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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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...

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?

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?

earle | @earle | Jul 22 1:38pm

In reply to @chubasdad "I believe you are saying that the various scans show no cancer, but to be absolutely..." + (show)

Yes. 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...

chubasdad | @chubasdad | Jul 22 11:40am

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

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?

earle | @earle | Jul 22 9:04am

In reply to @kmordan "We had the same scenario and our surgeon explained the same. They also inducted that chemo..." + (show)

And past research shows it conveys little if any survival advantage...

kmordan | @kmordan | Jul 21 6:08pm

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.

earle | @earle | Jul 21 9:14am

In reply to @s6819103 "He has no problem eating and drinking now. What is an SUV score?" + (show)

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...