General concerning radiologist and surgeon

howdyrichard

I have upper esphogeal cancer, T2, N0, M0. The mass lies at my collar bone level and is about 3.7cm.

We do not have a surgeon with this experience at the facility I am seeking help. 

My question:  Shouldn't the radiation onocologist be having converstion with a surgeon?  My doctor seems to have the vision that whatever is necessary will be dealt with by the surgeon after I'm finished with you!

 

Thank you in advance,

howdyrichard

 

 

paul61

Surgery is normally part of the "standard" treatment protocol

Hello howdyrichard,

Is your esophageal cancer squamous cell or adenocarcinoma? Typically, cancer that develops in the upper portion of the esophagus is squamous cell. So, given your staging information T2N0M0, you would be Stage II. Recent medical research has found that there are significant differences in preferred treatment protocols and outcomes between squamous cell and adenocarcinoma esophageal cancers. If indeed you do have squamous cell and are Stage II your medical oncologist may feel the best initial treatment would include radiation therapy perhaps activated with a minimized dosage of chemotherapy agents, followed by a series of PET or CT scans to determine the level of response prior to proceeding to surgery.

I would have a conversation with your primary oncologist about your long-term treatment plan. His plan would normally include a referral to a qualified surgical facility at the appropriate stage in treatment. On the other hand; if there is not a surgeon qualified to perform a minimally invasive esophagectomy on the staff of that facility, I would encourage you to seek a second opinion at a cancer treatment facility with a wider range of esophageal cancer treatment capabilities.

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 - Eight Year Survivor

howdyrichard

paul61 said:

Surgery is normally part of the "standard" treatment protocol

Hello howdyrichard,

Is your esophageal cancer squamous cell or adenocarcinoma? Typically, cancer that develops in the upper portion of the esophagus is squamous cell. So, given your staging information T2N0M0, you would be Stage II. Recent medical research has found that there are significant differences in preferred treatment protocols and outcomes between squamous cell and adenocarcinoma esophageal cancers. If indeed you do have squamous cell and are Stage II your medical oncologist may feel the best initial treatment would include radiation therapy perhaps activated with a minimized dosage of chemotherapy agents, followed by a series of PET or CT scans to determine the level of response prior to proceeding to surgery.

I would have a conversation with your primary oncologist about your long-term treatment plan. His plan would normally include a referral to a qualified surgical facility at the appropriate stage in treatment. On the other hand; if there is not a surgeon qualified to perform a minimally invasive esophagectomy on the staff of that facility, I would encourage you to seek a second opinion at a cancer treatment facility with a wider range of esophageal cancer treatment capabilities.

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 - Eight Year Survivor

Thank you

Yes, it is squamous cell and we did start off with Cisplatin and 5 FU for 4 days.  This is my 13th day of radiation.  I will be going back for my treatment this morning and will try to clarify a 'plan' which sadly, all I know is that we will repeat chemo in 2 weeks, another couple weeks of radiation and then determine if a surgeon is need, I guess.

I like what you said and will try to get some kind of commitment this morning on the plan.  I do have a second opinion scheduled with MD Anderson next Thursday.

Thank you,

howdyrichard

 

Deathorglory

Hello Richard

Hello Richard,

I'll just mention how my team worked/s as a point of reference for you.  My medical oncologist has been in charge of my treatment team since the beginning.  She coordinated with both the surgeon and my radiation oncologist.  She also worked with my gastroenterologist.  She was the team leader and made sure that everyone else was on the same page as they all worked together.  I was/am at a major teaching hospital and they are NCI designated and very well respected in the cancer world, especially for esophageal cancer.  From the very beginning, it was explained to me that they all worked as a team and it was also explained how that team would function.  I didn't have to guess.  That was one of the reasons I opted to have my treatment there.

Hope this is useful,

Ed