Doctors Lounge - Oncology Answers
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Forum Name: Esophageal Cancer
|joahsmom - Wed Oct 29, 2008 4:39 pm|
Hello. Just recently (Oct. 28th 2008) My 49 year old father went in for an endoscopy and a colonoscopy. The endoscopy was due to difficulty swallowing food. He has had the symptom for about a month. The colonoscopy was just routine, due to a high incidence of stomach/lymphoma cancer in the family. (Dad's oldest brother died several years ago from cancer, his next oldest brother found out that he had cancer about 4 years ago, and has undergone chemo and a few lymph node removals. He is cancer free right now but they keep close check on him and he visits his doctor regularly. My grandmother, was diagnosed with lung cancer 4 months ago at the age of 78, and she passed away last month.)
After my dad was brought back from the procedures we waited for the doctor. She came in and told us that she was not able to dilate the Esophagus because she found two hard masses close the the gasterointestinal junction. She said it looked like cancer. She said that while she was in there she took a biopsy. Of course my mother and I were devastated. My dad on the other hand has peace. He is a Baptist minister and knows that it's all in God's hands. Dr. Richardson said that there were two steps that she wanted daddy to take. 1) CT/Pet scan. (she wanted it done that day but they weren't able to schedule it that day. so they scheduled it for next monday. when we got home she called and said that she got daddy scheduled at another place for this Thursday instead.) 2) Special ultrasound of the Esophagus. We asked about his colon and stomach and she said that the stomach looked fine. Nothing at all in there, and she removed 3 minor polyps from his colon.
I guess my question is, does this sound very bad? I mean to us (my mother and I), it's the end of the world. Can a Gastro Dr. be certain of cancer? Is she rushing these tests because it looked very bad in there? I am grasping at any kind of reassurance I suppose. Some direction. I believe that God can heal my father as well, but he may use the Dr's to do it. What do we do? I am 31 years old and my daddy is my world. I have a 4 year old son that worships the ground my dad walks on. They are buddies. My son's father gave up his parental rights long ago, so my dad is the only father my son knows. He wants to be around to see him grow up and we need him so much. I'm sure this story is far from unique, but please can you help us? Tell us something? I am desperate.
We want the best for daddy and I have researched many many hours trying to find the best location for his treatment. I'm sure you wouldn't be able to be specific about his condition without the test results/labs, but is this something that can be treated even if it has spread? All of the research that I have done makes this cancer look very deadly, and the prognosis for most people is very poor. I am looking for a champion. Please can you help us?
|Dr. Safaa Mahmoud - Fri Oct 31, 2008 6:19 pm|
I understand your worry and hope that my answer to your questions will be helpful.
First, with endoscopy your doctor can visualize lesions in the esophagus or the stomach and get an idea about how likely these lesions are of malignant origin. Biopsy taken during endoscopic study is diagnostic.
The critical part in managing patients who are proved to have malignant disease is proper staging. The treatment primarily bases on the clinical staging which means how much the tumour has spread outside its organ of origin.
Staging in esophageal or gastroesophageal cancers is done by CT scan of the chest, abdomen, and pelvis, PET CT-scan and endoscopic US in addition to evaluation of different body systems.
Patients are then categorized into two main groups resectable or unresectable (locally advanced or metastatic).The general condition affects the treatment decision in both groups.
Surgery is the treatment of choice in patients with localized resectable disease but other options like chemo-radiotherapy exists also. Systemic therapy in the form of chemotherapy is used to treat patients with metastatic disease or those with localized disease as a preoperative or postoperative therapy to improve patients’ results including their survival.
So different treatment approaches are available based on the clinical staging and the general condition. His doctor is not in rush to do these tests, as you can see staging is the primary step in management and if surgery is a possibility the sooner the better.
I assume that your father’s general condition is good enough to tolerate all these options otherwise his doctor would not be concerned doing all these tests to properly evaluate him for further management. And this is a good point to start with. Prognosis (survival and disease control) is mainly stage dependent in addition to other contributing factors. Those with localized disease are expected to have their disease controlled and survive longer than those with metastatic disease.
I would advise you to follow up with your father’s doctor; obviously she is trying her best to make sure he will receive his proper treatment soon. We all hope it turns out that the lesion is either benign or at most at its early stage.
Hope you find this information useful.
Please keep us updated.
|joahsmom - Fri Oct 31, 2008 10:28 pm|
Thank you so much for your timely reply. We received a phone call today with the results of the CT/PET scan. She said that it had spread to the lymph nodes surrounding his esophagus, and there appeared to be tumors in other areas, but that the CT/PET radiologist that gave the report wasn't completely sure because it was hard to see, so she is sending him to an oncologist on Monday and for the Endo. Ultrasound on Tuesday. My question is, if it has spread to other areas, is this automatically a death sentence or is that treated in the same way a localized tumor would be treated...just in multiple areas? Thank you so much and I will keep you updated.
|Dr. Safaa Mahmoud - Sat Nov 01, 2008 2:55 pm|
Having a better idea about the disease, the treatment options and its limitations would make you more hopeful and also ready to deal with the situation and its consequences. Being hopeful will be for sure very supportive and encouraging to your father and your family, so try to keep this in mind.
There are still treatment options if his tumour has spread outside the oesophagus. Surgery is still an option even if some lymph nodes are involved (regional) and no major blood vessel or other organ involvement.
If the tumour is irresectable or metastatic to other organs, he will receive systemic chemotherapy aiming to palliate his symptoms and to control the disease from progression. Although cure is not expected there are still a variety of chemotherapeutic agents that are known to be active in oesophageal cancer.
Newly approved chemotherapeutic agents in metastatic oesophageal cancer have shown an improvement in both response rate and survival. About 15% of patients with advanced disease live for 5 years after systemic therapy and the majority survive for about a year.
Please understand that this is general information about the disease and no appropriate estimation for your father’s condition can be reached until all his complete work up results are out.
I would advise you to follow up with his doctor and to discuss with him all your concerns.
Hope you find this information useful.
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