Surgery or radio/chemo : Hi All I am... - Oesophageal Patie...

Oesophageal Patients Association
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Surgery or radio/chemo

Hi All

I am new to this site. A dear friend was recently diagnosed with squamous cell cancer. She is in her early sixties and has T3, Nx, M0.

She is in her second 3 week chemo cycle and has another CT scan in about 2 weeks. She then needs to decide whether to have surgery or 2 more cycles of chemo combined with daily radio. The doc says at her stage on cancer the survival statistics are similar.

The surgery may be an Ivor Lewis or something else but is serious- 6 hours and 10 days in hospital.

I wonder if anyone on this site has faced the same choices and how they decided and why. Thank you very much!

HM

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I also had squamous cell but with 2 nodes involved in the stomach. Chemo was not effective in those days so I was advised to have an operation to prolong my life. In my late fifties I had the op. I am now at the beginning of my 25th year post op. It is not an easy journey but there is plenty of help out there. It is a personal choice but what I would have missed, my children settled , my grandchildren growing up, a whole new outlook on life doing today instead of waiting for tomorrow. My bucket list got out of control. So good luck with the choice the hardest part is at the start deciding what to do for the best. Sally

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Sally

Thanks so much for your encouraging story. It’s all so worrying at the moment it’s great to hear there is hope.

Kind regards

HM

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Hi HM!

Sorry to hear about your friend. My husband is 72 and was diagnosed with oesophageal adenocarcinom T3N2M0 last October.

He had 4 doses of FLOT chemo before surgery. We did face a similar dilemma- surgery or further (different) chemo + radiotherapy. Having had further discussions with both surgeon and oncologist, he decided to opt for surgery because he wanted rid of the tumour.

There is no denying it's a major operation and he was in hospital for 2 weeks. Recovery is slow and he's now on his second round of a further 4 chemo sessions. I won't dress it up for you - there can be some unpleasant side effects - and he's had to make some major changes to his diet to accommodate his new internal plumbing. That said - and no doubt you'll hear this from the majority of people on this site - a decent quality of life can be resumed, albeit an amended one!

Your friend is still relatively young (compared to some who have this surgery). It's a big decision - as we know only too well - but my husband made his based on the fact that he would rather have the operation than radiotherapy to give himself a better chance of getting rid of the tumour for good. It goes without saying, of course, that there are no guarantees whichever route is chosen, but from what I learned from this site (and speaking to another person who had the same op at the same hospital), the vast majority opt for surgery. The hospital should suggest she speaks to someone who's had it done at her hospital. Perhaps they can also put you in touch with someone who chosen the other route? From what we were told, the surgeons don't suggest operating unless they consider there will be a good outcome.

All I can suggest - and this is purely from our own experience- is ask lots of questions, focussing on both quality of life and outcome.

Whatever decision your friend makes, I wish her all the very best. Kate

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Thank you Kate

That’s all really helpful. It’s interesting to hear most people go for the op. The hospital are trying to put her in touch with someone who’s had it.

Kind regards HM

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Hi again! Glad it was of some help. If your friend is being offered surgery, my guess is that her tumour is slightly lower in the oesophagus as usually with squamous cell carcinoma, this is not often an option. Once again, I hasten to add that I'm no expert but am just going on my own research.

Before my husband opted for surgery, I posed the very same question on this site. Everyone who responded (and there were a significant number!) all said have the surgery. Now, that could be that no-one had chosen the radiotherapy route or it could be that only those who'd had the surgery actually responded!! I guess it's not really indicative of anything really but I do know that lots of people recover well and continue to lead active lives - clearly with some alterations to their diet and lifestyle. In my view (and it is only my opinion as it's my husband who's going through this), it's a small price to pay. He does agree with me though and has a very positive outlook on the whole process.

