Hello all - my partner had his Ivor Lewis in December - we saw the surgeon this week for histology results - bit of a mixed bag - tumour margins at the oesophagus end clear - "a few cells" at the stomach margin which he felt sure the chemo would mop up and (this is the bit that worries me) twelve positive lymph nodes. Am trying not to fixate on this but finding it very hard to stop worrying - yes I know it doesn't change anything but try telling my head that - some negative feedback from the medical world but have also spoken to others including the lovely Dawn at OPA who tell me lymph node involvement is very common with this cancer and that made me feel better, was just wondering about other folks experience of lymph node involvement.
The main thing of course is that the tumour is out as Nielsen was lucky enough to have the surgery and he is doing very well post-op after a few setbacks and for that I am so very very grateful.
Peace to you all,
Lyn x
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Lynleahy
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I had lymph node involvement some were taken out some not! After surgery couldnt do full course of chemo, but tumour was out and I am still ok and recovering well as you know Lyn,but yes these things do get to you.Like you say, lucky to have surgery so for now concentrate on the many positives.Glad Neilson doing well and of course there will be setbacks and a few more I guess but being alive outweighs all that.I am at the stage now where I am more grateful and feel blessed each morning I get up that am still here.
I have spoken to you on the Mac forum and as you are determined to delve deeper into histology and prognosis find below extracts from various studies. They are a few years old but only a couple of years old when I used them for my own decision-making. Before making any decisions based on these studies speak to your oncologist and find out if there is more information based on newer studies, especially large scale ones.
Remember every journey is different and your situation is now a statistic of one.
Steve
Adjuvant chemotherapy in oesophageal cancer: a meta-analysis and experience from the Shanghai Cancer Hospital.
Zhang J, Chen HQ, Zhang YW, Xiang JQ.
Source
Department of Oncology, Shanghai Medical College, Shanghai, China.
Abstract
Whether adjuvant chemotherapy increases survival of oesophageal cancer patients has been widely debated. The present study used meta-analysis software to combine data from six studies up to July 2007 that were found and selected as suitable, comprising a total of 1001 oesophageal cancer patients. The results indicated that adjuvant chemotherapy did not significantly improve outcome in oesophageal cancer patients. A trend towards improved outcome from adjuvant chemotherapy was found in lymph node-positive patients, but did not reach significance. In our own study including 270 oesophageal cancer patients, adjuvant chemotherapy did not improve overall patient survival, but did improve survival for patients with metastases in cervical and/or celiac lymph nodes (stage IVa). Although our study had the largest patient sample, more prospective clinical trials with large numbers of patients are necessary to confirm the value of adjuvant chemotherapy in stage IVa patients.
Source: NHS Quality improvement Scotland
Management of esophageal and gastric cancer
Number 87 A national clinical guideline
5.4 pathological Staging of resected specimens
SAGOC illustrated the variability in the reporting of the pathology of resection specimens from
patients with oesophageal and gastric carcinomas.2
Accurate completion of pathology reports is essential to ensure accurate pathological staging
(for comparison with clinical staging), to inform assessment of prognosis, to indicate the
completeness and adequacy of resection and to assist in audit.
5.4.1 Important pathological parameters
Resection specimens need to be dissected carefully for accurate tumour staging. Tumour stage
correlates with prognosis (see section 5.2). The Royal College of Pathologists (RCP), in its
standards and minimum data sets has identified important parameters.159 The RCP standards
also give information on the ideal preparation and dissection methods for resection specimens
and the information which should be recorded for each resection (see Annexes 3 and 4).
The following parameters have been identified as important in the RCP standards:
Oesophageal, and junctional type I and II cancers - extent within the wall, longitudinal
margins, vascular invasion and total number of lymph nodes and number and sites in which
there is metastatic tumour. The latter is important to identify M1 nodes as these are associated
with a poor prognosis.145,146,159
Gastric, and junctional type III cancers - extent within wall (particularly serosal invasion)
and involvement of other organs; and numbers of lymph nodes in total and with metastasis,
respectively. Prognosis is associated more with the number of lymph nodes involved
rather than their location, with involvement of >6 lymph nodes associated with a poorer
I also had an Ivor Lewis & 6 nymph nodes removed in January 2011 & twelve months on I have now even managed to put on a bit of weight! It was tough going at times but it does get easier eventually, although you always have to be careful how much & what you eat. I wish Nielson all the best for his recovery & try not to be too concerned about the nymph nodes.
I would like to add to the above by saying that although I had infected lymph nodes I am also still here and doing well. Griff makes very valid points and like him I was unable to tolerate the chemo and had to stop. You can drive yourself crazy if you only err on the bad side of the statistics. Griff, I and many others are still here and doing very well dispite the scary histology.
Don't let these things rob you of your future plans and happiness. You have each other right now and that is all that matters.
Thank you Steve for that - I know too well that you can drive yourself crazy with the ifs and buts and whats. When I first joined the Mac site I was given some very good advice (by you!) not to look at stats and I have stuck to it ever since which is why I chose not to read your previous reply in its entirety. What has and does help however is the shared experience and advice given by people such as yourself - it helps me to be a better carer for Nielsen and him to make informed decisions about his disease and its treatment and that is what I was trying to get at with my posting - new site, new people = maybe new experiences to share.
As you know we have much to plan for and look forward to this year and I am living each day for the hours it gives us. Thank you Steve for taking the time again to respond to me.
I and many others will be looking forward to the wedding photo's. I like your new picture together you make a lovely couple and I am sending every positive vibe I have in your direction.
Hi Lyn, my only advice would be to say that there have been so many advances in treatment for this problem that you should both stay positive and go with what ever you think best, and follow your instincts regarding treatment. As a previous commentator said every case is different and the good thing is that your partner was operable and now they can blast these lymph nodes. Keep strong. Very best wishes to you both.
After my complete gastrectomy (adenocarcenoma of the upper stomach) they classified me as 3T/N0/M0 but before my histology, the consultant said that he would expect to find some lymph nodes compromised but he did say that I shouldn't worry as the lymph nodes act as gates and it doesn't mean that the cells have got beyond them and might have been entrapped, hence why they have this practice of removal of the lymph glands. Remember that there are a lot of nodes, I think they removed 50 from me ! I was also told about the 'mop up' with post surgery chemo. I am nearly... 3 days to go !, through my post course, it has been very fatiguing, but 3 x 3 weeks is a small price to pay if you get satisfactory results
Brian - it certainly does help and thank you. Nielsen will be starting his chemo in the next week or so - thing is post-op you have already been there once - you know how rubbish you will feel - but as you say a small price to pay. Hope the next three days go smoothly for you.
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