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Positive radial (Circumferential) margin- Post surgery lab reports-

mishti
Posts: 24
Joined: Mar 2011

Hi Friends,

My dad had a surgery on 3 April this and we have got his lab reports. It says that the radial margin of the removed esophagus still has cancer. When we asked the doctor, he said that since the disease was advanced. The radial margin that is the area on the outer layer of the removed esophagus has come positive. Just wanted to know how many of you have faced the same situation. Or what are the chances. It is quite a set back for the whole family. His surgery has lasted for 8 hours.

Mishti

JReed's picture
JReed
Posts: 463
Joined: Nov 2011

Dear William:

I am only assuming from what I read that they are in the same boat as Don and if that is the case, post op chemo is not an option. You can research that and find out why.

I love the fact that you are such a resource of information regarding esophageal cancer and so willingly share that information with all who come to this site.

I do not like the fact that you make me, anyway, feel like we have failed to do the right thing because we did not go to Dr. Luketich. There are other doctors who have just as much experience with EC surgery and who are experts in their own right.

We did everything right, had all the right tests, made it through surgery and are still ironing out a few bumps in the road. Our diagnosis is what it is - it is not as a result of not checking further or not getting second opinions or not doing everything that we thought we could.

This site has been a lifesaver to us, and you have provided as much information as others have to us, but please, William, do not keep insuating that just because someone did not seek the opinion of Dr. Luketich that they are a failure or their diagnosis is a result of this.

There are many doctors who have saved the lives of EC patients - not just Dr. Luketich.

FEC,
Judy

JReed's picture
JReed
Posts: 463
Joined: Nov 2011

double post

mishti
Posts: 24
Joined: Mar 2011

Hi,

We went in for a surgery only when the doctor told us that was the only last shot we have. Judy..isnt this a residual cancer which can be treated with chemo. Our doctor said that it can be treated with chemo. Just taking your advice as you seem to be in the same boat as we are. It is a set back for the whole family. We have been fighting this cancer for a year and half now. What doctors had mentioned that when they found that due to the strong radiation and chemo that was given to him, all the issues were stuck to each other and they had to separate all the organs one by one which made the surgery difficult. Really dont know what to believe and what not to believe. How is DON doing now

mishti

JReed's picture
JReed
Posts: 463
Joined: Nov 2011

Mishti and William:

After meeting with Dr. Hayman today, we have come to the conclusion that Don will receive no further treatment at this time. Don did not have any positive nodes - in fact, two of the nodes showed response to treatment and were basically destroyed.

They have explained to us just how rare Don's situation is - his distal circumfrential radial margin tested positive - not the nodes. The area that is likely to have cancer sits in between the lungs, heart and trachea - to have radiation again would likely cause more harm than any benefit to be gained. Don had a very poor response to treatment the first time and really had just about all the radiation a person would normally have. Don's poor response leaves the doctors to say to us "If it didn't work the first time which is the optimal time, it isn't likely to have much of an affect a second time in the same area which is very high risk."

I did not say that chemo could never be given agai; I said that in Don's case multiple doctors have explained that at this point, chemo would be of no help and neither will radiation. Now, if the cancer is active and goes into another area or organ, they would determine at that time what could be done, but, of course, we know that at that point, Don would then be classified Stage IV.

Ours is certainly a very rare case and we have now consulted with five different doctors as to the path forward. They have each looked at the data available and have consulted with each other and the best scenario offered was possibly 8 more radiation treatments which would be very moderate and if a fistula (hole) were to happen to the lungs, heart or trachea that likely mean death - therefore, we are choosing not to pursue this avenue and all of the doctors seemed quite relieved with our decision.

Obviously this is not something we wanted to hear and I know it was hard for the doctors to 'get real' with us about this. Dr. Hayman said that some people may want to proceed with the 5-8 radiation treatments, but if it were his family or loved one, he would advise against it due to the high risks associated with this particular situation.

As someone has stated before, we are a statistic of one and though I prefer to have my eyes wide open, I know that someone has to be the 1% so for now, we will carry on and pray and hope for the best.

We are on the way out the door and I did not read word for word what you wrote William - but I will.

Mishti - I think at this point, you have to gather as much information as you can and come to your decision. I don't think doctors would say you could do chemo if you could not. Each case is taken into account on its own and I think the doctors look carefully at each case and make their recommendations on that particular situation.

If the apparent benefits outweigh the risks, to me the choice is obvious, but it is a personal choice and one that each person needs to be comfortable with. In any event, we are contributing to the knowledge base of esophageal cancer and hopefully, someday soon, future esophageal cancer patients will reap the benefits of the seeds we each sow today.

We are thankful and grateful for any information or advice given to us and I do take the time to research all information I can find regarding this stupid cancer - so thank you for passing info along.

Please let us know how your case is going to be handled.

We can always agree to disagree William - a healthy debate moves things to positive outcomes I believe.

Hugs and FEC,
Judy

BobHaze's picture
BobHaze
Posts: 159
Joined: Sep 2011

Hi Judy:

In the “is the glass half-full or half-empty” department, I tend to choose to see it as half-full. So I likeed what Don said to me the other day, which was that although the path report tested positive at the radial margins, the radiation keeps working for some days or weeks after they stop it, so they can’t say for sure that there’s still any active cancer, which is great news. So personally, I’m glad you’re following your multiple doctors’ advice to not continue with any treatment at this time, and we’ll all hope there’s no need to restart it in the future. And difficult though it may be, I hope you guys can not worry about this for a while, and enjoy the beauty and rebirth of Spring. And, of course, it will help when Don gets the OK to put knees to the wind on that beautiful, new, shiny red Ultra!

FEC,
Bob
T1aN0M0
Dx 8/3/11
MIE 9/23/11

Ginny_B's picture
Ginny_B
Posts: 537
Joined: Sep 2011

Judy, sorry to read that no further treatment will be given, but you know, sometimes this is the right course of action. In my mom's case, no additional treatment was recommended, but then one doc said, "But we could always try..." and so off mom went to try that approach. When it just got too much she said, "Enough!"

Don has that beautiful new bike to look forward to! And that great ride to Sturgis! Hold on to that and each other! Love, hugs, and prayers going your way as always.

Gin

mishti
Posts: 24
Joined: Mar 2011

Hi Everyone,
Thanks for the valuable information. My dad’s oncologist has adviced further chemo. Radiation is not an option anymore as he has already been given a full dose of it. We will be going in for a second opinion this Saturday. We keep everyone updated on his state of health.

One more question, after the surgery, the biopsy report has staged him T3N0M0. What does this imply?. Does the opinion differ on the basis of this staging……

mishti

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