Post operation concern

Understand your concern
Hello Altra,

My husband, also T3N2M0, had his surgery 2 weeks ago. Presurgery, our doctor told us that there might be voice issues following as the vocal chords are "right there" and could be damaged during surgery. He said that it is a temporary condition but does take a while to work through. Perhaps a month isn't enough time?

I can't answer your post-op chemo question. We are still waiting to find out if post-op chemo is wanted by our oncologist. 7 nodes were removed for Nick, and all were clean. I would agree with you though - I have seen many post here with cancerous nodes after that post-op chemo was ordered for them.

Best of luck in your research and I wish your father good health and continued strength. He will be added to our prayers.

Terry
Wife to Nick, age 48
dx T3N2M0 05/19/11
THE 09/08/11

I would get a second opinion on the chemo
Hi Altra,

My husband just had an Ivor Lewis on 9/6, what type of operation did your dad have? I ask because if he had a THE surgery temporary damage to the vocal cords is more likely, of if he had MIE and they reconnected near the neck that is also possible. Since my husband had the IL it was less likely that he would have vocal problems, but when he woke up from surgery he could barely talk and any time he tried to talk loudly his voice would go up an octave. The surgeon wasn't concerned and said it would heal on it's own and was probably due to being intubated during surgery, but they said if it persisted that they would send him to an ENT. My husband's voice has completely returned at this time. Has your dad had his follow up meeting with the surgeon yet? If not, ask whether he should see an ENT doctor for review of the cords. From what I understand the ENT can assess the damage and help to rehab the cords.

Now on to chemo. I don't agree with your dad not receiving post-op chemo, I am not a doctor but common sense to me would say, he had live cancer removed from him during his surgery, who is to say there aren't a few live cells floating around in his body. Or that his surgeon didn't get out the one node that still has cancer in it. I don't say this to frighten you, but to me it only makes sense to have more chemo. Who advised against more chemo, the surgeon or the oncologist? If your dad has not yet visited his oncologist he should make an appointment. I would agree that doctor's often say there are no reports that say that post-op chemo is effective in stopping recurrance, but I have never heard of someone who had multiple nodes come back positive on the pathology report not have post op chemo. My husband had a clean pathology report and the surgeon still suggested post op chemo. You will hear people here refer to them as having mop up chemo, and that is exactly what it is, a little clean up after chemo. Did your dad handle chemo well the first time around? I would urge your dad to talk to his oncologist, or if he has already has that he talk to another oncologist. Where is your dad seeking treatment?

Paul and Donna both had post-op chemo because they had one positive node, hopefully they will chime in here or you can go search for some of their posts.

Hope this helps,

Niki
Wife of Jeff T2N1M0
IL 9/6/11

Altra said:

Thanks for the replies. I
Thanks for the replies. I love this forum so much!

I went and visited my dad for the first time in about a week this morning, and his voice sounded better than it did a week ago. Still quite hoarse, but I definitely noticed an improvement.

As for the type of surgery he had, I am unsure. I try to get as much information out of him as I can, but it is like pulling teeth sometimes. He was in the hospital for 6 days after the surgery before he was discharged, if that says anything (I think I read that expected hospital stay with Ivor Lewis is a lot longer?) so maybe he did have the MIE.

He told me quite bluntly today that the doctors said it is quite possible there will be recurrence and very well could be cancerous cells still in his body, so I really don't understand why they wouldn't suggest more chemo. Dad had a rough time with chemo the first time (mostly nausea issues), so I can understand why he isn't begging for more, but still.... it leaves me worried. It's a little hard to try to convince him to do something once his mind is set, and he puts complete faith in his team of doctors. It can be quite frustrating when he won't listen to my suggestions to get a second option.

Your words
are my husband EXACTLY....

"It's a little hard to try to convince him to do something once his mind is set, and he puts complete faith in his team of doctors. It can be quite frustrating when he won't listen to my suggestions to get a second option."

Nick is so much like your father. My husband meet with 1 surgeon, 1 oncologist, and 1 hospital. He really found faith in the team he met and that was "end of discussion".

You can share frustrations here anytime, Altra. We hear and understand you!

