Understanding Esophageal Cancer Surgery
- “ABC Sydney” radio host James Valentine, 62, will soon be undergoing a very rare operation amid his battle with esophageal cancer, after a 4-centimeter tumor was discovered at the base of his oesophagus. He will taking a three-month break from his show after undergoing a very rare surgery, something he spoke with his surgeon about on his radio show this week.
- An esophagectomy, which is a surgical procedure to remove some or all of the esophagus, can be used to remove esophageal cancer in some cases.
- If you are a candidate for esophageal cancer surgery, there are several things that need to be discussed with your doctor beforehand, such as what you can do to prepare and what to expect during and after the surgery.
- The surgery to remove part of all of the esophagus, an esophagectomy, is one of the biggest surgical interventions a person can undergo, according to Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System.
- “It is a surgery where if it is not done right can be fraught with a lot of complications,” Dr. Flores told SurvivorNet. “Even when it is done right, it is a surgical procedure that can have complications that can compromise the quality of life. That’s why I think it’s very important to make sure, when you see someone, you’re going to someone who is very experienced in performing esophagectomies.”
Valentine, who will be taking a three-month break from his show, announced his diagnosis to his radio show listeners on Thursday, saying, “The prognosis is that it’ll be fixed, but it’s a pretty dramatic fix. I know many of you have had to deal with this yourself, or had to deal with it in your family. This is hard to listen to.
Read MoreHe also revealed his first symptom of the cancer was when he had trouble swallowing and “choked and retched” while eating a curry dish this past December, and a gastroscopy [also known as an upper endoscopy and involves using a small flexible tube to look into the upper digestive tract] led to the finding of his tumor.View this post on Instagram
Valentine’s surgeon, Associate Professor Dr. Douglas Fenton-Lee at St. Vincent’s Hospital in Sydney, Australia, said during the radio show on Thursday, a “It involves removing the oesophagus, or most of the oesophagus, and the top part of the stomach, which is probably about a quarter of the stomach,
“We’re going to then bring your stomach up—we actually shape it so that it’s a tubular structure and we bring it up and join it into your neck, so we replace your oesophagus with your stomach.”
Point out how rare the procedure is, Dr. Fenton-Lee added, “It’s not a large volume procedure, especially in Australia. The unit would do maybe about 12 cases a year and I’ve been doing the majority of them.”
Recounting his cancer diagnosis in a story he published this week for ABC News’ website, Valentine wrote, “So, there’s something I have to tell you. I’ve used that phrase a lot recently. To my 96-year-old mother, to an audience at a gig, to people I’ve never met. Due to circumstance, I have to tell them the ‘something.’ I’ve become more adept at it and have found that it’s best to reveal the ending first.
“The end of the story is I’m going to be fine. The beginning is I have cancer. If you open with that, no-one ever believes you’re going to be fine. Cancer is a trigger word for just about everyone because your own body turning against you is a horrible thing and, for many, the course of the disease is ghastly, and for many it’s fatal. That’s why my cancer so far has been kind of odd. I’ve been fine. Right now, I’m completely fine.”
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Valentine said he immediately met with oncologists, radiologists, and surgeons and began five weeks of chemotherapy and radiation at the start of this year.
However, the beloved radio host who insists “everyone’s cancer is different and everyone will react to treatment in their own way,” continued, “In a few weeks, I will undergo surgery, which is the main treatment for my oesophageal [esophageal] cancer. The surgery will remove my entire oesophagus and then stretch my stomach up and attach it to my throat. Marvelous what they can do these days.
“After that, I’m very likely to feel like absolute crap for quite some time. It is likely I will recover, although that may take some months. I will be able to eat, but small amounts at a time. I will never woof down massaman beef [referring to how a choking incident occurred when he was eating massaman curry before his diagnosis] again and I think we’re all glad about that.”
He concluded, “So, I’ll be gone for a while. Probably two or three months. I’m going to make sure I’m fully recovered and my stomach is going to stay attached to my neck before I attempt broadcasting again. Wouldn’t want it to come loose mid-show.
“Cancer is confronting and of course I’m equal parts hopeful and terrified. I hope I’ll be OK, but I also know that I won’t be the same. The person writing this is already different to the person who went off in December to Tom’s party. Lord knows what I’ll be like a few months from now. I think I’ll be fine. That’s my ending. But right now, I’m still at the beginning.”
He reassure his fans on his radio show that he will “no doubt” return on-air once he has recovered.
All About Esophageal Cancer Surgery
If you are a candidate for esophageal cancer surgery, there are several things that need to be discussed with your doctor beforehand, such as what you can do to prepare and what to expect during and after the surgery.
The surgery to remove part of all of the esophagus, an esophagectomy, is one of the biggest surgical interventions a person can undergo, according to Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System.
Esophageal Cancer Surgery: What to Expect
“It is a surgery where if it is not done right can be fraught with a lot of complications,” Dr. Flores told SurvivorNet. “Even when it is done right, it is a surgical procedure that can have complications that can compromise the quality of life. That’s why I think it’s very important to make sure, when you see someone, you’re going to someone who is very experienced in performing esophagectomies.”
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During the esophagectomy, the surgery team will go into the abdomen and make a tube out of the stomach. They will then go into the chest and take out part of the esophagus before putting together the stomach and the remaining esophagus, Dr. Flores explained. The team will then take the esophagus with lymph nodes out in an attempt to remove any cancer.
“There are two parts to that. One is the resection for cancer cure, and one is the reconstruction for your quality of life,” Dr. Flores said.
