Decision Made!

We've dramatically changed direction. I won't go to surgery next week as planned. Instead, I will begin preparation for a combination of radiation and chemotherapy. I will begin treatment in the first week of February and continue for 5-6 weeks. Then, I will need to 6 weeks of recovery before surgery. All together, I will need to be out of work for the next six months.

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I am so impressed with these doctors! The surgeon, the radiologist, and the oncologist are among the most impressive people I have met. They are tops in their respective fields, and their manner is perfectly tuned. The people around them are also great. In the end, the decision wasn't that hard.

I had hoped to avoid radiation and chemo altogether but we couldn't get assurance that skipping that step was safe enough. It was heartening to learn that the doctors who discussed the strategy recommendation have not seen many situations like this. There are very few patients who come in with this early stage esophagus cancer. The diagnosis is T2M0. They were very curious how someone who had no symptoms managed to get an endoscopy that was almost perfectly timed.

After a very long discussion in what they called a 'tumor board' there was no consensus. The tumor board consists of specialists and dedicates time to collaborate on cancer patients. The board consists of a surgeon, an oncologist, a radiation oncologist and an anesthesiologist. They try to jointly come up with a recommendation. It's possible that surgery, by itself, could eliminate the cancer. It's also possible that a combination of radiation and chemo could eliminate the cancer. On the other hand, it would be safer to do all three treatments, but each treatment has it's own risk and discomfort. If I were older or in poor condition, they would have tried one thing or another and taken the risk of the cancer coming back. In my case, it is possible to do all the treatments because I am in good health and relatively young. So, we decided to be as thorough as possible. We agreed to do some additional testing and planning next week. We will begin the week after. I will have to go in for radiation five days a week at the Stanford Medical Center. I will have to spend about 5 hours doing chemotherapy every Monday. The remainder of the chemotherapy will be by tablet. So, we will plan to stay in San Carlos Monday through Friday and go to Pacific Grove on weekends as long as I feel good enough.

After the radiation and chemotherapy, I will need about six weeks to build my system back up and get ready for surgery. Surgery should take place in early May. I'll probably be recuperated enough to work in July. We feel good about the strategy. I feel that I got diverse, thorough and first class advise. I also feel that I was in control of the decision.