CT and PET scans negative after chemo and radiation: Still do surgery?

Posted by luisc @luiscoelho, May 28 11:48am

Seeking opinions, completed my chemo and radiation 6 weeks ago, did the the CT and Pet scan last week, both negative, show no signs of the tumor. Do I still do the surgery, I was Stage 2.

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

mrgvw | @mrgvw | Jun 2 8:47pm

In reply to @luiscoelho "Yup, where my family is from, I’m from Gary Player and Ernie Els country ." + (show)

Love those two... watched them play at the Masters a couple of times... and elsewhere. I just might go visit SA soon. I've been counseling a couple there (they actually moved up to Namibia now)... and they said they'd love to have us visit. So we're thinking about it. My wife and I flew to Australia last October to visit a patient I've been counseling for over 20 months. I promised him we'd come visit if he got to surgery and was doing well. He did get to surgery, but things didn't look good with his post-op pathology (9 positive lymph nodes). But after some adjuvant nasty chemo and immunotherapy he is somehow showing NED... so went ahead and flew down under. Had a blast. We stopped over in New Zealand on the way back. I think Roy and his family will come visit us in California this Christmas.

I'll tell you Luis... EC is horrific... but I've sure made some great friends and I wouldn't change a thing. Sure... I have no clue why I'm still here... us T3N1M0 stage 3's have less than a 25% chance of making it to 5 year OS.... but I have a shot now at 4 years. Time will tell.

Be well Luis.

Gary

earnest | @earnest | Jun 9 8:56am

In reply to @mrgvw "I'm not your oncologist, GI doctor, nor thoracic surgeon... or Tumor Board. But these folk should..." + (show)

@mrgvw

I'm not your oncologist, GI doctor, nor thoracic surgeon... or Tumor Board. But these folk should be individually (and collectively as a Tumor Board) be advising you as to next steps. And my guess is the consensus would overwhelmingly be to now have the esophagectomy. This because it offers a big statistical advantage towards never seeing your esophageal cancer again (buy not a 100% guarantee).

I've counseled hundreds of our fellow EC patients all over the world... so I've seen the paths they took.

Yes... two ways to go... stay closely monitored... and wait to see if it "returns"... or... have the surgery.

I put "returns" in quotes because it's somewhat meaningless that your solid original EC tumor is now showing no signs of existence. But are these cancer cells still around... whether in your esophagus, or in some lymph nodes, or in your bloodstream? Most likely.... but it's just tough to see right now. The whole reason we do chemotherapy... do radiation... maybe do immunotherapy... is to beat the crap out of our cancer... to prepare the breeding ground (esophagus) for removal. And NOW is the time to cut it out. And after they cut it out, they should still follow up with more chemo and/or immunotherapy... but this will be highly dependent on what is seen on your post-op pathology. I've seen stage 1's go straight to surgery (zero neoadjuvant treatments) and wake up as stage 4s due to many positive lymph nodes. How is this possible? Because again, scans cannot see tumors smaller than 5 to 8 mm. PET scans may or may not show some SUV uptake... but even these areas are hard to judge as cancer or not.

Just pm me if you'd like to discuss further. And just so you know... just because I did chemo, radiation, esophagectomy, and a year of immunotherapy... 4 years ago... doesn't mean I want YOU to do this as well. Each case is dependent on many factors... your age, your stage of EC, type of EC, location or tumor, nearby lymph invasion, other comorbidities, etc. Depth of penetration thru the layers of your esophagus is most important as to what comes next. But if you finished your last treatment 6 weeks ago... surgery should be coming in the next few weeks. Otherwise you will need to be re-scanned.

Gary

Jump to this post

I would have to agree with Gary. He just about sounds like a freaking doctor himself! But I wouldn't ask cancer patients about their recommendations. You have a team of doctors working on your case. Talk to them. They cannot make you do anything. But I wouldn't defy their suggestions. They know best. So kudos to Gary. Well played my friend!