Dad diagnosed of squamous cell carcinoma (update in comments, another update surgery completed)

I had a diagnostic history similar to your Dad’s. I had adenocarcinoma of the esophagus; but had the same initial tests that your Dad had. They said “good news we have caught it very early and we will go straight to surgery”. When they got the pathology results back on the tissue removed in surgery they found that I had active cancer cells in one of the lymph nodes removed during surgery. They then recommended follow up chemotherapy after surgery.

Chemotherapy is difficult under the best conditions, but going through chemotherapy while trying to recover from a major surgery, is very difficult.

I would very much recommend a second opinion and perhaps a PET scan to insure the cancer inside the esophageal wall.

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
Seven Year Survivor

Hello Mayflower,

When I started down this road in 2008 with Stage III EC, I had had reflux for years (decades actually).  What spurred me to get checked was that food was getting stuck in my throat.  I found out this is called dysphagia and is a common symptom of EC.  Reflux generally leads to adenocarcinoma, which is what I have, not as frequently to squamous cell carcinoma like your dad has.  Hopefuly, they've caught him very early (Stage I is ideal) like you've said.  Treatments are generally much more successful when EC is caught early.

As far as your dad's proposed treatment goes, my understanding (I'M NOT A DOCTOR!!) is that somoetimes surgery will be done by itself if the cancer is caught early enough.  Trimodal (radiation/chemo/surgery) therapy is what I understand is the most common path if it is possible.  I would certainly ask about this with your dad's doctors and perhaps seek a second opinion.  EC isn't something you want to treat casually, you want to make sure you're doing the best you can do the first time, because too frequently there isn't a second chance.

Wishing you & your father the best,

Ed

Mayflower18 said:

Thank you Paul. I will keep

Thank you Paul. I will keep this post updated as things move on . Do you remember what symptoms you had ? My dad for now is feeling and eating normal. He does get the pain in chest once in a while but said it's bearable. 

My initial symptoms were not very pronounced. It included occasional pain when swallowing and sometimes a feeling like my food was getting stuck on the way down but it always cleared when I drank something. I originally went to my primary care physician because I was having frequent acid reflux at night. In fact I had been having acid indigestion for most of my adult life but I had heard that there was a medication I could get from my doctor that would help more than the Tums I was taking on a regular basis. He said “Let’s run some tests just to be safe” and that is when they found the tumor.

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
Seven Year Survivor

LorettaMarshall said:

Mayflower~Thanks 4 the reference 4 Dad's surgeon -Dr. Palanivelu

 Thanks so much. 

I've copied some links into my file.  Dad’s surgeon obviously has a passion to help his people, and certainly is well respected in both civilian and medical circles.   I'm impressed and relieved! 

That reminded me that among my husband's doctors back in 2003, there were two doctors who were in charge of his 25 radiation treatments.  They were both young.  One was from India—one was from Russia.  We asked the doctors what motivated them to come to America.  The Indian doctor said it was for the opportunities that were available here.  He had some small children.  He added that there were advantages and disadvantages though.  He liked all our freedoms but he thought we had a very permissive society here, more so than in India.  In other words he meant very loose morals here.  Those weren't his exact words, but that was what he meant.  He wanted his children to enjoy all the freedoms to excel academically and financially, but he thought we were a bit undisciplined as a society.  I agreed with him.  There are a lot of tears in our "moral fiber!"  

I grew up in a time when we were much more respectful of each other.  Love of God and country were in vogue.    We were proud to pledge allegiance to the flag of the United States of America, and proud to say “ONE NATION UNDER GOD! I’m still proud to say that, but I believe like the Indian doctor, that we are too permissive in many things we tolerate these days.   However, I'm really appreciative of the advances we have made in the medical and technological fields.  Even Dr. Ivor Lewis would be amazed at how far we’ve come in the way Esophagectomies are performed today.  And I'm so grateful for our Thoracic Surgeon, Dr. James D. Luketich, the pioneer of the MIE, and I'm glad to know that the Ivor Lewis Minimally Invasive Esophagectomy is also being performed in India by Dr. Palanivelu.

Now if we could only find a cure for cancer and the common cold, wouldn’t that be fantastic?