Enough of my ramblings! Wishing you and your friend very best wishes. Kate

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Thanks Kate for your further reply. I’ve now looked out your original question and the replies which are also very helpful. Kind regards HM

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I had an ivor lewis op for osoephegul cancer, iwas in hospital for ten days ,dont hesitate have the op done ,im only six months post op and i am feeling good ,all the best ,if you want a chat no problem

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Rasor Thanks so much for your encouraging reply. Its a huge step but holds out the possibility of cure. Kind regards HM

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Hi

Yes exactly the same choice with a slight variation.

After the 3 weekly chemo it’s usually followed by weekly chemo-radiotherapy. Usually 25 to 30 daily doses with weekly chemo. This is usually the choice : definitive chemorad or lower dose chemorad.

Definitive means the greys (dosage) is too high to operate afterwards. Too much damage to the tissues and a larger radiation field.

Lower dose is usually not more than 46 greys with surgery 6 weeks after. This is called neoadjavunct - meaning preoperative dosage.

I went on to have the oesophagectomy which was supposed to be 8 hours but was 12 as they found more cancer. Had I not chosen this route the squamous cell cancer would not have been found as it did not show up on scans as is the case with small lesions/tumours.

The surgery is life changing, like doing the olympics and takes a year to recover from. In effect chemo beats back cancer but only radiotherapy or surgery gets rid of it. I made sure I researched it and understood it’s ramifications. You are completely Re-plumbed so you have lifelong eating challenges, etc.

Despite surgery my cancer metastasised into my hip so I had further surgery and radiotherapy to my hip. It is very rare however. As my surgeon said - my scalpel is no match for the biology of cancer. Luck plays a part too.

As to her choice, I was told going for the 3 treatments was my best hope for survival and so far I’ve made an extra 2 years and 3 months since I was diagnosed. I was told this by 3 different oncologists and surgeons and what came up in my research. However, every oncologist will have a different view. Another preferred definitive chemo-radiotherapy. This is generally preferred treatment route in UK for Squamous cell cancer as some surgeons do not have the required experience due to the more complex locations of SCC. . however in Asia Where SCCS are prevalent (in the north west it’s adenocarcinoma) they prefer surgery (Japan is reknowned for this surgery) and have high survival rates. The US also uses chemo followed by chemoradiotherapy and has higher survival rates. Uk has the lowest survival rates for this cancer in Europe (maybe diet, when it’s found, treatment -who knows)

Once your Mum has all the facts then she can make a choice. If she has other health problems (heart,etc) then surgery is obviously not ideal. The best is to erase arch, write questions for the oncologist and then she can make an informed decision (a bit obvious I realise).

I wish you her all the best and for you too - it’s hard to be the carer too.

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Hi Blossomstix

Thank you for your very helpful reply. There was a huge amount of detail we didn’t know and it’s given her things to research. It sounds as if your own treatment journey has been very tough. Wishing you all the

very best with that .

Kind regards

HM

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Hi hm I am having my third chemo and 11th radiography today of 5 chemos and25 radiographs . The only effects have been moderate tiredness but a lot of nausea. It is a fifty/fifty choice so I chose chemo and radiography. Wishing you all the best.

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Hi Ian

Thanks for your reply. I’ve been trying to find the research that shows the 50/50 outcome. Do you know where I should look or is this a patient specific judgement made by her oncologists? Kind regards HM I

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Hi hm 15 when I saw my oncologist doctor he informed of the size and condition of the surrounding area after a pep scan. It was just my gut feeling to take this course of action first , if it does not work I will have to take the alternative. I hope you know that it was decision taken with a view to a positive outcome. Good luck with yours.

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Hi I was offered both as I have a very complexed body. I went for surgery as i was told it possibly would be a curative. Chemo radiotherapy i was told would only prolong my life. Also i asked if i went for chemo radiotherapy could I have an op later on. My surgeon said he would not attempt it after radiation.

At the end of the day it is down to you. It is a very long recovery if you have the full open surgery but manageable. We learn how to cope with our new plumbing, how much and what we can eat after.

Good Luck

Debbie

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Debbie Thanks for your reply. I do hope the surgery has worked well for you. Kind regards HM

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