Sequence/Timing of Chemo and Radiation prior to Surgery

morley
morley Member Posts: 24
in Esophageal Cancer #1
I'm new here, but was diagnosed with a 4 cm tumor at the E-G Junction on April 24.

All the testing and appointments seem to move too slowly for me.

I had CT Scan, Barium Swallow test, PET scan and Esophageal Ultrasound through mid-May and ultimately diagnosed as T2N0M0 (stage 2a).

I had an appointment with Dr. Mark Orringer at the University of Michigan last week and he referred me to Oncologist (Dr. Urba) and Radiation Oncologist (Dr. Hayman) prior to surgery. I have my Oncology appointment next Tuesday (June 5) and Radiation on June 14.

My question is timing of starting treatment and the sequence of chemo and radiation. I'm scared of waiting too long to start treatments.

- Can (or will they) start chemo before even having the radiation conultation?
- How long after the radiation consult before the radiation treatments actually start?

It seems like I am looking at several more weeks before treatment begins if I have to wait through all the appointments. It will be 2 months since original diagnosis if I have to wait through all the consults.

For those of you that have been treated at Michigan - what have been your experiences and did you have your chemo/radiation treatments at U of M or closer to home (I live near Grand Rapids - 2 hours from Ann Arbor)

I have read through most of these discussions and am touched by your stories and knowledge (and your care for all those on this terrible journey)

Thanks
Dave

Comments

  • sandy1943
    sandy1943 Member Posts: 824
    #2
    Welcome to finding a good
    Welcome to finding a good site to help you through treatment. I will let some of the others with better answers to your questions respond. I didn't take radiation so I don't know the answers. I do know the testing is awful. After a bad diagnoses of Ec, we all want to start treatment immediately, but the testing is to our advantage.I'm glad the results so far is stage two. So many are unfortunate in discovering it in time. I didn't check your about me page. If you haven't filled it in, please do. It helps us to know you better.
    Prayers' Sandra
  • Guigna
    Guigna Member Posts: 63
    #3
    waiting
    when my husband was diagnosed, I made all the first phone calls. I got "well you can come in in a month" i told them that wasn't acceptable, i needed something sooner. Every time I tried that it worked. Ask for cancellations.
    As it turned out, even as quickly as we acted, it was still too late for my husband, who is slowly dying from this cancer today. But there is no way i could have complacently waited until A MONTH had passed to even start fighting.

    Good luck. Be assertive. It's your life!
  • paul61
    paul61 Member Posts: 1,392 Member
    #4
    You should be able to have your treatment locally
    Dave,

    First of all, although I am sure you may not feel this way, you are fortunate to be diagnosed at an early stage. Since your cancer is "localized" it makes it much easier to treat.

    You should be able to define a treatment plan with Dr. Orringer and his staff and then have the actual treatments done at a facility in Grand Rapids. There are many survivors here who have worked with a major cancer center to have their treatment plans defined and monitored and then had the actual treatments at a local facility.

    As relates to start of treatment, after the initial consultations, my chemotherapy started the week after my consultation with my oncologist. I did have a short delay of a few days while I had a infusion port placed. Here is a brief overview of what an infusion port is:

    chemo port overview

    Radiation therapy will take a bit longer to set up because they need to define the area and paths that the radiation beam will use and they will create some small tattoos on your body that the radiation technicians will use to line up your treatments.

    Chemotherapy and radiation therapy are typically done concurrently but chemotherapy could begin in advance of radiation therapy if there was a need.

    I know it seems to take a long time for treatment to begin when you are wondering "how fast is this stuff spreading in my body?" but there is value in making sure the staging has been done correctly and the treatment plan is comprehensive.

    It is not unusual for it to take about a month to get all tests completed and a treatment plan underway.

    If you would like to send me a private message I can send along my telephone number if you would like to talk.

    Stay positive, this thing can be treated and put behind you.