Terry

Donna70 said:

Altra, my dr said nothing proves it works but did it
Hi,
I had T3N1MO squamous cell and had the big surgery. One positive node was found during surgery. My onc dr had me do the post op chemo. He said there is no proof that it works but was doing it as insurance and hoping he would not see me come back with a recurrence. Now about the voice. My neck was cut and my vocal cord left side was paralyzed. They told me at first I might get my voice back because in many cases it does come back. Mine never did and I speak in a real high breathy voice. I have had lung issues also. So I am getting ready to get my vocal cord surgery to help me speak with more breathing done easier and also so I could talk more clearly. Hopefully, your Dad is only having temporary issues and his voice will get stronger. But there are alternatives if his voice does not come back. I was not a candidate for the injections in the vocal cord because of jaw issues. Just tell him to be patient, he is only one month out and it takes awhile to get your sea legs back, but you see improvement over the long run. He is lucky to have a good caring daughter like you. take care,
Donna70

Good question about post-op chemo.


When I met with my surgeon and oncologist in Boston before my surgery they both said if any cancer was detected at pathology follow up chemo would be needed. Both doctors said if the pathology report was clean then additional chemo would not be necessary. I asked my local oncologist about follow up chemo and he said he had never heard of it regardless of the pathology results. In my case I’m ten months out from MIE with a clean pathology and no follow up chemo and have recently discovered I have a recurrence. “Complete faith in the doctors”? How about absolutely no faith in these guys! I don’t understand how something like cancer treatment that is suppose to have so much money and research into it can be so poorly coordinated.

Joel

Altra said:

Yes, it seems the general
Yes, it seems the general consensus says he should be getting more chemo. He handled it "well enough" the first time. Yes, there was some vomiting, lots of nausea, some weight loss, but I am sure he could handle another round. He is 65 and in excellent health otherwise.

"Nick is so much like your father. My husband meet with 1 surgeon, 1 oncologist, and 1 hospital. He really found faith in the team he met and that was "end of discussion"."

That is my dad exactly. And his name is also Nick. Made me chuckle, despite the seriousness of the situation.

Thanks for the smile!
I always told him the stubborness was "just being Nick". Glad to see I was right - it *is* the name

I'll share this with "my Nick" when I get home tonight. I know he will appreciate it.

Terry

Hi, I agree with Paul. It
Hi, I agree with Paul. It would be risky not to have the chemo. We have been through a lot to get to this stage, so why not go the extra chemo. I've known cancer patients that didn't and had recurrance. I had a node that was positive, but had to stop chemo right after it started, because of completions. I feel blessed that without the chemo, I am still three years cancer free.
My surgeon is the only one I know that doesn't do radiation for EC. He did a several year study, and feels the outcome is just as good without it. So far I am okay and pray I'll stay that way. I wasn't aware of the common treatment or I would have probably had a lot of doubts in him. He is an excellent thoracic surgeon with a lot of experience, so in a way I'm glad I was ignorant at the time.
Encourage your dad. I know how hard it is to take more chemo, but I feel it is worth it for that extra assurance.
Sandra

chemosmoker said:

DON'T take NO for an answer!!!!
Altra,
In MY opinion, ANY reputable cancer center will do post-op chemo after surgery. I would not take NO for an answer. I have YET to see but a small handful who did NOT have post-op chemo that have not had a recurrence. It is just not worth it to have come so far to make a mistake like that, and I am oposed to chemo on principal personally. THAT should say it all.
GET THE CHEMO or go somewhere that will give it to him! Positive nodes or NOT!

I know they don't LIKE to give it too soon after being weakened from the surgery, but I know of may who have started WEEKS after the surgery or sooner, and are doing fine. All the rest, save a few (some are here posting) have had a recurrence as I said.

God bless and good luck. As it was said, YOU MUST BE THE ADVOCATE and teach these doctors and demand what you want, or else.

-Eric

thanks for your good words
Eric,
thanks for giving Altra a really good response to this question. I am surviving Stage III with positive node before and after surgery and so glad my dr was an advocate for post op chemo. Everyone on this board caregivers and patients alike must always remember the best advocate for their best care is themselves!!! I got my surgery early December and started post op chemo in February and it was hard but I am doing fine with all clear scans and wish that was the outcome for so many on this board who were not as fortunate. You are so right about demanding the level of care you deserve. Thanks for putting it so succinctly. take care,
Donna70