Small trial suggests the scans might help, but experts aren't so sure
by EricG on Wed May 11, 2011 08:11 PM
I'd like to know whether other folks had chemo after surgery, and, whether or not they did, I'd like to know if the cancer has stayed away. I just had Ivor-Lewis surgery 3 weeks ago and am getting conflicting medical opinions about whether I should get more chemo.
The reason for the conflicting opinions is that there aren't studies that apply to my circumstances. I started with inoperable adenocarcinoma at the gastro-esophogeal junction 6 months ago; the cancer had spread to near and distant lymph nodes. After 7 rounds of EOX chemo I no longer had any visible tumors in my scans, so they decided to do surgery to remove most of my esophagus and much of my stomach. The post-surgery pathology report showed no living cancer in any lymph nodes, but that there was still a small, 1 mm tumor in my stomach wall, which they removed with cancer-free margins.
Given the good surgery results, my oncologist doesn't think I need more chemo; he says there is no medical study that shows more chemo will help in my circumstance (plus the chemo bears its own risks). I lean toward getting more chemo (maybe another round or two), to make sure they get any microscopic stuff that remains. My surgeon said he agrees with me.
I'd love to hear the experience others have had that has any bearing on this question. Thanks!
by EricG on Wed May 11, 2011 08:21 PM
For what it is worth, I thought I would add that I am 38 years old with 2 young kids at home. I am willing to do anything it takes to be around for them as long as possible.
by MariaL on Thu May 12, 2011 12:11 AM
My husband Joe is a Stage 3 EC survivor. He was diagnosed at 55 yrs. old 3 yrs. ago EC with a tumor at the junction. He had Ivor Lewis surgery 1 week after his diagnosis. If I remember correctly, he had 3 weeks to recooperate and then started intense chemo with no radiation. From what I've read on this board, chemo following surgery does not seem to be the norm. Recooperating from the surgery and having chemo was very rough (and he was in great shape prior to diagnosis) but Joe's alive andtoday doing very well.
by rickjenn on Thu May 12, 2011 02:34 AM
EricG, My situation was a little different. After being diagnosed with an adenocarcinoma at the gastroesophageal junction in July 2008 (age 55), I had surgery first followed by 4 rounds of chemo (5-FU) and a 5-week round of radiation. The follow-up chemo/radiation was because 10 of the 21 nodes removed had evidence of cancer, so it was likely there still were some cells remaining. My oncologist said without the chemo there would be about a 70% probability it would return, but with chemo/rad that probability could be lower to about 30%. I'm almost 3 years since surgery now with no signs of a reoccurrence, and I'm feeling great, primarily I think because we have a very healthy diet and I get as much exercise as I can fit in. I'll never know if it was necessary to go through the chemo/radiation regimen, but even though it was hard, I have no regrets. Everyone is different and it is hard to weigh the trade-offs some times, but best wishes on your decision. Rick
by andy2009 on Thu May 12, 2011 02:50 AM
post surgery chemo does not have an evidence of adding any more effectiveness. if your surgery does not show any cancer cells remaining, i think there is good case to say no more post surgery chemo. the only reason to have it is peace of mind. i was stage 3 and did 2 rounds of post surgery chemo - i was against post surgery chemo but did it for my wife''s peace of mind. i was supposed to have 4 rounds of chemo but agreed with my oncologist we will stop if i did not feel i want to continue. so i did it half way. i am 22 months post surgery.
by mccoy70 on Thu May 12, 2011 07:52 PM
I had surgery in July of last year. There were signs of any cancer anywhere after surgery. My ongologist suggested I have two more rounds of chemo for several reasons. He thought it would be prudent because I had responded so well to the first rounds of chemo and it would get any microscopic stuff still hanging around. I really debated on this and I decided, along with my sig other, that I would do it if for no other reason that on down the road should this pop up again I won't say "I shoulda........
I have had two scan since then and both have been clear and I am doing really well.
by mccoy70 on Thu May 12, 2011 07:54 PM
Always proof read. I had No signs of cancer after surgery...
by EricG on Sat May 14, 2011 02:40 AM
Thanks for the input everybody -- this is very helpful.
by tongrenhealer on Sat May 14, 2011 04:49 PM
Similar situation, but had active cells at surgery in lymph. Stage IVb with lung and lymph mets, chemo and radiation followed by I-L. 3 of 6 lymph nodes at surgery showed cancer cells, but lung and esophagus clear. Surgeon wanted mop up, oncologist did not. Husband was beat and she felt it was best in his case to wait and see if it came back. It did...again and again. He is still fighting at almost 5-1/2 years and 55 years old. We don't regret the decision to hold off even though it came back. Not sure he would have survived more chemo right after surgery, or that outcome in terms of return would have been any different. But that's the story since it does have some similarities. Pat was also adenocarcinoma at G-E junction.
by donna70 on Wed May 18, 2011 11:23 AM
Had Ivor Lewis in 12/09 after chemo and radiation and one positive node found after surgery and decided with my onc's help that I would do mop up chemo which consisted of Taxotere in 3 cycles started after I recoup'd some from surgery. He did state that it was an either/or situation but felt that it was a good call to do it. Have had all negative scans since and am feeling good all around. I am 67 now and hoping that I will have more time with my family. take care,
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