Surgery or EMR for Stage 0 EC

Gma_60
Gma_60 Member Posts: 1
in Esophageal Cancer #1
Today I got confirmation that I have stage 0 EC where the cancer has not grown into the submucosa layer, yet. Gastrologist, thoracic surgeon and oncologist have been recommending for the past month that I have the surgery -- remove it and make it be gone. No need for chemo or radiation. The Barrett's tissue would be removed and unless cancer has occurred or occurs in the future somewhere else, I'd be cancer-free.

Now a new gastrologist is recommending an EMR to scrape the cancerous tissue out and perform more biopsies. Then follow it up by trying to remove the Barrett's with a cauterization or PDT. The Barrett's must be removed because it has definitely shown it is advancing to cancer and will continue to do so. If all the Barrett's cannot be removed, I'd have to have the surgery anyway. If all of it is removed, I would just have to have an EGD every few years to ensure it hasn't returned.

Why do I feel like I am totally gambling? They caught the cancer at the earliest possible stage and now I feel that I am gambling that it won't return and if it does, they'll catch it soon enough. What are the odds they would catch it this early again?

The doctors just keep telling me the surgery is "life altering". Takes months to recover, is really a big deal but I just don't understand the life altering part. I get that the recovery is slow, painful and not something I'm looking forward too. I'm suppose to be able to eat, do pretty much what I do today so can somebody tell me what I'm missing?

Comments

  • mlbrooks852
    mlbrooks852 Member Posts: 67
    #2
    Life altering
    The surgery is indeed life altering. My better half had stage 2b cancer, and only after the surgery ( MIE ) was completed, did we find out that it had spread to some of the lymph nodes. That resulted in chemo therapy and all that accompanies that. I can tell you that even with the surgery you are never sure when or if the cancer is going to return. Either way, you are probably looking at frequent scans and EGD's to monitor your esophagus. I understand your wanting to get it out and be done with it. You are the only person who can make the decision about surgery.......you know what you can be comfortable with. The doctors should give you the information you need to make an informed decision and then support your decision, whatever it is! Good luck and prayers are with you. We have been in your shoes!
  • paul61
    paul61 Member Posts: 1,391 Member
    #3
    EC Surgery is DEFINITELY "Life altering"
    Hello,

    Congratulations on being diagnosed at Stage 0. We very seldom see someone with that early of a diagnosis here. Esophageal Cancer surgery is certainly a “life altering” procedure. Even if you have a surgeon skilled in Minimally Invasive Esophagectomy, (a robotically assisted laparoscopic technique) you will lose a part of your esophagus and potentially part of your stomach. Depending on where the pre-cancerous tissue is located defines how much esophagus and stomach must be removed to gain clear margins around the affected area.

    The stomach is then pulled up from it’s traditional position to make up the gap created by the area of the esophagus that has been removed. The vagus nerve that goes to the stomach is often cut to stop the peristaltic action of the stomach. Your stomach does not function as it has in the past. It acts more like a funnel that delivers your food to the small intestine where digestion occurs.

    This modified digestive system creates a number of “life altering” compromises. They include:

    - Your stomach does not have the storage capacity or ability to stretch to hold food as it used to so you need to eat frequent small meals ( I eat 7 times a day)
    - If you eat too much at one time your stomach can empty too quickly into the small intestine causing diarrhea (called “Dumping Syndrome” a frequent problem for people who have gastric surgery
    - Foods high in sugar or simple carbohydrates frequently cause water to be drawn into the small intestine too quickly and cause diarrhea
    - Eating too much food at a single setting often causes abdominal discomfort and cramping (I find it helpful to avoid activity for 30 minutes after I eat to let things settle)
    - You will be required to sleep on your back in an elevated position because you no longer have a lower esophageal sphincter to block stomach contents from moving into your esophagus
    - You will most probably lose a significant amount of weight and consuming enough calories and protein to maintain your weight is an ongoing challenge after surgery

    Of course I am not a doctor and the above observations are based on my personal experience, your experience could be different.

    At Stage 0 the medical profession is having good results with non surgical approches. Below find an extract from an article from CancerNetwork.com.

    BARRX Medical, Inc, a global technology leader in treating Barrett's esophagus, announced the publication of two related European trials that report a 100% eradication rate for early esophageal cancer and precancerous dysplasia using endoscopic resection followed by ablation therapy with the HALO ablation system. Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) and is a known risk factor for esophageal cancer, the fastest growing cancer in the Western world.

    You certainly have a difficult decision. The reality is that there a no guarantees in either approach. I understand you’re wanting to get it over with if surgery is required. Even if you do have surgery you will require regular scans and endoscopies.

    But esophageal surgery is most definitely “life altering”.

    I would get multiple opinions before making a decision.


