Staging to treatment - timescales? Advice please

Hi all,

Mum has been very lucky in that her cancer has been found at stage T1a N1, pet scan was clear. MDT meeting next Wednesday where they decide best course of action. Today consultant mentioned surgery without chemotherapy beforehand, could mum be in hospital for this operation? Is any preparation required? My mum says she will stop smoking as soon as she knows she got to have operation but I'm worried her lungs won't have long enough to 'recover'.


12 Replies

  • Sorry what I meant to say was how soon could mum be booked in for this procedure? Silly phone typo xxx

  • What procedure it's not clear? What is generally clear is that the fitter you are for surgery the quicker the recovery so I would have thought ceasing smoking would increase fitness and benefit surgery

  • Stop smoking now, immediately. This is not a lecture or a holier than thou message from me. The simple fact is that smoking will have an impact on your mothers general health and suitability to any surgery and the recovery times/process. I was a smoker and went through surgery. To be honest (and I will be) I could not face my surgical and medical teams who were working to save my life knowing that I was effectively sticking a finger up at them by continuing to smoke. There is not one single benefit to be had from smoking against massive gains in giving up.

    If your mother has been diagnosed early (it sound like she has) then she may want to consider buying a lottery ticket. Most people are not diagnosed early and will require chemo before and after surgery. They chemo in itself requires all your strength and that is before you add in the effects of the surgery.

    Give up the fags.

    Good luck to you and your mum.


  • The decision about surgical treatment depends on two factors - a) the TNM analysis and likely outcome, which you have described above; and b) the fitness of the patient. If it is to be an oesophagectomy, there is considerable strain on the lungs, so if she keeps smoking, the operation might be delayed. Non-smokers can develop a cough for a period. So the advice to stop smoking is absolutely the right thing to do, asking for help from the NHS if necessary.

    There are possibilities of having endoscopic mucosal resection (ie done with an endoscope) which would be far less invasive than an oesophagectomy but the presence of a lymph node being affected makes for a complication and I am not sure how this would be dealt with - it might just depend on its location. But the advice about giving up smoking is just as good, regardless.

    Preparation invariably means trying to get as fit as possible beforehand. Your mother is indeed fortunate, and has a good chance of a successful outcome - it is definitely not the case that she has cancer that will finish her off regardless and that carrying on smoking will be an unnecessary hassle for her, if you see what I mean. Smoking can relax the lower oesophageal sphincter and lead to a bit more acid reflux rising into the oesophagus, which would be bad for her prognosis.

  • I'd been an ex-smoker for ten years before my oesophagogastrectomy. Although generally a decade is enough time for the lungs to recover, pretty much fully, it ain't necessarily so. In my case there was evidence of permanent lung damage, but not severe enough to stop me having the op. However, my right lung (the one that is collapsed during the procedure) didn't re-inflate, and I had to be retubated and spend another 24 hours in intensive care. Last week, I had three days as an in-patient having a chest drain - an astonishing 1.8 litres of fluid had accumulated in the right lung. Painful still, but hey - I'm still here.

    I agree with the earlier reply that suggests that continuing to smoke is in effect an insult to the professionals who look after us. Arguably, it's worse than that. The NHS is strapped for resources, so it's irresponsible not to give yourself the best chance of success. (One day, I think we may even hear calls to refuse treatment to people who won't take this step or are involved in other self-destructive behaviours.)

    The very best of luck to you and to your Mum. I hope she makes a complete recovery.

  • I was T1b and did not need chemo so went straight to surgery. I do not smoke but if I did I would have stopped. Its a major op and you need to give yourself the best chance of recovery. Good luck.


  • All,

    Thank you for all of your comments. I apologise for not being clearer with regards to treatment. At the moment we do not know 100%. All we have been told is that they have found mums cancer early. She has had all of the tests and no cancer has been found elsewhere. The consultant said yesterday that they need to decide wether to undertake surgery straightaway or chemo + surgery. I assume we will find out next week the "type" of surgery they are suggesting. Her cancer is squamous and in the middle to lower third of the oesphagus.

    My mum has been quite distressed following her diagnosis as she was going to the doctors for a very long time, and unfortunately they kept miss-diagnosing her. H-Pylori was found in her stomach back in July of this year for instance! So we all feared the worst, I think this aided her decision not to stop smoking until she knew what she was facing.

    I will read her everything you guys have said, and hopefully a bit of "tough love" will work wonders. You are completely right, she is very very lucky.


  • She has had a letter today, inviting her for a pre-op assessment do any of you know what this will entail?


  • A pre-op assessment is simply a range of tests, including blood tests and, possibly, an X-ray, to determine your mother's general state of health prior to surgery. They are normally carried out only a week or so prior to admission to hospital, so it sounds as though your mother's operation could be quite soon.

    Going back to your earlier question, if the MDT decide to proceed directly to surgery without pre-op chemotherapy, then she could be booked in very quickly, i.e. within weeks. The sooner the better.

    Good luck to her. G

  • Hi from Australia

    I too had a squamous oesophagus cancer (2 in fact one 4 years ago and the first 6 years earlier than that both in different places). The first one was removed by endoscopy which is not invasive and a night in hospital.

    My second cancer was more advanced for this procedure so in consultation with my surgeon I had surgery as these cancers do reoccur. After the surgery I got pneumonia and was in ICU for a month. Since then I have constant colds. I am not a smoker and would have had more problems if I had been. My cancer was T1bNO Stage 1A right in the middle of the oesophagus and I did not need chemo/rad before or after surgery. Stopping smoking immediately is a no brainer.

    Good luck to your mum.

  • Hi,

    I was diagnosed T2N0M0 and just had the op. Pre assessment test included blood tests(felt like an armful!), blood pressure, X ray, swabs for MRSA and a session on an exercise bike to check my lung and heart functions - despite the worry I quite enjoyed that. I've never been a smoker but I did have mild asthma so that did cause them some concern. Still here with few problems two and a quarter years after the op.

    Good luck

  • My Surgeon refused to do the Op (Ivor Lewis) unless I promised to stop smoking.

    Naturally I agreed; that was 24 years ago. If I'm honest I still miss my pipe but it has been a small price to pay for so large a dividend.

    Just to add insult to injury my previous thirty years of puffing did catch up with me yet again, six years ago, requiring removal of one lung .............but on we go!

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