Surgery and recovery

Hi,

some weeks ago I posted about my mother who had been diagnosed with Barrett's with high grade dysplasia, and my worry about the fact that she had been quickly advised to have an oesophagectomy without any consideration for other treatments. I received quite a few messages urging me to look at all the options and it was partly that which prompted my mother's decision to get a second and even a third opinion. In the end however, she went ahead and had the surgery with the first guy, on 4 August.

He proved himself an excellent surgeon and he was right in thinking that mum's Barrett's had turned into something more serious (two earlier biopsies had not picked up actual cancer cells so we could not be sure that it was really cancer). He took out about 3/4 of her oesophagus, 1/3 of her stomach and 19 lymph nodes, two of which were cancerous. He is confident that he "got it all" and is leaving the decision of whether to have follow-up chemo up to her.

It is now 16 days later and she is still in hospital. She had various complications but nothing really serious. The main issues were the nurses' incompetence with the chest drainage tubes and a nasty little intestinal bug called c. difficile. But now she seems to have turned a corner and hopefully will be home before the 3-week mark.

The initial diagnosis of high-grade dysplasia was a big challenge. To cut or not to cut? It seemed like such a massive operation for something that maybe wasn't even cancer yet. I guess it is good to know that she didn't have the surgery for nothing. But those two lymph nodes make me nervous... should she have follow-up chemo?

My dad was dx stage 3, had surgery in March, and was told all biopsies from surgery were negative.  He had his first follow-up CT scan a few months later, followed by MRI and PET scan.  All showed cancer near the esophagus...but none of this was picked up in his scan just before surgery.  The reason he didn't have follow-up chemo was because the doctors didn't see anything to treat.  They said the cancer cells were so small that they weren't showing up on that scan before surgery.  I don't think they can do chemo as a "just in case" precaution, especially if all indicators pointed at no cancer after surgery.  Dad currently undergoing treatment again with a "no cure" understanding at this point. 

Good luck to you!  Maybe this information will help with your decision.

On 8/20/2009 bdm22 wrote:

My dad was dx stage 3, had surgery in March, and was told all biopsies from surgery were negative.  He had his first follow-up CT scan a few months later, followed by MRI and PET scan.  All showed cancer near the esophagus...but none of this was picked up in his scan just before surgery.  The reason he didn't have follow-up chemo was because the doctors didn't see anything to treat.  They said the cancer cells were so small that they weren't showing up on that scan before surgery.  I don't think they can do chemo as a "just in case" precaution, especially if all indicators pointed at no cancer after surgery.  Dad currently undergoing treatment again with a "no cure" understanding at this point. 

Good luck to you!  Maybe this information will help with your decision.

bdm22

My husband is a Stage 3 EC cancer survivor and had surgery first followed by intensive chemo.  Your response got me thinking and so I went on the internet and am copying what I found here:

"Chemotherapy can be given after an operation (this is known as adjuvant chemotherapy) when all the visible cancer has been removed but there is a risk that some cancer cells, which are too small to be seen, may have been left behind. The aim is to destroy these cancer cells."

As I recall, this is the same advice my husband's oncologist gave him. 

Maria

My oncologist wanted me to have CHEMO after surgery due to the fact microscoptic cancer cells could still be present and if we were going for a cure it would be necessary to kill these off. Unfortunately, I had one Chemo treatment Oct.2, surgery was Aug. 14, but I became very ill from it and had to be hospitalized for 9 days, all I was doing was throwing up. I should have stayed longer, but I signed myself out as I wanted to go home, wish I would have stayed in there longer as I had to go back on hydration at home one day later. Anyway my point is some microsoptic cells are not visible, but are there and can cause problems later on, so if the oncologist suggests CHEMO following surgery, it is usually necessary.

Take Care and Be Positive

Evelyn

had my surgery on 7/7. post surgery pathology shows only microscopic cancer cells. have been going back and froth between post surgery chemo. finally decided to go with it - i have been told that if the cancer comes back, the chance for cure at that time is very small. doing it now does not guarantee no cancer return but do reduce the risk.

tentatively we are planning on carboplatin and taxol. 4 times once every 21 days - which doesnt seem onerous. if you have experienced this drug combo, would like to hear your feedback on side effects etc.

andy

They frequently recommend "just in case" chemo after surgery in the US. There is always a risk there are cells leftover that were undetected. That's the nature of cancer. We chose not to do "follow up chemo" the surgeon recommended, on the advice of our oncologist (we knew he had 3 lymph nodes which were the only thing showing live cancer cells). He didn't seem strong enough to tolerate more chemo then, and we felt we could go after it if it came back. We hoped it wouldn't, but it did. I don't regret our decision, but we have had to fight the lung mets a few more times since. I'm doubt his body could withstand more treatment then. He's always been stage 4, so there was never a shot at a cure, and we have gone way beyond any expectations of how long he would make it. If it were staged lower, and you were eradicating it before it spread anywhere else, that could make follow up treatment worthy of consideration. We seem to be in the minority not having follow up chemo, but I've seen people do it and still have it return and metastasize from stage 2 or 3's, so there aren't any guarantees no matter what you do. You can get a 2nd opinion if you aren't comfortable with the doctors plan.

I had surgery first then chemo and radation for E.C.  in Charleston W.V. three mo.after treatments the cancer was back . when the cancer returned I went to the Ceveland Clinic.  The E.C. D.R. said there was a 90% chance that the cancer would return because it  was in two lymph modes. i also had stage 3 cancer.  i would say go for the chemo and the rad. i have been cancer free since Oct. 

pre surgery i was T3N1M0 but post surgery T3N0M0 i e no lymph nodes involved. i have been very lucky as i had zero side effects from my first round of chemo/radiation so we are assuming/hoping this time around it will be the same. i realise there is no guarantee but want to do all i can to minimise the risk right now and hopefully confirm cure. as i mentioned, oncologist says if cancer returns in future, the probability of cure then is very very low.

also if i develop side effects and i can't take it, i can always stop the treatment.

andy