So here's hoping for all the best in every way on June 20^th. 

Loretta

 

 Okay - This is the day that will determine how the rest of your Dad's days will go.  Just know that we are praying that the surgeons will have gotten a good night's sleep, because Dad probably might not have rested so well.  We know how the anxiety builds as the day of the surgery approaches.  Just be thankful that your Dad has been able to have surgery, and especially that there are good surgeons in India experienced in performing the Ivor Lewis Minimally Invasive Esophagectomy like Dr. Palanivelu. 

We pray that there will be no difficulties--and that there will be no residual cancer in the lymph nodes that will be removed and biopsied for malignancy during the surgery.  We hope that the stage is as "early" as the doctors think it is. 

We'll be praying for the family who is "sitting on pins and needles" in the family "WAITING" room.  What a suspenseful time that is!  And don't be surprised when you get to go in and see your dad for the first time after he "comes to!"  He will be in immense pain, and will have "zillions" off tubes and machines all "doing their thing."  When my husband had his MIE, when I first went into the room, I was amazed at how many pieces of equipment were there to monitor him.  If he is like my husband, he will have a "naso gastric tube", and hopefully a "morphine drip" that he can activate when his pain becomes intolerable.  My husband is capable of tolerating a lot of pain, but he said that he felt like he had been run over by a "MACK TRUCK".  But by the end of the first day, he was out of ICU, and into a step down unit.  By the end of the SECOND day he was transferred out on the regular ward.  He was discharged on Day 5 and downtown shopping with me on Day 8.  How does a wife celebrate such a victory--first by giving God the praise--and then going shopping! 

Oh, and of course, the nurses will have him up and walking within the first 18 hours, even if he doesn't want to!   You don't want to have pneumonia.  Dad should get stronger with each day.  And no doubt, Dad will have a Jejunostomy (J-tube)  tube implanted in the second section of his small intestine in order to supplement his intake of food.  And of course, we pray that there will be no leaks--the "ANASTOMOSIS"- is the place where the organs are rejoined when it's all over. We can't have any leaks!

And, so as I think of you and your dad, in my mind, I'm right back in the waiting room at the University of Pittsburgh Medical Center, and oh how I hope that your dad's outcome will be as great as ours has been.  We're celebrating now the 15th year of survival without a recurrence.  I could never have imagined that when we first received the diagnosis of Esophageal Cancer Stage III (T3N1M0) back in November of 2002!

Wishing your dad every SUCCESS!

Loretta (& William) 

Well Hello Again “Mayflower”

Thanks for the update.  So many write here and we try to be a help, but often we never hear from them again.  I will say that this report is good in that your dad seems to be “no worse for wear”.  That’s a positive and we’re pleased to hear from you. 

As for tiredness, all we chemo patients can identify with that.  Personally as for me with my own cancer, I’ve been in 3 different treatments since 2013 and “tiredness” during the first treatments were especially debilitating.  I couldn’t walk up and down the driveway twice without having to sit down, and my husband had to push me in a wheelchair when I went to the doctors for treatments.  I had to use a shower seat to shower.  And I’m left with residual neuropathy from that very first series of treatments.  On the second series, I broke out in a terrible rash that covered my torso and legs.  So that introduced me to another set of physicians—dermatologists.  Prednisone was prescribed and that came along with its own side effects.  Hopefully, I never have to take that again.  Not to mention that all my hair came out with each series.  By the second week of my first set of (6) treatments, my hair was coming out in “clumps.”  So the next series I just had it shaved to begin with.  The 3^rd time around, I didn’t bother to go to the beauty shop, I shaved it myself, with some help from my husband.  With each series I always had to use a cane.  I now use one because of the neuropathy.  During the last treatment regimen which ended in January of this year, 2017, my fingers were numb and tingly.  That went away, but the neuropathy from the first treatment of Carboplatin and Paclitaxel (Taxol) still remains.  I totally understand Dad’s weakness, believe me. 

