overwhelming. For a year I've been told indigestion and side effects.of blood thinners until a doctor finally sent me for a.scope. The tumor is 4 inches long which everything I'm reading saying that a large tumor is 1.5 inches. Which doctor saying that probably higher stage of cancer and might not be anything they can do for me. I feel like they've jumped the gun with info when they have no idea.of a.plan as don't know full info themselves yet. It's nice to see this post as im not a pharmaceutical type of person. Tried having a discussion with oncologist and 3 different times felt he was going to throw me.out of his office as I questioned what he was telling me. It was like all he really wanted was me to accept his plan for me without questioning it. My mother and siblings think I should just jump on.board with treatment. My children were raised herbally and.say it's my decision. So I have support without pressure from them. I've been researching since I actually know what it is now and the results dontseem great especially if doctor saying with size probably stage 3 or 4. Very nice to see others questioning treatment and quality of life with treatment. After the scope I couldn't even eat chicken noodles soup for 3.weeks and took all day to get 2 ensure in me. I've lost 40 lbs in six month so even if they decide.they can do treatment they say they need to fatten me up 1st as only.105 lbs now. I made the mistake of telling him I started to do herbs that are.suppose to boost my.immune.system and reduce.inflamation. was told if I do herbs he would not be my doctor. He wants me to sit here for months doing.only pain killers and indigestion pills as the stomach acid is hurting the tumor. Also told me that I would need a.stint as tumor will keep getting bigger.and I won't be able to swallow liquids before the weight is on. After herbs or maybe the scope just inflamed eosphogus and is now for 2 weeks I can eat soup drink ensure and cheesies and small pieces of fish. So for some reason my eating getting better. I think I need all the info so I can decide myself risk/benefit. A longer life if poor quality of life is not necessarily a good thing. I need alot more info before I can make a decision like that and I don't think I'm going to get the info from the doctor I have. I'm in canada and really only have cancer society clinic as an option. No private clinics. So hoping to get info from reading people's actually experiences. I haven't figured out how to navigate this site yet. Can't figure out how to post a.question so just reading answers to others.questions atm. I don't feel like thos doctor is one to ask what if I chose part of treatment but not it all. Tried to get him to explain immunotherapy and he wouldn't have that discussion as not an option here until u do chemo/radiation and surgery if u want it 1st then it's 10 thousand dollars every 3 weeks of treatment. After all other options tried its free. So didn't get to find out how does it work after you tear down the immune system with treatment to try to then boost it. So hoping to find info about partial treatment instead of full and what best for my situation. Obviously I need pet scan and results before I can even start to think about what is best for me in my opinion. Sorry such a long post, but really no one to talk to about anything about this as kids are trying to stay without opinion and family trying to push me into just doing what doctors say. But would like to find out why people make the decision they do. Poor survival rates? Poor quality of life? Or something else

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Some herbs can interfere negatively with things like chemotherapy; that’s why the doctors recommend foregoing them during treatment. You don’t want to be doing something that is helping the cancer because it’s negating the treatment. My hubby had four cycles of chemo, the mass shrunk by about half, and he has surgery this Thursday. It’s hard to know what to do and not do sometimes but doctors should be willing to talk with you and explain things. I’ve found that they often don’t like when we question them but it’s important to know what your options are and have doctors who listen when you tell them what you’re feeling.

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Profile picture for shboston @shboston

The 'Canadian' system is really a motley collection of provincial systems that are federally funded. The governments of some provinces want to replace the public system with a more US-type private system. These pro-private projects are, of course, very well funded by private interests.

Sorry for the rant, this may not be the best place for it, but I feel bound to add the necessary nuance to discussions of the 'Canadian' health care system.

Thanks for your response.

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So far I'm finding that mentioning any herbs or questioning there standard treatment is taboo. Not very promising when you should be able to speak openly with your doctor. The oncologist has made it very clear that if I have any thought that don't align with his thoughts that he is wasting his time and does.want me as a.patient

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Profile picture for emersonmoon @emersonmoon

Some herbs can interfere negatively with things like chemotherapy; that’s why the doctors recommend foregoing them during treatment. You don’t want to be doing something that is helping the cancer because it’s negating the treatment. My hubby had four cycles of chemo, the mass shrunk by about half, and he has surgery this Thursday. It’s hard to know what to do and not do sometimes but doctors should be willing to talk with you and explain things. I’ve found that they often don’t like when we question them but it’s important to know what your options are and have doctors who listen when you tell them what you’re feeling.

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Hopefully your hubby's surgery has a good outcome. I understand that if they start treatment that they would want me to stop herbs as don't know the effect the herbs would have on treatment. But considering they want me to gain 30 to 40 lbs before they could do any treatment baffles me that he wants me to stop using them immediately. After the scope my throat was Raw for a few weeks some of my herbal teas soothed it. And my aloe gel was a great relief.

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Profile picture for earle @earle

Spot on! I made the same decision, based on exactly the same factors, except I'm 85. I've been through Mayo for a different condition, but I chose MD Anderson for my EC. For one thing, all MDA does is treat cancers. My initial meeting was with my MD team - a surgeon, a medical oncologist and a radiation oncologist, as a group. I had already made my mind up at that point and explained my attitude to the surgeon. He was very gracious and said that he understood my reasoning and that my decision was, for me, an informed and best decision. (My ex-wife, still a friend, also had EC and had surgery at Johns-Hopkins, so I'd had the opportunity to observe her aftermath. She was 77 at the time.) That was the last I saw of him. I know you've made a difficult decision, having been there, and I wish us both the best of luck...

Jump to this post

Once pet scan is done Monday and get results Friday I will at least know what stage and what there actual plan is not hypothetically depending on finding. I'm fi ding that the waiting if I think too much about it sends me in a head spin as don't have the necessary knowledge to even except let alone deal with the psychological aspects of it. Once I know the extent of it be it bad or better then thought and the acceptance of the reality of my situation sets in I think I can get a better equalization of my feelings. But oncologist made it sound like because it's 10cm (4inches) that the scan will show late stages. I hope you are doing well with your situation

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