Radiation and possible surgery for stage iv EC - is this normal

eternalife

Hi Stage iv EC patients and caregivers,

My husband diagnosed with stage iv EC Dec. 2011 has only received chemo to date, his recent PET scan showed no visible mets, however the esophageal wall has thickened, he has some intermittent swallowing problems, not major, still able to eat on his own.

The oncologist recommends radiation to shrink the primary tumour site and then look at surgery.

The surgeon said he would not perform surgery on a 70 year old male, but for my husband in his 50s, he said there is hope and would like to operate.

What has been your experience and your thoughts on this?

Thanks

paul61

It is certainly unusual to hear of surgery for Stage IV

In the three years I have been on this forum this is not the first time I have heard of surgery being offered to a Stage IV patient; but it is certainly unusual. I think before I would proceed with surgery, I would make sure I had a second oncological and surgical opinion about the potential benefits of such a complex and invasive surgery.

 The definition of Stage IV is that esophageal cancer has been detected in other major organs or at points in the body distant from the primary tumor. Therefore surgery is almost never offered to Stage IV patients because the potential for surgery to get to all the cancer is not that promising; and why put someone through a complex and difficult surgery that takes at least six months to recover from, that would not offer a promise of long term remission.

 I would be asking:

1. Based on your latest scans and examination do you feel my current staging has changed?
2. Is the intent of the surgery “curative” or is it a component of Stage IV management?
3. What do you feel my chances of long term remission are post-surgery?

This is so unusual I would want to get several perspectives on the benefits of surgery.

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

eternalife

paul61 said:

It is certainly unusual to hear of surgery for Stage IV

In the three years I have been on this forum this is not the first time I have heard of surgery being offered to a Stage IV patient; but it is certainly unusual. I think before I would proceed with surgery, I would make sure I had a second oncological and surgical opinion about the potential benefits of such a complex and invasive surgery.

 The definition of Stage IV is that esophageal cancer has been detected in other major organs or at points in the body distant from the primary tumor. Therefore surgery is almost never offered to Stage IV patients because the potential for surgery to get to all the cancer is not that promising; and why put someone through a complex and difficult surgery that takes at least six months to recover from, that would not offer a promise of long term remission.

 I would be asking:

1. Based on your latest scans and examination do you feel my current staging has changed?
2. Is the intent of the surgery “curative” or is it a component of Stage IV management?
3. What do you feel my chances of long term remission are post-surgery?

This is so unusual I would want to get several perspectives on the benefits of surgery.

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

Thanks

Thanks for your suggestions, will ask these questions on friday when we meet with the doctor. We are in line to do radiation first, then likely a scan to follow, if the wall shrinks and there is no evidence of disease outside of the primary site, then surgery might be offered as a curative measure. I agree it is a lengthy surgery and recovery process and there really are no guarentees that the cancer will be stamped out or put in remission.

Right now, my husband has very little energy, and may be barely up to radiation first.

 

Glad to know that you are doing as well as you are since your diagnosis.