But I will say that as for my husband, he fared much better than I during his neoadjuvant treatments.  Within 6 months he totally regained his ability to do everything he had done before his MIE. He was 65 when diagnosed and 66 at the time of surgery.  Now of course strength increases with time but he had minimum decrease in energy soon after surgery.  Now I must say William was an exceptional case.  He was only in the hospital 5 days and we were downtown shopping on Day 8.  We rode the bus to town, but during the first 3 months, we “had a SECOND HONEYMOON” so to speak.  We toured several adjoining states and William (Billy) did ALL the driving.

• I will tell you that it’s nothing short of a feeling of totally not knowing what is going to happen when you see your loved one wheeled down the hall and out of sight, and you sit in the “family waiting room for 7 hours.”  Family members were with me.  Our relationship hung in the balance and only God knew what was happening in that operating room.  In that moment, I think the possibility of not ever seeing my husband alive again was real.  As one wife of a Stage IV EC 48 yr.-old patient said, 6 weeks into their diagnosis, “Having the future tense stripped out of your language when you’re talking to the person you wanted to spend the rest of your life with, and now probably can’t, makes talking sometimes really awkward.”  Well, perhaps “numb” or “limbo” fits, but certainly a totally helpless feeling and a total dependence on the Lord for strength brought me through.  And now, it’s my husband’s turn to “wait”.  So we thank God that the “wait” has lasted 4 and 1//2 years longer than we expected, and I’ve had the joy of having my husband by my side for now going into the 15^th year of survival.  So miracles do happen.  Pardon me, but a Stage IV diagnosis is “emotional experience” in the strongest sense of the word, and those who are there, either as the patient or as the caregiver, will certainly attest to that. 

And so I never fail to give God the credit for giving the doctors the expertise to know what to do.  What a relief to see my husband again.  I know that everyone doesn’t have this kind of a “Cinderella” story.  Esophageal Cancer is the 6^th largest killer of male men in the US today.  It’s a stealth killer and many present with Stage IV from the very beginning.  For them there will be no opportunity for an Esophagectomy—only palliative measures.  It grieves us deeply every time we read of another patient that has EC at any stage.  So we’re really pleased that your Dad has fared well all things considered, and that he has a good thoracic surgeon that will perform the Ivor Lewis Minimally Invasive Esophagectomy. 

(Now we’ve got to take into consideration the time it takes to readjust to a “new normal” way of eating and sleeping.  Initially problems with “eating, digestion and dumping” will be the biggest adjustment.  But we’ll cover that subject when Dad gets there!  Everyone goes through that cycle no matter the type of surgery, but for minimally invasive esophagectomy patients, return to normal activity is quicker than for those who experienced an open (Transthoracic) esophagectomy.  (This is barring unforeseen circumstances of course.)

Exactly what is the name of the chemo combo they’re giving Dad, just curious?  Since 5-FU comes in a tablet form called Xeloda (pronounced zuh loda), is that the pill form he takes daily when he comes home?  My husband was given 5-FU and Carboplatin via infusion.  Now he didn’t lose his hair.  Of course, hair is incidental, and having much or little “does not a man or woman make!”

In any case, as for the ability to swallow after the first treatment—most often people are able to swallow better after they’ve begun radiation because radiation is designed to “shrink the tumor” itself, while chemo circulates throughout the whole body.  So I usually associate the ability to swallow better with a treatment regimen that includes radiation.  So it’s great that he was able to swallow better even without the benefit of radiation, and to gain some weight.  Now after surgery, if he is like most, a weight reduction is normal, because of the limited intake of food possible.  That new “gastric tube” will not hold much.  The one “tube” serves as both the stomach and the Esophagus.  But those are instructions for a later time.  We’re just elated that according to your update, “so far I would say the news is all good!”  Neoadjuvant chemo and/or radiation isn’t for sissies!

Now about the treatment schedule and CT afterwards. 

In all the cases that I’ve been familiar with, the normal practice here in the states to wait approximately 3 weeks after the last treatment to access the total effectiveness of the treatment sessions.  Chemo has a residual effect of up to 3 weeks after completion of the regimen.  I know that in my own case, my tumor markers continued to decrease even after my last treatment.  And on a side note, I noticed that my “eyebrows” continued to decrease in “number” even after I finished my last treatment.  And I said to myself, “Hhmmm I guess this is proof that the chemo still is working even after I’ve stopped treatment.”  So in my case the chemo continued to do its work even after my last treatment.  Now, 6 months later, I awoke this morning with a full set of eyebrows and at least 2 inches of hair—enough white hair on my head to brush.  (After all, I’m 78 and there aren’t too many natural brunettes, blondes and redheads at my age!)  Now that’s a double blessing—first that I woke up—and secondly that I had some hair to brush. 

