Esophageal cancer is a malignant tumor with a poor prognosis. In general, the 5-year survival rate of esophageal cancer after surgery ranges from 25% to 40%, but the earlier the stage, the higher the survival rate, specifically: the 5-year survival rates of stage I, II, III and IV are about 90%, 50%, 35% and 15%, respectively. After the surgery, to get a good treatment effect, the “troika” is inseparable – standardized treatment + regular review + self-care. In particular, regular review will help you to detect uncertainties and give new treatment plan to stop the deterioration of the disease.
Why do I have to go to the hospital for regular follow-ups after surgery?
Localized tumors are not solved once and for all by surgery or radiation therapy.
First, there is a possibility of recurrence of the primary lesion; second, there may be undetected, but latent lesions that were already in the body at the time of initial treatment, and when the primary lesion is removed, the underlying lesion may grow back.
The only way to detect these metastatic or recurrent tumors and to give new treatment options is to have a “monitor” on the tumor with regular review.
The purpose of postoperative review of esophageal cancer is to check for recurrence and metastasis. Although the review cannot stop or delay recurrence or metastasis, it can detect it early and take treatment measures as early as possible.
Regular postoperative reviews can also guide you in nutritional support therapy. After surgery, your transoral eating habits will be different than they were before surgery. If your postoperative diet is not appropriate, you may experience bloating, nausea, and diarrhea, which can lead to malnutrition and even aspiration and pneumonia because of postoperative swallowing impairment. Therefore, your doctor needs to monitor your nutritional status regularly and give guidance.
Reviews within 2 years of esophageal cancer surgery are most critical
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The peak time for recurrence of esophageal cancer is within 2 years after surgery, and about 80% of patients recur within this time frame.
Therefore, review within 2 years after surgery is the most critical and frequent, and the frequency is every 3-6 months;
2 to 5 years after surgery, the risk of recurrence is relatively low, and the interval can be extended to every 6 months;
5 years after surgery without recurrence is generally considered to be clinically cured. However, a small number of patients still have recurrence after 5 years after surgery, so it is still necessary to review. The cycle interval can be extended further, such as once a year, but generally not more than 2 years.
Mediastinal lymph nodes and residual esophagus are the most common sites of recurrent metastases after surgery for esophageal cancer, and early detection relies on enhanced CT of the chest. common distant metastases include non-regional lymph nodes, lung, liver, bone, brain, and adrenal glands, which have a relatively low incidence. In addition to liver, bone, and brain metastases with corresponding clinical symptoms, metastases at the remaining sites also need to be detected by periodic review.
What review tests do I need to do?
The review should be determined by the primary surgeon, that is, the hospital and the surgeon where the surgery was performed, so the postoperative review should ideally be done there as well. This is because only the primary surgeon and his or her team know the most about your entire disease, its development, and treatment process, so that the most appropriate review plan can be taken for you. If your family is out of town, you can also choose to have your review at a more authoritative local hospital, taking into account the local medical conditions. Of course, we still recommend that you return to your surgical hospital for a review.
The routine items for review include: enhanced CT of the chest and abdomen, ultrasound of the neck, upper gastrointestinal tract imaging, and tumor markers; other tests should be added according to your specific symptoms, and the choice of items should be based on the stage and degree of differentiation of the tumor.
Generally speaking, the schedule of review and examination items are as follows:
1. 1~2 years after surgery, review: chest CT, abdominal hepatobiliary, pancreatic and splenic, and bilateral kidney ultrasound, tumor markers; gastroscopy should be done within 1 year after surgery.
2. 2 to 5 years after surgery, review: chest CT, abdominal ultrasound, tumor markers; gastroscopy once a year.
3. More than 5 years after surgery, the content is the same as the examination in previous years.
For the examination items, there are a few points that need special emphasis:
CT of the chest and abdomen, usually a plain plain CT is sufficient. Enhanced CT is required if the following conditions are present:
- Postoperative results report the presence of mediastinal and abdominal lymph node metastases and residual tumor;
- Lymph node metastasis in the abdominal cavity, requiring periodic review of enhanced CT of the abdomen.
Annual cranial enhancement CT or MRI (magnetic resonance imaging) and bone scan may be done if conditions permit.
These are the times and items for regular review without special circumstances. If there is any special discomfort, you should always review it to detect and deal with the problem early.
For example, if you have difficulty swallowing, you need a gastroscopy to see if there is a recurrence of anastomosis; if you have pain throughout the body, you need a bone scan to see if there are bone metastases; if you have dizziness and headache, you need a cranial MRI to see if there are brain metastases, etc.
Want to highlight that even if you don’t have any symptoms after surgery, it is important to insist on regular follow-ups. Because the early stages of recurrence are not usually symptomatic, once clinical symptoms appear, the disease may have progressed to a certain level, which can affect the outcome of treatment after recurrence.
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