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Surgical Recommendations

AKRN2013
Posts: 22
Joined: Apr 2013

So, my dad was just diagnosed with Stage III T3N1M0 adenocarcinoma of the EG junction.  The oncologist recommneds surgery first, chemo/radiation after.  We are referredto Stanford and have an appointment with a surgeon Friday.  Anyone with experience with this center?  Any recommendations for surgeons?

 

Thanks!

paul61's picture
paul61
Posts: 1105
Joined: Apr 2010

Heather,

 

It is rather unusual for Stage 3 esophageal cancer patients to have surgery prior to chemotherapy and radiation therapy. The normal protocol is chemotherapy and radiation therapy first, followed by a rest period and PET assessment of response. Followed by surgery. Then occasionally adjuvant chemotherapy based on the results of the surgical pathology.

Best Regards,

Paul Adams

McCormick, South Carolina

DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009

Cisplatin, Epirubicin, 5 FU - Three Year Survivor

 

South Side Steve's picture
South Side Steve
Posts: 23
Joined: Nov 2011

Heather,

I definitely agree with Paul's concerns about surgery before chemo and radiation, especially for a Stage III diagnosis. The most common treatment plan calls for chemo/radiation and then surgery. There is usually a 4 - 5 week period between chemo/radiation and the surgery to recover from chemo/radiation and get in shape for the surgery. I suggest questioning your surgeon about that.

Steve

Dad'sfight
Posts: 155
Joined: Feb 2013

Paul and Steve are both right!!!

 

Steve & Paul, I wanted to thank you for your words of encouragment.  Dad is home and healing.  THANK YOU!!

AKRN2013
Posts: 22
Joined: Apr 2013

I was a bit suprised by the oncologist's recomendation too.  All of my research finds treatment plans for chemo/radiation followed by surgery.  I keep asking my parents what experience the oncologist has with esophageal cancer but my parents wont ask her.  They assume she woud not ahve taken the case if she wasnt familliar.  She is a frined of my moms so I think they dont want to offend her.  I dont have that problem....unfortunately, I am in alaska and they are in Cali!  I asked that they call me from the surgeons office today so I can ask my questions. I will let you all know what I find out.

 

Thank you all for your support.  It really helps to be able to communicate with others who are or have gone throughthe same thing!

 

Heather

Dad'sfight
Posts: 155
Joined: Feb 2013

My parents were the same way, never liked to 2nd question the doctor. I DID, and had no problem doing it. I too have worked in the healthcare field for many years, so your knowledge is going to be a great asset for you during all of this.

AKRN2013
Posts: 22
Joined: Apr 2013

So, my parents met with the surgeon yesterday.  Unfortunately, due to miscommunication between myself and my sister I was not able to conference in so I only have second-hand inforamtion. 

The surgeon's name is Jeffrey Norton and he is the chief of surgical oncology.  The assiting thoracic surgeon will be Dr. Shrager, chief of thoracic surgery and an EC surgical expert. Dr. Norton told my parents that he would need 3 months of chemo and radiation prior to surgery.  This is more inline with what me research has shown to be the preferred protocol.  I am a bit concerned about my parents choice in medical oncologists as she has already misinformed them once.  If she is not even aware that stage 3 is treated with chemo before surgery what else is she going to miss?  My parent really like her and are not interested in changing at this point.  I will likely be runing his treatment plan through this board to get everyone's input on whether her course of treatment matches standard protocol. 

As far as surgery, it sounds like they want to do the TTE.  I am concerned that they want to go transthoracic when there are less invasive options such as THE and laporoscopic.  I have his e-mail addredd and he has said that he will answer all of my questions.  I am also concerned about my Dad's ability to tolerate the surgery due to his moderate COPD.  Any one with experience with this.

Now we are back to the waiting game to find out when he gets his port placed and starts chemo.  I would love information on what he can expect for side effects of the most common therapies.  I am familiar with some of the chemo's as I administer them to pediatric oncology patients.  But some I am not familliar with.  I am trying to decide if I shoudl go home to help him with this phase.  My mom has to work as do my sisters so he will be home alone a lot during treatment. They dont want me to come down until surgery bu tI am thinking I shoudl be there earlier.  Do you recommend someone stay with him or should he be okay alone? 

Thanks again for your support and information!
  

JKGulliver
Posts: 81
Joined: Apr 2013

Surgery first is only recommended for T1 or T2, stage 1.  There are protocols.  I believe surgery first for T3 N1 M0 is outside protocol.   This is something that should be questioned.  You can find the NCCN protocols online. 

You do not say where this surgeon is affiliated.  If I were you, I'd encourage your parents to go to UCLA Medical Center.  It is the top rated cancer center in California.  However, bear in mind that this is an overall rating for ALL types of cancer.  EC is a beast of its own:  http://health.usnews.com/best-hospitals/rankings/cancer

If your parents are in northern Cal, note that UCSF is highly rated.  Surprisingly, Stanford is behind both of the other two schools. 

Best of luck to you.

 

joymitch
Posts: 16
Joined: Dec 2012

My husband, Paul, had EC surgery on February 19.  His tumor was a stage II and he had chemo/radiation prior to surgery.  He is glad he did as he would not have wanted to have it after surgery.  Healing takes time and rest after surgery.  

Dad'sfight
Posts: 155
Joined: Feb 2013

I'm glad your husband is doing well.  My father had his sx 4/1/13 after having chemo/radiation.  Dad told me the same thing your husband did, if surgery would have been 1st he wouldn't have done the chemo/radiation.  Did your husband have any diff. with back pain?

joymitch
Posts: 16
Joined: Dec 2012

Paul had back pain about 1 week after coming home from the hospital.  He woke up with it one morning and thought he had twisted something.  We are not sure if he did or if it was related to the surgery.  It lasted about 1 week and was treated with Advil.  He is now 9 weeks out of surgery and is doing wonderful.  He has not been hungry since surgery and it is a struggle to eat 5-6 times per day to keep his weight from dropping.  He still gets fatiqued easily but that is to be expected.

South Side Steve's picture
South Side Steve
Posts: 23
Joined: Nov 2011

Everyone reacts differently to the chemo/radiation treatments and there are different chemo cocktails used by different doctors, but this was my experience. I had 7 weekly infusions of Paclitaxel and Carboplatin and tolerated them pretty well. I did start to lose my hair on about the 4th infusion. I had minor nausea, but nothing too serious. I also had morning nosebleeds and some minor mouth sores, but again, nothing too serious. Mostly, it was just major fatigue and loss of appetite. I didn't have any problem with radiation until my final treatment when my esophagus got so raw I couldn't even swallow water. As a result, I got dehydrated and had to go in for an IV. I lost between 30 - 35 pounds during my treatments. My wife was my main caretaker and she did a great job of pushing food and liquids at me. I was home alone during the day and often skipped lunches because I didn't have an appetite and it was easier to skip them than make something to eat. It really helped to have her "persuade" me to eat, even if I didn't think so at the time.

I was fortunate not to have any complications after surgery, so after the first week home, I was able to stay home alone without any problems. My wife would come home at noon to flush my J-tube and make lunch for me. The biggest frustration for me after surgery was the long recovery period. I know you had mentioned in a previous post your dad was planning a big fishing trip to Alaska in July. That might be wishful thinking. I had the Ivor Lewis surgery and didn't have any strength or stamina for the first few months post-surgery. Your dad will also have to be sure he heals completely before doing anything too strenuous to avoid a hernia. That probably isn't what your dad wants to hear, but it takes a long time to recover from this experience. The good news is he should be able to make a full recovery with just a few lifestyle changes.

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