I am a bit surprised that doctors did not decide to use radiation in addition to chemotherapy since radiation is given to “specifically target and shrink” the tumor.  Incidentally, people older than 76 have had an MIE.  From your previous correspondence a PET scan was given that indicated 2 lymph nodes were affected.  I don’t think the doctors thought this to begin with.  And so, I’m not sure why a repeat PET/CT scan will not be given, but only a CT scan. 

A PET (Positron Emission Tomography) scan shows “metabolic activity” while a CT (Computerized Tomography) only shows shapes and sizes and measurements.  In reading about the advantages of a combined PET/CT, it seems that the CT scan will show the shape and size (measurements) of a suspected tumor in millimeters or centimeters, but the PET will indicate if there is “live” activity there.  Sometimes cell activity is so small that it doesn’t show up on a scan PERIOD.  However, during surgery it’s not unusual to find more cancer present than was first detected on the scan. As for me, I would certainly want a combination PET/CT scan as opposed to just a CT scan, knowing what I know NOW!  But I know you’re not the doctor.  That is why it is usually at least 3 weeks after the neoadjuvant chemoradiation before surgery is performed.  Here in the states, it is customary to not break up the chemo cycle into 3 weeks before surgery and 3 weeks after the surgery.  Some doctors may order additional chemo after surgery just to be sure of a “clean sweep.”  But most often, if NO tumors are found in any of the lymph nodes removed during surgery, no post-op chemo is recommended.  Just recovering from the surgery is a big enough job to tackle in itself.  And those who have to undergo adjuvant chemo because of residual cancer discovered in lymph nodes that were removed for biopsy during surgery are really in for a tough time!  Paul can attest to that.  No additional chemo was recommended for my husband because no residual cancer was found in the 22 lymph nodes removed during surgery.

On that note, when I was first diagnosed with Peritoneal Carcinomatosis via CT scan, nothing showed up in my ovaries.  When I went to the University of Pittsburgh Medical Center for a SECOND opinion, exploratory surgery and a PET scan revealed cancer in both ovaries as well!  But remember, I’m speaking as a cancer patient myself, and also in the case of my husband, William, who was diagnosed with Adenocarcinoma @ the Gastroesophageal junction, Stage III, (T3N1M0) in 2002.  We are “elated” to still have him in remission still in 2017!  And one more advantage to having a few weeks in between the last chemo and the surgery would be that your dad would have a little bit more time to recuperate and be stronger to undergo the surgery.  But then again, I’m not the doctor.  My husband was in great shape when the time for surgery came.

Now, of course, pathological examination will be made of the lymph nodes that are removed during surgery.  Should there be any residual cancer detected during the surgery, adjuvant (post-op) chemo should be recommended.  And we sure hope that this will not be the case.  But it happens, so just so you know, that this is the usual protocol post-surgery.  Usually a minimum of 22 lymph nodes are removed for examination.  

So on that note, I will give you my husband’s treatment schedule together with other links that usually put a 3-to-8 week time interval after neoadjuvant chemoradiation treatments prior to the actual Esophagectomy.

William’s last treatment was on March 17, 2003.  The follow-up PET scan was conducted 6 weeks later.  This allowed for optimum time for chemo to have maximum effect.  Then his Minimally Invasive Esophagectomy (MIE) was performed 19 days later on a Saturday, May 17, 2003, by our beloved thoracic surgeon, Dr. James D. Luketich at UPMC.  We thank God for giving us talented physicians who actually can understand the human anatomy!  My husband’s surgery took place in the 9-week time frame.  He underwent neoadjuvant chemo/radiation treatment here.  He was due to have the OPEN Ivor Lewis surgery (Transthoracic) here in Norfolk, but while awaiting the actual surgery, we learned about the MIE.  We immediately called UPMC.  They worked us in because my husband already had a surgical date set.  We didn’t need a referral.  UPMC said, “Bring all your records and if you’re a good candidate for our type of surgery, then we will perform it.”   So that caused a short delay of the surgical date.  Otherwise, my husband would have been operated on during the 3-to-8 week interval after the last neoadjuvant treatment regimen. 

