Poor Post Op Pathology Report

[Positron]

I hope that some of you can help who may have been in the same situation as we encountered today. My husband was diagnosed in September with T3,N1,M0 cancer of the oesophagus. He had 6 weeks pre-op chemo and then the op on 3rd January. The surgeon thought all had gone well but said the team had recommended post op chemo for mopping up micro-scopic cells. We went to see the oncologist today feeling quite positive but got a real shock when he said the pathology report was poor. The circumference margin was less than 1 mm and there were a total of 6 positive lymph nodes. He said post op chemo would not help us and they will only proceed with radiotherapy if the results of further scans are clear. So now begins another awful wait just like when he was first diagnosed.

Has anyone else found themselves in this position please?

Any advice welcome

Thanks

Chris

[Hidden]

It is important that pathologists examine things really carefully because that is the way that surgeons and their colleagues work towards the best outcomes - but sometimes this brings unwelcome news. I suppose the question might be how comprehensive the pre-surgical scanning was, and whether the surgeon was able to know what margin to calculate. Sometimes the tumour is in a very awkward position and they cannot allow the size of safety margin that they would like to.

Further scans do sound a sensible next step and it is a great anxiety when you have to wait for these results, so you have our greatest sympathy for your situation. Sometimes it is only the pathology report that can determine for sure whether any nasty cells have remained in the system. Once the results of the new scans are known you will need to sit down with one of the medical team who will know the exact details. It is not unusual to have post-op chemo but there must have been something in the oncologist's mind to make him say what he said.

Leaving aside this cloud, I do hope that your husband makes good progress from the operation itself.

I think it would be worthwhile for you to ring Dawn on our helpline 0121 704 9860.

[Lynleahy]

Chris I can totally empathise with what you are going through my husband was diagnosed in Aug 2011 - same staging - and after op the histology was that he had two clear margins and one with cells a and twelve out of fourteen nodes were positive. When we saw our surgeon for the results he told us that our oncologist would probably be very negative about them but that he as the surgeon was very pleased we would need what he termed "mop up" chemo and that we should stay positive. Boy was he right ! Our oncologist was the voice of doom and told us the risk of recurrence was high - no point to radiotherapy as the area involved was too big but she did suggest chemo and he managed all three sessions. As Alan has suggested to you I did speak to Dawn - I was in bits and she really helped. Further scans have revealed a hot node which had shrunk on his last scan but the fear that it will return never leaves me ongoing symptoms of pain and vomiting have worsened so much over the past two weeks that we have urgent appt to see surgeon on Monday - I hope to god it is something functional they can sort out but those words do the oncologist really haunt me. I think I would be looking for a second oncology opinion if I were you.

All the best

Lyn

[Positron]

Thank you both. I have spoken to Dawn this morning and she was very reassuring and calming. It is interesting how we also got such different inferences from the surgeon and the oncologist with the same information. What a roller coaster!

Best wishes

Chris

[zilpha]

Hi Chris ...Received your e.mails.This guy Paul Hamel,has sent replies to quite a few people i know,including me,i don't know where he gets his information from,but take it with a pinch of salt. Lymph nodes are mean't to soak up any infections,including cancer,the gates will have closed on rest of nodes,surgeon would have removed a heck of a lot more had he been that worried. As for other information on close or positive margins,i can't find any difference to how they are treated in our country. Like i have already said to you,it depends on lot's of factors as to if there is a recurrence. Some people with a good prognoses has a recurrence.There are people on this site that prove the facts of this. Try to stay positive,i know how hard that is. It does not help us to read negative comments,we are all aware this disease is aggressive.

When do you go back for scans? which hospital are you under? Did your husband respond well to chemotherapy? I am asking you these questions,as i have a friend who's daughter is a medical oncologist (chemotherapy oncologist) who has taken her elective year in Houston USA

i can give her all this information,and see what she comes back with,maybe something you could approach your oncologist with. Some of these medic's have no sensitivity,so hang on in there with a positive approach. Speak soon . Ann