Surgery for Esophageal Cancer: What are the Potential Complications?
Dr. Flores noted that one of the most dangerous potential complications from esophageal cancer surgery is something called a “leak” (a leakage from the connection made during surgery), which can lead to an infection called sepsis, trouble eating and swallowing, and more issues.
Other potential complications include:
- Bleeding
- Cough
- Other infection
- Changes in the voice
- Acid or bile reflux
- Nausea/vomiting/diarrhea
- Respiratory complications (like pneumonia)
- Difficulty swallowing
Dr. Flores noted that with esophagectomies, curing the cancer is obviously the priority, but reconstruction is just as important to avoid as many of these potential side effects as possible.
Diagnosing Esophageal Cancer
When it comes to esophageal cancer, the disease begins on the inside lining and spreads to the outer layers of the esophagus as it grows. Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer.
Unfortunately, esophageal cancer is frequently diagnosed at later stages.
“”Esophageal cancer, we know is a tough one,” Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, told SurvivorNet in an earlier interview.
“It’s one of the cancers with some of the lowest cure rates out there. But like many cancers, if we find it early, we can often treat it effectively either with surgery, with surgery and chemotherapy, or with chemotherapy and radiation.”
Dr. Stiles says esophageal cancer may be diagnosed at later stages because symptoms of the disease can be tough “to pin down sometimes” so those experiencing them may not think of cancer right away.
It’s important to be aware of signs of this disease, which include:
- Pain/difficulty swallowing
- Weight loss
- Pain behind the breastbone
- Hoarseness/cough
- Indigestion/heartburn
- A lump under the skin
This is why it’s so important to speak to your doctor about getting checked out if you do have concerning symptoms or notice any changes to your body or health. The earlier you are diagnosed, the better the prognosis will be.
Diagnosing esophageal cancer may involve taking a physical exam and health history, a chest X-ray, and an upper endoscopy (where the walls of the esophagus are examined using a small camera).
Other tests may be used as well to help get an accurate diagnosis. The upper endoscopy is particularly important because it helps your doctor to clearly see if there are any abnormalities in the wall of your esophagus.
Treating Esophageal Cancer
The treatment route you and your medical team decide on after an esophageal cancer diagnosis will depend on several factors, including the severity of the disease and your overall health.
Often, the treatment approach will involve several different types of therapy, Dr. Stiles explained.
Currently, there are several treatment options available for people with esophageal cancer. These include:
- Surgery
- Radiation
- Chemotherapy
- Chemo-radiation
- Laser therapy
- Electroagulation (using heat from an electric current to destroy abnormal tissue)
- Immunotherapy (training the immune system to recognize and attack cancer cells)
“It’s rare these days that I just do surgery for a patient with esophageal cancer. They’ve often gotten other treatments,” Dr. Stiles said.
“Remarkably, with very early stage disease, stage one, a patient can often have their tumor resected endoscopically, through a scope down their esophagus without the need to invasive surgery,” Stiles added. However, it’s important to know that that’s “a very selected group of very early, invasive cancer.”
So what’s available for patients with advanced disease?
“Because esophageal cancer is such an insidious disease, and because it has high rates of recurrence and metastasis (spreading), we really try to throw everything we have at it,” Dr. Stiles said.
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“For patients with more advanced disease that are not surgically resectable (removable), they can often also be treated with chemotherapy, sometimes with radiation with what’s called local control, to try to shrink the tumor so that patient can eat better.”
He added that some patients may also benefit from newer options like immunotherapy and targeted therapy, which specifically targets proteins that control cancer cell growth, according to the National Cancer Institute.
The Importance of a Good Support System Amid Esophageal Cancer
Getting the news that you have cancer, especially a disease that is known for being difficult to treat like esophageal cancer, can be a very traumatic experience. When it comes to treating cancer, making sure the patient feels healthy mentally is part of the process as well and that may look different from patient to patient.
Esophageal cancer is more commonly diagnosed in men, who stereotypically have a more difficult time asking for help when they are struggling mentally.
“The esophageal cancer population is a unique population,” Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. “Many of the people who develop esophageal cancer are men who are taking care of their families, who are proud, who are strong, who are self-reliant. So when they get faced with this diagnosis and this real vulnerability, they get depressed in a way that can make them crawl up in bed and not want to get out and that’s when the family comes into play.”
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Dr. Flores stressed the importance of having a good support system in place. Having close friends or family members there to rally for you when you feel the lowest can make a huge difference in how a patient handles treatment.
He also stressed the importance of having a solid doctor-patient relationship. Patients should feel comfortable bringing their concerns about their disease and treatment to their doctors, and that includes struggles they may be going through mentally.
“There’s a lot more connected with this disease than just your body getting harmed,” there’s your soul, your emotions. There’s a lot that goes with it,” Dr. Flores said.
“I think it’s very important to understand that about your patients so you can treat them appropriately. Once they know you see them and where they’re coming from, that’s when you get the, ‘Doc, I’ll do whatever you say, whatever you tell me.’ That’s when you can really get them to the best treatment that they need.”
There are also plenty of resources available for people living with cancer who feel like they’re struggling mentally, from traditional therapy to support groups to integrative medicine that may include treatment approaches like acupuncture or meditation. Check out SurvivorNet’s resources on mental health for cancer survivors.
Questions to Ask Your Doctor
- Will I need surgery for my esophageal cancer?
- Will I need to undergo chemotherapy and/or radiation before surgery?
- What type of side effects can each of these therapies cause?
- EWhat is likely to be the most effective treatment combination for me?
Contributing: SurvivorNet Staff
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