Most all the abstracts that I’ve scanned show a surgical starting time frame of 3 weeks to 8 weeks after completion of neoadjuvant chemo treatment.  Of course, there are always exceptions to the rule, but this is the general time frame most often quoted.  That makes sense to me, since chemo does have a residual effect after the last treatment.  I am in total agreement with Ed.  I think waiting at least a few weeks for chemo to accomplish its maximum effect is preferable.  Both my surgeon and my husband’s surgeon waited for chemo to have its fullest effect prior to our surgeries.

As usual, I’ve included more than you asked for but I thought some insight into how chemotherapy works is inciteful along with the articles that gives a “best time” frame in which to undergo an Esophagectomy after neo-adjuvant chemoradiation treatment.  You also mentioned your dad’s blood counts so I put in a link relative to understanding blood counts.

Continuing to keep you and Dad in our prayers,

Loretta (& William)

____________________________________________________________________

1.       William’s treatment schedule was as follows:  Diagnosed in late November 2002.  After a barrage of tests, chemo/radiation regimen began on(Feb. 10 & completed March 17, 2003.)

  ·       Week 1 ~ (02-10-03) Chemo 96-hr. continual infusion of Carboplatin/5-FU (via Fanny pack)

  ·       Weeks 2, 3, and 4 ~ (02-17-03) Five days-a-week radiation treatment.  (No CyberKnife equipment (targeted radiation) in this area in 2003, but now we do have one in our Tidewater area.)

  ·       Week 5  ~ Combination radiation plus SECOND chemo continuous 96-hr. infusion (via Fanny pack)

  ·       Week 6 ~ (03-17-03) Final week of radiation.

   ·       Repeat PET Scan on 04-28-03 ~ results - COMPLETE ERADICATION OF TUMOR in Esophagus and the 2 affected lymph nodes.

2.       http://news.cancerconnect.com/cancer-treatment/chemotherapy/understanding-and-monitoring-your-blood-counts/

Understanding and Monitoring Your Blood Counts - Overview

A reduced number of blood cells in circulation is a common side effect of chemotherapy. Blood is composed of three basic blood cell types: red blood cells, white blood cells, and platelets. Blood cells are produced in the bone marrow and regularly released into circulation. Chemotherapy destroys rapidly dividing cells, a characteristic of cancer cells. However, bone marrow cells also divide rapidly and are frequently damaged by chemotherapy. Blood counts are monitored with a laboratory test called a Complete Blood Count (CBC). The best way to treat low blood counts is to prevent them before they occur. This can be accomplished with the administration of blood cell growth factors. In some circumstances, blood transfusions may also be necessary.

3.         https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041623/

DOES THE TIMING OF ESOPHAGECTOMY AFTER NEOADJUVANT CHEMORADIATION AFFECT OUTCOME?

[My note here:  When reading these articles most often certain procedural words are spelled out completely in the beginning and from then on abbreviations are used.  And in this report, I understand that the “C” stands for Chemo, and the “XRT” stands for radiation therapy only.  So in this article, when “CXRT” is used, it is speaking of a combination of chemotherapy and radiation.  As usual, one has to read this entire article to understand the full meaning, but I always give enough of an excerpt so that one knows it is applicable to their inquiry.] 

After neoadjuvant chemoradiation (CXRT) for esophageal cancer, surgery has traditionally been recommended to be performed within 8 weeks.  However, surgery is often delayed for various reasons. Data from other cancers suggests that delaying surgery may increase the pathologic complete response rate. However, there are theoretical concerns that waiting longer after radiation may lead to a more difficult operation and more complications. The optimal timing of esophagectomy after CXRT is unknown…

Successful treatment of locally advanced esophageal cancer remains challenging. Randomized trials have shown that the addition of neoadjuvant chemoradiation (CXRT) leads to a survival benefit compared to surgery alone for the treatment of locally advanced esophageal cancer.[1–3]

Most of the clinical trials evaluating neoadjuvant therapy have stipulated that surgery be performed within a defined time-frame after completion of therapy.