    Best Regards,

    Paul Adams
    McCormick, South Carolina

    DX 10/22/2009 T2N1M0 Stage IIB
    12/03/2009 Ivor Lewis
    2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
    6/21/2010 CT Scan NED

    Life may not be the party we hoped for, but while we are here we might as well dance!
  • ddub
    ddub Member Posts: 3
    #4
    paul61 said:

    EC Surgery is DEFINITELY "Life altering"
    Hello,

    Congratulations on being diagnosed at Stage 0. We very seldom see someone with that early of a diagnosis here. Esophageal Cancer surgery is certainly a “life altering” procedure. Even if you have a surgeon skilled in Minimally Invasive Esophagectomy, (a robotically assisted laparoscopic technique) you will lose a part of your esophagus and potentially part of your stomach. Depending on where the pre-cancerous tissue is located defines how much esophagus and stomach must be removed to gain clear margins around the affected area.

    The stomach is then pulled up from it’s traditional position to make up the gap created by the area of the esophagus that has been removed. The vagus nerve that goes to the stomach is often cut to stop the peristaltic action of the stomach. Your stomach does not function as it has in the past. It acts more like a funnel that delivers your food to the small intestine where digestion occurs.

    This modified digestive system creates a number of “life altering” compromises. They include:

    - Your stomach does not have the storage capacity or ability to stretch to hold food as it used to so you need to eat frequent small meals ( I eat 7 times a day)
    - If you eat too much at one time your stomach can empty too quickly into the small intestine causing diarrhea (called “Dumping Syndrome” a frequent problem for people who have gastric surgery
    - Foods high in sugar or simple carbohydrates frequently cause water to be drawn into the small intestine too quickly and cause diarrhea
    - Eating too much food at a single setting often causes abdominal discomfort and cramping (I find it helpful to avoid activity for 30 minutes after I eat to let things settle)
    - You will be required to sleep on your back in an elevated position because you no longer have a lower esophageal sphincter to block stomach contents from moving into your esophagus
    - You will most probably lose a significant amount of weight and consuming enough calories and protein to maintain your weight is an ongoing challenge after surgery

    Of course I am not a doctor and the above observations are based on my personal experience, your experience could be different.

    At Stage 0 the medical profession is having good results with non surgical approches. Below find an extract from an article from CancerNetwork.com.

    BARRX Medical, Inc, a global technology leader in treating Barrett's esophagus, announced the publication of two related European trials that report a 100% eradication rate for early esophageal cancer and precancerous dysplasia using endoscopic resection followed by ablation therapy with the HALO ablation system. Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) and is a known risk factor for esophageal cancer, the fastest growing cancer in the Western world.

    You certainly have a difficult decision. The reality is that there a no guarantees in either approach. I understand you’re wanting to get it over with if surgery is required. Even if you do have surgery you will require regular scans and endoscopies.

    But esophageal surgery is most definitely “life altering”.

    I would get multiple opinions before making a decision.


    Best Regards,

    Paul Adams
    McCormick, South Carolina

    DX 10/22/2009 T2N1M0 Stage IIB
    12/03/2009 Ivor Lewis
    2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
    6/21/2010 CT Scan NED

    Life may not be the party we hoped for, but while we are here we might as well dance!

    EMR Decision
    Hi,

    I faced a similar decision 1 year ago, and certainly understand not only your concern, but the strong feeling that you are somehow gambling with your future.

    Like you, I was fortunate enough to receive an early diagnosis. An endoscopy with biopsies revealed a small area of Barrett's that was classified as high grade dysplasia. After discussing the possibility of surgery with a highly regarded thoracic surgeon, I decided to go with the EMR procedure knowing that surgery was still an "option" for the future. The procedure itself was a breeze - felt no different than a routine endoscopy. My surprise came when a biopsy was performed on the larger section removed during the EMR and a tiny tumor was found. I was then classified as T1a and referred to an oncologist. Due to the fact that the tumor was surrounded by clean margins, and had not invaded through the muscularis mucosae, no additional treatments were deemed necessary.

    So, it's been a year, and I remain under close surveillance and will continue to do so for the rest of my life (I'm 49 years old). I go for an endoscopy (with biopsy)every 4 months, an annual PET scan, and a CT scan every 6 months. I have never regretted this decision, and remain confident that if I experience a recurrence, it will be caught early enough. My chance of "cure" is estimated at 85%.

    As a further precaution, I underwent Fundoplication surgery last June. Severe GERD was the cause of my Barrett's, and I'd suffered from reflux for almost 30 years. The results have been amazing - I eat whatever I want, whenever I want with no discomfort, and have hopefully greatly reduced the source of future irritation.

    All that being said, not a day goes by when I don't wonder if I've made the right decision. As of today, I'd obviously say yes...

    Please don't hesitate to email me directly with any questions. There is so little information available to those of us blessed with an early diagnosis. Good luck to you!

    Don

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