Digestive Disorders / Gastroenterology Expert Forum
Re: Understanding Staging of esophageal Cancer
About This Forum:

This is a place to ask questions about digestive problems and receive a personal answer from a highly qualified doctor. You will also find support from other members who share your interest in digestive disorders. Digestive Disorders include: Anal and Rectal problems, Barrett’s Esophagus, Bleeding in the Stomach and Digestive Tract, Constipation, Crohn’s Disease, Gastritis, GERD, Heartburn, Proctitis, Short Bowel Syndrome, Ulcers, Whipple’s Disease, Zollinger-Ellison Syndrome (and many more).

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank

Re: Understanding Staging of esophageal Cancer

Posted By Paul Sawhny on July 31, 1998 at 12:49:40:

In Reply to: Re: Understanding Staging of esophageal Cancer posted by HFHSM.D.-ym on July 22, 1998 at 19:38:51:






: : My father is 74 years of age. On June 16 he was diagnosed with esophageal cancer. At this time, in addition to an edndoscopy, a barium swallaow X ray and numerous CT scans were performed. The biopsy from the endoscopy confirmed the tumor to be squamous cell carcinoma. The CT scans revealed that the surrounding area/organs appeared free of tumor.
On June 29 Dad underwent surgery to remove the tumor. The surgeon had advised me of the seriousness of esophageal cancer and I have confirmed it my self with extensive research. The surgery went well and the surgeon advised that he did not see any spread beyond the esophagus. The surgery required an incision below the chest and along the side. The surgeon removed 2/3 of the esophagus.
Upon completing the surgery, I asked the surgeon if the lymph nodes were involved. He said he would wait for the pathology report. A weel later he  called me to advise me that the lymph nodes were not affected. I was very happy to hear this. The following day I asked for and received a copy of the pathology report from the hospital.
The following is quoted from the pathology report:
: : -Squamous cell carcinoma, moderately differentiated extending through the wall into periesophageal fibroadipose tissue [Adventitia]
: : - Proximal and distal surgical margins free of tumor.
: : - No regional lymph nodes seen
: : - Tumor is 3 cm x 4 cm in greatest dimension.
: : - No lymph nodes identified grossly.
The way I read this report, I was unsure how the surgeon could conclude that the lymph nodes were not affected. It seemed to me that the pathologist had no lymph nodes to analyse. I confronted the surgeon with this question and he reiterated that the lymph nodes were not affected. Can you shed some light on this? Is it not standard for a surgeon to deliberately remove lymph nodes to ***** the stage of the cancer.? Please advise any additional thoughts.
Assuming the lymph nodes are indeed not affected and scanning revealed no metastasis, Dad would be classified T3N0M0 which is a Stage IIa for esophageal cancer. The oncologist involved wants to perform chemo and radiation once Dad is stronger. He wants to max him out on radiation for 6 weeks 5 days per week mixed with Chemo.  I feel this is probably the right thing to do. Do you agree??
By the way Dad was released from the hospital 5 days ago and is doing very well. He has been going out for a morning walk of approximately 1/2 mile and a shorter evening walk. He is eating soft food such a soup, lentils, mashed potatoes. ice cream with no problem.
Thanking you in advance.
Paul
Dear Paul,
From the way the pathology report is worded I must agree with you that it appears that lymph nodes were not present in the resected specimen. Assuming that no lymph node involvement is present, your staging is correct. Most oncologists favor treating patients with esophageal cancer (regardless of histological type) with adjuvant chemotherapy and radiation therapy, that is, if they are strong enough to undergo this treatment. I'm glad that your father has done well post-operatively and I wish him well.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
: *Keywords: esophageal cancer, staging, adjuvant therapy



______


: : :


_____


: : The questions I would like to have your opinion are as follows:
1. Is it unusual to not have removed lymph nodes while performing the resection?
2. Without the presence of regional lymph nodes, can an assesment ne made of the lymph nodes? Is there some procedure during the surgery wherby the surgeon can determine condition of lymph nodes??
Please share your thoughts with me and anything else I might be overlooking.
Thank you very much.  
Dear Paul,
Many cancer operations include regional lymph nodes in the resected specimen. Many different approaches are available in the surgical treatment of esophageal cancer. The type of surgery performed depends upon the location and stage of the lesion, the patient's comorbid illnesses, and the expertise of the local surgeon. It appears that your father had an en-bloc resection of the tumor that means that just the area felt to be abnormal during surgery was resected. At surgery, the surgeon palpates (feels) around and dissects the area of the tumor mass before resecting it. Sometimes he can tell if firm, hard, nodular areas consistent with diseased lymph nodes are present. There is no definitive evidence that one type of surgical approach affords a better survival than another in the surgical management of esophageal cancer.
There are several imaging modalities that can also be helpful in detecting local or regional tumor metastasis. CT scan of the thorax and upper abdomen may be useful, however, a newer modality that may detect lymph node involvement is a test called endoscopic ultrasound. Endoscopic ultrasound (EUS) is a test where a balloon is attached to an endoscope with an ultrasound probe at its end. EUS can allow the endoscopist to see beyond the walls of the gastrointestinal tract and get an idea as to the depth of a lesion and can also assess surrounding structures. It is mostly performed at university centers and larger institutions and requires specialized training. The drawback of EUS is that although lymph nodes can be imaged, it cannot be determined with certainty whether the lymph nodes are inflammatory or cancerous in nature. Capabilities for fine needle aspiration and biopsy are being developed. Furthermore, after a surgery is performed, scar tissue is present which can distort the picture so that one cannot be sure that one is seeing lymph nodes.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: esophageal cancer, surgery, lymph node involvement, endoscopic ultrasound



________


:


  _______
Based on the pathology report and the surgeons report that no abnormal lymph nodes were felt, Are we correct in staging the cancer at T3N0M0? Or would it be more accurate to state that the lymph nodes could not be assessed? Also, if there are no regional nodes in the resected area and the the resected area completely removed the tumor, can the assumption be made that the cancer did not travel to the nodes.
Secondly, since the primary tumor invaded the muscle layer and the adventitia, is it correct to assume that some form of metastasis has occured??
Thirdly, the oncologist is recommending maximum dosage of radiation over a 6 week period concurrent with 6 treatments of chemo at 1 month intervals. The chemo cocktails being recommended are TAXOL and carboplatinum. Is this an advisable approach in your opinion??
Thanks very much for your help.
Related Discussions
Continue discussion Blank
This Forum's Experts
351246_tn?1379685732
Dr. Kokil MathurBlank
Consultant
,
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating: What Your Closet ...
Jul 09 by Roger Gould, M.D.Blank