Traditionally, this has been within 3–8 weeks after completing radiation therapy.[2–7] An extrapolation from this tradition is that surgery is recommended within a pre-defined duration whether patients are on or off clinical protocol. However, for a variety of reasons, many patients do not undergo surgery within that time frame.

Some patients have suffered adverse events from medical therapy or simply have not adequately recovered from their neoadjuvant therapy. Other patients have their surgery delayed for personal or logistic reasons.

Radiation-induced tumor necrosis may increase over time and studies of neoadjuvant radiotherapy for rectal cancer suggest that a longer interval between radiation and surgery may actually result in improved pathologic complete response and decreased postoperative morbidity.[8,9]

On the other hand, there are theoretical concerns that waiting longer could make the dissection more difficult due to increased radiation fibrosis.[10]

[My note:  This is a similar article noting the fact that waiting longer than 9 weeks post surgery was associated with increased mortality rates.  Likewise, remember that chemo does have a residual effect of approximately 3 weeks post last treatment regimen.]

________________________________________________________________

4.       https://www.ncbi.nlm.nih.gov/pubmed/26652139

 “Esophagectomy Timing After Neoadjuvant Therapy for Distal Esophageal Adenocarcinoma.

Franko J¹, Voynov G², Goldman CD³. - Author information - 1Department of Surgery, Mercy Medical Center, Des Moines, Iowa. Electronic address: jan.franko@gmail.com. – 2 Department of Radiation Oncology, Mercy Medical Center, Des Moines, Iowa. – 3 Department of Surgery, Mercy Medical Center, Des Moines, Iowa…

Abstract - BACKGROUND:

The time elapsed between completion of neoadjuvant therapy and esophagectomy may influence response rate and possibly allow for avoidance of surgical intervention in selected cases ("wait and see" approach). However, a very long postradiation interval has been associated with worsened surgical outcomes in esophageal carcinoma. Therefore we analyzed outcomes of patients with invasive distal esophageal adenocarcinoma treated with neoadjuvant chemoradiation and esophagectomy based on the time elapsed between completion of neoadjuvant chemoradiation and resection…

A postradiation interval of 9 weeks or more was associated with increased perioperative mortality odds both at the 30-day (adjusted odds ratio [OR], 2.160; 95% confidence interval, 1.099-4.242; p = 0.025) and 90-day follow-up (adjusted OR, 1.912; 95% confidence interval, 1.290-2.835; p < 0.001). Similarly, a postradiation interval of 9 weeks or more was associated with an increased mortality risk (adjusted hazard ratio [HR], 1.194; 95% confidence interval, 1.032-1.380; p = 0.017).

CONCLUSIONS:- Perioperative mortality and overall survival are significantly associated with the time interval between neoadjuvant chemoradiation and esophagectomy. A "wait and see" approach after neoadjuvant therapy for esophageal adenocarcinoma may not be safe. Further studies based on more detailed data are needed…”

_______________________________________________________________________________

[My note:  Just for your satisfaction – This 2016 article PROVES the benefit of an MIE over OPEN surgery.  Five year survival rates are similar though the “OPEN” recipients will have a longer period of recovery during the initial period following surgery due to the large incisions and possibility of post-op complications.  So your dad will benefit from having the MIE.]

5.       https://www.ncbi.nlm.nih.gov/pubmed/26652140

“Outcomes With Open and Minimally Invasive Ivor Lewis Esophagectomy

After Neoadjuvant Therapy.

Abstract- BACKGROUND:

Neoadjuvant therapy is integral in the treatment of locally advanced esophageal cancer. Despite increasing acceptance of minimally invasive approaches to esophagectomy, there remain concerns about the safety and oncologic soundness after neoadjuvant therapy. We examined outcomes in patients undergoing open and minimally invasive (MIE) Ivor Lewis esophagectomy after neoadjuvant therapy.

METHODS:  - This was a retrospective series of 130 consecutive patients with esophageal cancer undergoing Ivor Lewis esophagectomy with curative intention after neoadjuvant therapy at a tertiary academic center (2008 to 2012).

