Any insights on surgery decision?

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CynR
CynR Member Posts: 9
edited March 2014 in Esophageal Cancer #1
My 62 year old manfriend was diagnosed 12/23/09 with T3N1 squamous EC. The primary lesion is just under the sternum, the node near the collarbone. In the initial blur, we both heard the docs explain that any surgery would have to be delayed until the lesion was (hopefully) shrunk with chemo/rad. He's had 1 week of fluorouracil/cisplatin and 5 weeks of radiation, then nothing the last two weeks. The rad doc says it's still too soon to do another PET scan. The GI doc inserted a g-tube Friday, and said that the lesion appears to be responding to treatment, that it seemed cleaner and had produced significant scarring and stricture.
Here's the big question. He is scheduled for another week of chemo starting tomorrow, and not sure how many more weeks of radiation starting Tuesday. Now we are hearing that my friend has to decide on a treatment course - that if he is even considering surgery EVER, the radiation cannot go forward. The rad doc seems very concerned and says missing this window, i.e. not resuming radiation at this time, would mean future radiation wouldn't have much use.
We are also hearing that if he should go ahead with radiation, then he can't ever have surgery.
We are told that the two local thoracic surgeons believe the operation is too dangerous at this time (and unfortunately, my friend totally did not hit it off with the recommended surgeon, but that's another story...) My friend's health status pre-diagnosis was so-so, a little HBP, not diabetic, certainly not overweight (there'd been a slow weight loss for maybe a year leading up to diagnosis) and he smoked too much. It's ALL too much, I know. He still is smoking but now about 1/2 pack a day or less. We live an hour from San Francisco, but are told that it would be at least 3 to 5 weeks to set up any sort of surgical consultation at one of the major teaching medical centers there, that if the consultation were pursued, there can't be any radiation during that time and that the local rad doc believes the time lapse to be very dangerous.
We are thoroughly confused! I've been reading these boards now and then since his diagnosis and it's really clear to me that so many of you who have been through this are probably as insightful and practical as all of the docs put together, if not more. We would both appreciate so much any advice. We feel as though this is a hugely important decision and it's not the way we thought things would go at the beginning. Where are our thoughts getting offtrack? ARE they off track? Haven't some of you had surgery after more than one round of chemo/rad? Thanks so much.

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  • K_ann1015
    K_ann1015 Member Posts: 500
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    many, many have radiation TO BE ABLE TO actually HAVE surgery
    just wanted to share that radiation should not preclued surgery---but every patient is different.. mY dad HAD to finish his radiation & chemo to be able to even be CONCIDERED for surgery...
    kim
  • Betty in Vegas
    Betty in Vegas Member Posts: 290 Member
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    layne had 2 months of rad right before surgery
    I think your rad and surgeon may not see a lot of ec patients. I would get a second opinion
    . Or third.
  • CynR
    CynR Member Posts: 9
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    K_ann1015 said:

    many, many have radiation TO BE ABLE TO actually HAVE surgery
    just wanted to share that radiation should not preclued surgery---but every patient is different.. mY dad HAD to finish his radiation & chemo to be able to even be CONCIDERED for surgery...
    kim

    Thanks for your help!

    Thanks for your help!
  • CynR
    CynR Member Posts: 9
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    layne had 2 months of rad right before surgery
    I think your rad and surgeon may not see a lot of ec patients. I would get a second opinion
    . Or third.

    Thanks for your help!

    Thanks for your help!
  • unclaw2002
    unclaw2002 Member Posts: 599
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    If your doctor is not doing
    If your doctor is not doing many esophageal cancer surgeries in a year he/she may be hesitant and worried about radiation. The first surgeon my father consulted (not at a cancer center specializing in esophageal cancer) said the same thing oh I am not sure about radiation, surrounding tissue etc. etc. it will make the surgery too hard and I want as much of the esophagus and stomach as I can use for reconstruction. At the second surgical consult at Sloan in NY - the surgeon said he didn't have any problem operating after radiation. He noted that radiation can be targeted to minimize damage to surrounding tissue and that he wanted my dad to have the double treatment of chemo and radiation prior to surgery because that seems to provide the best survival outcomes and additionally the radiation shrinks the tumor. The standard protocol seems to be a three chemo regime/ followed by a pet scan, then more chemo and radiation at the same time (For 30 days - a short treatment every day M-F) and an evaluation as to how things are going. You can do less than three chemo agents if the patient can't tolerate that but you need to probe and find out what the side effects are, etc. etc.

    Just another opinion - guess that's why they call it a practice :) I would say keep calling and try to get yourself on a waiting list or ask about the policy when a cancelation occurs. Keep pushing don't let them put you off.

    Best,
    Cindy
  • CynR
    CynR Member Posts: 9
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    If your doctor is not doing
    If your doctor is not doing many esophageal cancer surgeries in a year he/she may be hesitant and worried about radiation. The first surgeon my father consulted (not at a cancer center specializing in esophageal cancer) said the same thing oh I am not sure about radiation, surrounding tissue etc. etc. it will make the surgery too hard and I want as much of the esophagus and stomach as I can use for reconstruction. At the second surgical consult at Sloan in NY - the surgeon said he didn't have any problem operating after radiation. He noted that radiation can be targeted to minimize damage to surrounding tissue and that he wanted my dad to have the double treatment of chemo and radiation prior to surgery because that seems to provide the best survival outcomes and additionally the radiation shrinks the tumor. The standard protocol seems to be a three chemo regime/ followed by a pet scan, then more chemo and radiation at the same time (For 30 days - a short treatment every day M-F) and an evaluation as to how things are going. You can do less than three chemo agents if the patient can't tolerate that but you need to probe and find out what the side effects are, etc. etc.

    Just another opinion - guess that's why they call it a practice :) I would say keep calling and try to get yourself on a waiting list or ask about the policy when a cancelation occurs. Keep pushing don't let them put you off.

    Best,
    Cindy

    These posts have been very
    These posts have been very helpful. Tyler is going ahead with the chemo/rad this week, but also going to push ahead for a consultation at a major teaching center. So far he's doing really well with his feeding tube. I am delighted at the more than double (from pre-tube days) calories he's been able to tuck in!