My Dad and surgery?

Raphael

Hi everyone,

I have been checking out this forum for a few weeks since my Dad was diagnosed with early stage esophageal cancer and it seems everyone is supportive and informative.  We have only just got the full picture - stage 1 (I think), adenocarcinoma of lower esophagus with no spread according to ct and pet scans.  He will start chemo and raditation this week for five weeks and then will likely have surgery.  We saw the surgeon today.  The surgery sounds more major than we thought.  My Dad is 78 years old, had heart bypass surgery 21 years ago but is in reasonably good health and no heart problems since.  The surgery sounds scary though with major possible risks and complications.  Dad has about a month to consider whether he wants to go ahead with the surgery although it sounds as if he doesn't have much choice if he wants a reasonable chance of cure.  He was told without surgery his chance of total cure is only about 5%, although he could possibly have 2 or 3 years of good quality of life.  With surgery it will be about a 50% chance of cure, but a 5% chance he wont make it through the operation.  The surgeon is well respected as one of the best in the country (I live in Australia) and has only recently begun to perform the keyhole esophageal surgery. 

Of course this is my Dad's decision, but just wondering what others think about all of this?

 

Ladylacy

Thoughts

So sorry to hear about your Dad.  Do a lot of research on this subject as this surgery is quite bad and the older the person generally the harder the surgery and recovery.  This is what our specialist told my husband.  But as his cancer has spread to his lungs, surgery is not an option and he is 76.  Since he had already been thru radiation (35 rounds) 2 different times and chemo, chemo was the only option, and we were told it wouldn't cure only prolong and possibly hasten.  My husband had already told me, he wouldn't do anything else, but would talk with the specialists. 

This was his decision and I didn't try to change his mind.  Wanted to don't get me wrong, but it is his decision.  Right now since January when we were told, he has been doing fairly well, so I think he made the right decision. 

Wishing you and your family the best -- Sharon

paul61

Other treatment options

I had this surgery when I was 61 years old and in generally excellent health. It took me about 8 months to recover to the point that I could do every day things around the house again. I had Ivor Lewis surgery which is the “open” surgery not the minimally invasive esophagectomy “keyhole” surgery, but irrespective of what approach is used this is MAJOR surgery, with significant respiratory and infection risks. If I were 78 years old I would give serious thought before proceeding with surgery.

Given your Dad’s early Staging have they considered the possibility of radiofrequency ablation, or endoscopic mucosal resection (EMR)? These treatment options are for very early Stage 1 cancers but given your Dad’s age, if he responds well to chemotherapy it might be an option to prolong quality of life. It may be worth at least asking the question.

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

BobHaze

paul61 said:

Other treatment options

I had this surgery when I was 61 years old and in generally excellent health. It took me about 8 months to recover to the point that I could do every day things around the house again. I had Ivor Lewis surgery which is the “open” surgery not the minimally invasive esophagectomy “keyhole” surgery, but irrespective of what approach is used this is MAJOR surgery, with significant respiratory and infection risks. If I were 78 years old I would give serious thought before proceeding with surgery.

Given your Dad’s early Staging have they considered the possibility of radiofrequency ablation, or endoscopic mucosal resection (EMR)? These treatment options are for very early Stage 1 cancers but given your Dad’s age, if he responds well to chemotherapy it might be an option to prolong quality of life. It may be worth at least asking the question.

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

Second Opinion

 

I agree with Paul’s suggestion that your Dad should research his options, and maybe get a second opinion from a major cancer center with lots of experience with EC.  I was early Stage I and there are a couple of others who used to post here and still do in the Facebook EC group, and in my experience it’s very unusual for Stage I’s to have chemo or radiation prior to surgery.  As it was explained to me, the purpose of chemo for Stage II or III folks is to “down-stage” the cancer in preparation for surgery.  But of course there is no need to “down-stage” from Stage I, so I thought that chemo and radiation were not indicated.

 

Again, I would encourage your Dad to seek a second opinion, and make sure the cancer center AND the specific surgeon he goes with have extensive experience with Esophageal Cancer, not just cancer in general.  Regional hospitals generally do not fall into that category, no matter how comfortable one is with his or her local doctor or hospital.  This is a relatively rare form of cancer and, as you and others have said, it is major surgery and shouldn’t be undertaken except by specialist doctors with experience with it.

 

Just one man’s opinion.  Best of luck to your father.

 

FEC,

Bob

T1aN0M0

Dx   8/3/11

MIE 9/23/11

Raphael

BobHaze said:

Second Opinion

 

I agree with Paul’s suggestion that your Dad should research his options, and maybe get a second opinion from a major cancer center with lots of experience with EC.  I was early Stage I and there are a couple of others who used to post here and still do in the Facebook EC group, and in my experience it’s very unusual for Stage I’s to have chemo or radiation prior to surgery.  As it was explained to me, the purpose of chemo for Stage II or III folks is to “down-stage” the cancer in preparation for surgery.  But of course there is no need to “down-stage” from Stage I, so I thought that chemo and radiation were not indicated.

 

Again, I would encourage your Dad to seek a second opinion, and make sure the cancer center AND the specific surgeon he goes with have extensive experience with Esophageal Cancer, not just cancer in general.  Regional hospitals generally do not fall into that category, no matter how comfortable one is with his or her local doctor or hospital.  This is a relatively rare form of cancer and, as you and others have said, it is major surgery and shouldn’t be undertaken except by specialist doctors with experience with it.

 

Just one man’s opinion.  Best of luck to your father.

 

FEC,

Bob

T1aN0M0

Dx   8/3/11

MIE 9/23/11

update on Dad and surgery

Thank you so much for your replies.  At this stage it looks like Dad wont go ahead with surgery.  After being seen by chief anaesthetist at our hospital it was suggested that at his age (78) surgery is a major undertaking with lots of risks.  The medical team are hoping that the chemoradiation will pretty much get rid of the cancer for now and believe he could have at least 2 or 3 years or good quality of life.  Apparently in some cases the treatment can cure the cancer for life, although I am realistic enough to know that he would be very lucky.  Surgery could take that away from him and then the cancer could return anyway.  Even if it all goes well there are no guarantees or curing him and it just doesn't seem to be worth the trauma he would have to go through at his age.  I think that both Dad and Mum are sort of relieved in a way and just remaining hopeful that the treatment will get this beast for now.  It's hard because I just want the best possible outcome but I also understand that the ramifications of surgery could just be too big and if he didn't make it through then I would lose him much earlier than otherwise.  So...the journey continues for now.  It's strange how you sort of get used to it all in a way.  I was so devastated at first, but as time is going on I am somehow coping and just trying to keep positive. 

Jen