RESULTS:  - An open procedure was performed in 74 patients (56.9%), and 56 (43.1%) underwent MIE after neoadjuvant therapy.

MIE patients had shorter median intensive care unit (p = 0.002) and hospital lengths of stay (p < 0.0001). The incidence of postoperative complications was similar (open: 54.8% vs MIE: 41.1%, p = 0.155).

 However, observed respiratory complications were significantly reduced after MIE (8.9%) compared with open (29.7%; p = 0.004).

 Anastomotic leak rates were similar (open: 1.4% vs. MIE: 0%, p = 1.00).   Mortality at 30 and 90 days was comparable (open: 2.7% and 4.1% vs MIE: 0% and 1.8%, p = 0.506 and p = 0.634, respectively).

Complete resection rates and the number of collected lymph nodes was similar. Overall survival rates at 5 years were similar (open: 61% vs MIE: 50%, p = 0.933). MIE was not a significant predictor of overall survival (hazard ratio, 1.07; 95% confidence interval, 0.61 to 1.87; p = 0.810).

CONCLUSIONS:  MIE proves its safety after neoadjuvant therapy because it leads to faster progression during the early postoperative period while reducing pulmonary complications. Open and MIE approaches appear equivalent with regards to perioperative oncologic outcomes after neoadjuvant therapy. Long-term outcomes need further validation…”

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7.       http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/side-effects/late-effects

“Late side effects of chemotherapy

Most chemotherapy side effects are temporary and disappear once your treatment is over. For some people chemotherapy can cause long term changes in the body months or years after treatment.

Many people feel more tired than usual for a long time after chemotherapy treatment. This is most likely to happen after a lot of treatment, or very intensive treatment. For example, after high dose chemotherapy or if you are having a bone marrow or stem cell transplant. 

8.       http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/how-chemotherapy-works

“How chemotherapy works

Mayflower18 said:

Open esophagectomy (long post)

Update on dad. Please bear with me as this is a long post. So we completed 3 cycles of chemo. Dad was doing ok eating almost normal diet but just weak from chemo esp after the 3 red cycle. After almost 3 cycles we did the CT scan. CT scan showed lessening in thickness compared to pre chemo but few nodes were still showing. So the dr saw the CT scan and according to him the tumor was now starting from upper eso originally it was at mid eso. To confirm they did an EUS and confirmed tumor starting at 20 cm instead of 24 cm pre chemo. So their opinion was chemo didn't work also tumor location is now upper esophagus so they won't get clearance for surgery as the upper eso area was a complex one and they cant do laparoscopic and they refused to do the surgery and asked us to go for chemo/radiation instead. We were not convinced as dad was lot better after chemo he didn't have any symptoms of cancer post chemo.We went for second opinion in one of the best cancer hospitals in India in another city. The dr here gave a completely contradictory opinion that the CT scan showed lots of regression in tumor and nodes. They said surgery is definitely possible but wanted a PET/CT done. So the PET/CT report showed good regression in tumor size and lymph nodes but no significant change in suvmax value. Pet scan also showed few lymph nodes nearby to the tumor. So again the dr here also said chemo didn't work that well as suvmax has not changed much even though tumor shrunk by 2 cm. He said surgery is now the best option since reports showed cancer has not spread to other organs. We went to another famous thoracic oncological surgeon and he gave the same opinion . So the esophagectomy was done last Tuesday. He is doing well post surgery no icu stay . He is 6th day post surgery today and has started taking liquids by mouth. Today we got the pathology report and that's where there is confusion. They did 3 field lymphadectomy but all the nodes came back clear even if the PET showed nodes post chemo. And to add to that the tumor has invaded only the 3rd layer of esophagus there was some fibrosis that the pet scan has showed as cancer. These are all positive but the negative news is although the radial margin is clear of cancer the cancer starts at 0.2 cm below the radial margin. Anyone have any idea on what all this means. He was staged as T3N1/N2M0. But now it looks more like T2N0 except for the radial margin being too close. Does this mean his chances of reoccurrence is high?

Hello Mayflower,

Sorry, I don't understand all of the technical information you gave, so I don't know about your father's chance for a recurrence.  I'm glad to hear that he seems to be doing well and I am sending positive thoughts his way.

Best Wishes,

Ed