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Re: Understanding Staging of esophageal Cancer
Posted By Paul Sawhny on July 22, 1998 at 14:31:02:

In Reply to: Re: Understanding Staging of esophageal Cancer posted by HFHSM.D.-ym on July 21, 1998 at 22:23:09:

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.
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.
*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.  

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