    Best Regards,

    Paul Adams
    Grand Blanc, Michigan

    DX 10/22/2009 T2N1M0 Stage IIB
    12/03/2009 Ivor Lewis
    2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
    Two year survivor

    Life may not be the party we hoped for, but while we are here we might as well dance!
  • JReed
    JReed Member Posts: 428
    #5
    Univ of Mich
    Dave:

    My husband is Stage 3 - his surgeon was Dr. Reddy (on Dr. Orringer's team - Orrigner being the perfector of the THE surgery). You are in great hands. You will meet with med oncologist for a chemo setup (if chemo is part of your treatment) and Dr. Hayman is one of the world's best radiation oncologists - doctors from around the world go to him for answers. We just met him for a 2nd post op opinion due to a difficult and rare outcome for my husband.

    It does take FOREVER when you are diagnosed - but the tests are absolutely necessary to get the best information possible as to the target area of the tumor, what chemo is likely to work in your case.

    Don had his surgery March 22 at Univ of Mich - was home one week later. If you would like to talk with Don - let me know in a private message and I will send you his number. He will be happy to share his experiences with you.

    It looks to me like you have the best of the best over there. I'm with you on the waiting - it stinks, but before you know it - you'll be strengthing yourself for surgery.

    Judy & Don
  • bingbing2009
    bingbing2009 Member Posts: 177
    #6
    My Docs Moved Quickly
    All I can tell you is how fast things moved in my case. The following is a timeline of my care:
    2009:
    Tuesday, Oct. 20, a.m.—Primary physician appointment
    Tuesday, Oct. 20, p.m.—Barium swallow test
    Thursday, Oct. 22, a.m.—Gastroenterologist appointment
    Thursday, Oct. 22, p.m.—Endoscopy
    Friday, Oct. 23, a.m.—CT scan
    Friday, Oct. 23, p.m.—Gastroenterologist called with bad news of EC
    Monday, Oct. 26—Oncologist appointment
    Tuesday, Oct. 27—Radiologist appointment
    Wednesday, Oct. 28—PET scan
    Thursday, Oct. 29—Transesophageal ultrasound
    Monday, Nov. 2—Oncologist surgeon appointment
    Tuesday, Nov. 3—Surgery—port and feeding tube placed
    Wednesday, Nov. 4—Dismissed from hospital
    Monday, Nov. 9—Began chemo and got permanent radiation marks
    Monday, Nov. 9 thru Friday, Nov. 13—Infusion of Cisplatin Monday and week of 5-FU
    Tuesday, Nov. 10—Began radiation treatments
    Monday, Dec. 7 thru Friday, Dec. 11—Indusion of Cisplatin Monday and week of 5-FU
    Thursday, Dec. 17—Last radiation treatment

    As you can see, in just barely over 2 weeks from diagnosis, I was starting chemo and radiation.

    Melinda

    DX October 2009: T3N1M0
    November and December 2009: chemo (Cisplatin and 5 FU) and radiation
    February 2010: Ivor Lewis surgery
  • a1phil
    a1phil Member Posts: 29
    #7
    radiation and chemo 2 home town. I am sched. for surgery 6/22.
    I also see orringer, I chose to have my treatments in Jackson,thats where I live. I juCst saw the DR 5/31 2012. Good luck on your treatments , rember radiation will be daily. Contact me if I can answer questions. I was dx 1/31 2012. Ity all moves slowle, but the time seems fast.
  • monica_sss
    monica_sss Member Posts: 54
    #8
    Understand your frustration...
    I remember being frustrated waiting for my Mom's treatment to start. She was diagnosed in late November and December was full of various tests and measurements. She began radiation and chemotherapy in mid January. Feb 19th was her last treatment and she had surgery on April 4th.

    We were told that they won't do radiation with the chemo because they are most effective when done together.

    When I expressed concerned about all of the waiting her surgeon told me that the tumor has likely been there for at least 5 years and it wasn't going to explode in a matter of 4 weeks (she was dx stage 3A). I'm so sad to read about those that have progressed from 3 to 4 during the wait period - I wonder if the surgeon was giving me a "line" on that one. Thank God the tumor had shrunk and there was no sign of spread by the time she had her pre-op PET scan and CT scan.

    I echo the previous thoughts, be assertive if you feel that things aren't progressing in a timely way.

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