A friend who lives in an area with a high incidence of esophageal cancer asked: My dad’s friend was diagnosed with mid-stage esophageal squamous cancer a year ago. After the surgery, the doctor said that the situation is good, chemotherapy and radiotherapy are not necessary, just regular review. Six months after the surgery, this uncle went to the hospital to review CT, tumor markers and other indicators, which were all normal. However, a month ago, I suddenly heard that he had passed away because of the recurrence of esophageal cancer. My father also had esophageal cancer and had just undergone surgery, so this news made me worried. Why did this uncle pass away not long after the review? What should my dad be aware of?
For this question, let’s start by asking a few “no’s”:
- Did your uncle have his follow-up exams at months 3, 6, and 9 after surgery? Were all indicators normal, or partially normal?
- How was the postoperative pathology report staged? Were there any lymph node metastases?
- Did he have any discomfort such as recurrence or worsening of dysphagia after that postoperative review six months after the surgery, and did he see the doctor in time at that time?
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Why are these questions being asked?
First, you should review your esophageal cancer every 3 months for the first 2 years after surgery. The review should include: chest CT, abdominal ultrasound of liver, gallbladder, pancreas, spleen, and both kidneys, and tumor markers. If you miss several reviews during this period, or if you miss certain items during the review, you may allow recurring or metastatic cancer cells to take advantage of the situation.
Second, the postoperative pathology report is important as a basis for whether to proceed to the next step in treatment. If the postoperative pathology suggests lymph node metastasis or invasion of the esophageal lining, the risk of recurrence is high and postoperative adjuvant therapy is needed.
Third, if there have been no special circumstances after surgery, then regular review can be done as ordered by the primary care physician. If special discomfort occurs in between reviews, you should always review to identify and address the problem early. For example, if you have difficulty swallowing, a gastroscopy is needed to find out if there is a recurrence of anastomosis; if you have pain throughout the body, a bone scan is needed to find out if there are bone metastases; if you have dizziness and headache, a cranial MRI is needed to find out if there are brain metastases, etc.
So if your father has had an esophagectomy, just follow the doctor’s orders for regular follow-up. Don’t put too much psychological pressure on yourself in life, and keep an eye on your body and seek medical attention if you feel unwell.
Lastly, it is important to review your esophageal cancer within 2 years after surgery. 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, the review within 2 years after surgery is the most critical and frequent, and the frequency of review is every 3-6 months within 2 years; the risk of recurrence is relatively lower between 2 and 5 years after surgery, and the interval of review can be extended appropriately to once every 6 months; no recurrence 5 years after surgery is generally considered to be clinically cured, but there are still a few patients who have recurrence after 5 years after surgery, so it is still necessary to review, and the interval of review can be extended further. The interval between reviews can be extended, such as once a year, but generally not more than 2 years.