What are the pros and cons of post-op chemo for cancer of the oesophagus?

[groomfield]

[OPA_LarryR]

Hi - that is a very broad quesiton that is almost impossible to answer without knowing a great deal more about your particular situation.

By way of guideline - and please keep in mind that every patient is different and should disucss these matters with their surgeon, oncologist and other members of their support team.

Post-op chemo is an option that is usually considered following analysis of the histology that is carried out after the tumour and surrounding tissues have been removed. This includes analysis of the lymph node infection.

Needless to say it is a complicated decision and takes into account many factors.

If it is prescribed it is to provide the maximum "clean up" of any rogue cells.

It is never pleasant to undergo another round of chemo particularly after such difficult surgery but it is generally accepted that it is a valuable safety net if your medical team advise it.

Hope that helps a bit.

Let us know more and I'm sure others will pitch in also.

I wish you well.

regards Larry

[groomfield in reply to OPA_LarryR]

Hi Larry, thanks for the reply. The histology of my tumour and 24 lymph nodes was clear , with post-op chemo due next week I wonder what the advantage will be, if any, plus i have lost 3 stone since my op and am a bit frail !

[Hidden]

The idea of pre-op chemo is to shrink the tumour and give the surgery a better chance of success. I believe that the idea originally was that patients feel so knackered after the surgery that they were unable to cope with the chemo so well.

Post-op it is, as Larry says, a matter of wiping out any stray cells. There are some surgeons who are almost obsessive in trying to cut out a high number of lymph nodes. This is on the basis that it is through the lymph nodes that any recurrence of cancer might spread. The chemotherapy also attacks this possibility.

Some patients have post-op chemo; some don't. (which is probably why you have asked the question!). Some patients can tolerate chemo well; some cannot (Luck of the draw). Quite a lot of patients have chemo until it seems to virtually kill them, or at least that what it feels like. It does not sound very medical (and we are not medically qualified anyway) but it as if you get given as much chemo as you can take.

Subject to those all important conversations with your medical team (who do work on the basis of medical trials and research findings), you might like to think about it as if it is a rather expensive, exhausting and painful insurance premium. You never know what the future outcome is, but if it turns out to make some vital difference, you have assured yourself of a better result from all that surgery that you have been through.

Do not worry about your weight. Some people have lost 6 stone in all this process and are having a good quality of life afterwards. You will end up with a new 'normal' weight. Think of it as a wardrobe problem for the time being.

[Hidden]

Myself,I did have post op chemo against my surgeons advice!! He said my margins were good and post op chemo was only successful in 4% of patients.One week in and I had to stop as made me very unwell.Anyway 18th months on am doing great.As Alan says we all have drastic weight loss so thats normal.Best to discuss it with surgeon etc as a lot has to do with margins and any infected nodes they may or may not have taken out.

[seventrees]

Hi, I am 2 years post treatment and am pretty much back to normal, I was told by surgeons post op chemo not required, 6 weeks later saw oncologist who offered a 9 week course of post op chemo...what a dilema!!! I thought about it for a least 1 sec!! and concluded that I never wanted to have to look back and say to myself " IF ONLY"......9 weeks of discomfort seemed a relative small price to pay after all I had been through.Be positive, be strong and have faith. Good Luck.

[Westoncromwell]

Hi

I'm 13 months post op. things are normalising pretty well but I will have to accept a 3 stone lower weight which ironically is the perfect weight for my height but at my age, my slimness seems out of place

I had post op chemo after 50 nodes all clear were removed. Pre op chemo was ok, post op was tougher and I was glad to finish but as seven times said if it does come back you will regret not having put in those extra nine weeks which are a small price to pay.

Best wishes

Brian

[Thorno]

Hi

I had 3 months of post-op chemo as one of 42 lymph nodes removed had a trace. The choice was mine and it completely wiped me out as it was not long after the op which was gruelling of course (I was utterly exhausted anyway) but for me, I had to do it as I couldn't face the 'what if' debate I would have had with myself every waking night.

It's down to individual choice based on as much information and knowledge as your team can provide.

Peter

[badfriday]

My wife had the op some 18 months ago. She didn't have any post op chemo, indeed, I don't believe it was offered.

But problems have been multiplying in recent weeks, and a scan revealed the news we were expecting with a tumour in the thyroid area. A new series of chemo sessions is starting today.

Maybe post op chemo would have prevented this, maybe it wouldn't. Everyone is different, but I think it will help move the odds of a successful outcome in your favour.

Good luck whatever you decide to do!

[Charlie36]

Hi BadFriday,

you refer to "new chemo sessions" so does that mean your wife had preop chemo? I too did NOT receive postoperative chemo as my Consultant felt it unnecessary and the percentage of benefit compared to not, outweighed the possible negatives of chemo. I have gone on to have 2 further tumours after 2 years and am not in a good place. I am still not having chemo but having targeted rt instead. I hope chemo helps your wife. My best wishes to you both.

Hi Greenfield, I guess it's all about personal choice and balance and looking at the stats in the end. Chemo must push the odds in the patients favour but to me, it's about at what cost regarding quality of life and also how the individual can cope, what level of fittness/support he has etc. Your Oncologist is the best person to talk you both through all the facts and stats and advise you individually. Best wishes with whatever choice you make.

Charlie

[badfriday]

Charlie,

Yes, she had a couple of week long sessions of chemo in the months before the operation. RT has been discussed, but I think that will depend on what the scans show after another session or two of chemo.