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Follow up/preemptive chemo for patients in partial remission

davek
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This is a bit of a long shot.

My question is whether anyone in a similar position to me has been given chemo as a second, perhaps preemptive, attack on the remaining cancer, either privately or as part of NHS funded treatment? 

After I finished my chemo, which thankfully put me into partial remission, I was put into a "watch and wait" scenario. I have CT scans every six months and I'm basically waiting for the cancer to start growing before I restart chemo. I've been in this situation for about 18 months and my body has almost fully recovered from the side effects of the chemo. I am obviously really happy about this unexpected outcome but I'm beginning to wonder whether "watch and wait" is the right approach for me.

We know that a quite large cancer is still there where the oesophagus meets the stomach and that it is wrapped dangerously around my aorta. I'm now fit enough to endure another few rounds of chemo which might shrink the cancer again, or at the very least discourage it from growing. If I wait until it has grown enough for the change to show on a CT scan, its growth may be unstoppable.

I thought I'd ask on here before I discuss my thoughts with my oncologist. I've done extensive searching using Google and Google Scholar and have so far drawn a blank. My thoughts are that if I were to present as a new patient with a similar sized cancer in the same place, I'd probably be offered chemo to try to shrink it. So why not repeat my treatment as if I were a new patient? 

Thanks
Dave

 

  • Hello Davek,

    Lucie has asked us if there is anything we can say.

    In advanced cancer, as a general rule after initial (first line) chemotherapy, no further treatment is given until the cancer progresses (starts to grow again).  As you know, because of the side effects, there is a trade off between treatment potentially doing some harm and potentially doing some good. Chemotherapy tends to work best on rapidly dividing cells and not so well in a cancer that isn’t growing fast. So although a pre-emptive strike is a logical idea, it might not work well enough and could be a waste of ammunition that would come in handy later on. But every case is unique and it is always worth talking things over with the specialist again, so do bring this up when you see them and let us know what they say.

    Take care,

    Julia

  • Offline

    Your thoughts make great sense Dave and Julia's answer is a reiteration of what I have always been told by 'the experts' and makes sense too.  I am not sure there is a definitive answer but, like you, would be wanting to discuss this with my oncologist - and maybe a second oncologist to see if their opinions agreed.

    If the watch and wait scheme is deemed the best in your situation - the only thing I would feel personally, is that I would prefer 3monthly scans so I could catch progression earlier.  I know you are worried about the implications of radioactivity but i had a long discussion with my Prof of Oncology about this 2wks ago and he quite rightly told me this  ' I think when you have a cancer as serious as you Max, the last thing you need to be worrying about right now is radioactive-induced disease' (with a smile I may add).  I felt a bit of a wally to be honest!!  Three monthly scans are not considered harmful from anything I have read and the benefits far outweigh the risks when disease is at stage 1V.  This may be a compromise for you and your oncology team

    It must be very hard to sit back and wait and not feel like you are tackling something so serious, so I can undertand your frustrations and reservations about whether this is best in your situation.  Hopefully if you gleen the opinions of several professional oncologists - it will not confuse you further but will reassure you.

    Take good care MM x

  • Offline in reply to max56

    Max/Julia,

    Thanks for your replies, I'll definitely discuss this with the oncologist when I next meet her.

     

    Thanks
    Dave 

  • Offline in reply to davek

    Dave, purely personal and my opinion only.  I would do as your oncologist suggests and wait and see.  The cancer could be very slow growing or not growing at all and if you start chemo again, pumping all those toxic chemicals into you who knows what it could do.  Also, your own immune system, which you have spent a lifetime building up, has had 18 months to rebuild itself and protect you.  I would hold back, if it were me.

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