Re: metastatis to liver

Posted By HFHSM.D.-rf on April 27, 1998 at 19:26:02:

In Reply to: metastatis to liver posted by mary  on April 21, 1998 at 15:21:16:






: My mother has stage 3 esophageal cancer and has undergone two rounds of
: chemo and is 3/4 through with radiation.  She underwent a follow-up CT scan
: and they discovered several spots on her liver.  Of course she's very
: discouraged.  I know this latest development is not good and from what I can
: get from a phone conversation (she lives in a different state so I can't hear
: directly from the doctor), the doctor is now more concerned about the liver.
What does this mean for us?  Based on your clinical experience, what is the
: life expectancy for patients with this complication.  Her doctors have dis-
: couraged the idea of surgery of any kind and aren't too keen on the more
: experimental therapies.  Are there any new treatments on the horizon for
: people in my mom's situation?  They have also discussed the idea of a feeding
: tube, which she finds very repellant at this stage.  What sort of surgery would
: this involve and what is the typical response of patients after they get this
: surgery (both physically and emotionally).  I know these are difficult questions
: to address since the info is sketchy and I'm asking for fairly specific answers.
: These are also emotionally charged questions, but we are facing some very
: difficult times and need to have some ideas of what to expect.
: Many thanks for your help,
: Mary
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Dear Mary,
I am sorry to read about the problems being experienced by your mother. I assume that the new CT scan shows liver "spots" that were not present at the time of the initial evaluation.  The most likely explanation for the liver abnormality is that the tumor has extended into the liver despite the aggressive treatments.  It is necessary, however, for tissue confirmation of liver metastases.  This can be done quite easily, as an outpatient, by a directed liver biopsy done under ultrasound or CT direction.
Unfortunately, it is impossible to provide survival numbers that have any meaning.  Talking about time until death has value when one is describing a large population of patients, but has no meaning when considering how long an individual patient will live.  Factors such as overall health status and concurrent cardiac, pulmonary diseases will affect survival.
I do not know the therapy received by your mother, but in general a radiation and chemotherapy combination is an aggressive therapeutic approach.  There are no novel  treatments for your mother if she has liver metastases.
I would strongly encourage you to consider the placement of the feeding tube.  As the esophageal tumor grows your mother will experience progressive difficulty swallowing food or liquids because the tumor occludes the swallowing tube.  An outpatient endoscopic procedure will place a tube in your mother's stomach through the abdominal wall.  This should be a quick and relatively easy procedure.  It takes us approximately 10 minutes to do the endoscopy and place the tube.  The advantage of a percutaneous feeding tube is ease of obtaining fluids and nutrients.  Your mother will have less frequent episodes of dehydration and will not require chronic intravenous lines.
I hope that this information is helpful to you. If you have additional questions, please follow up with another message,
HFHSM.D.-rf
*keywords: esophageal carcinoma, feeding tube
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Dear Mary,
I am sorry to learn of the recent course of events.  Esophageal cancer is a difficult tumor for the physician because it is usually not surgically curable at the time of diagnosis.  The side effects of chemotherapeutic drugs are usually dose-related: the larger the dose the more severe the side effects.  Unfortunately, large dosages are required to kill the cancer cells.  The most frequent complication of mitomycin treatment is bone marrow suppression, being reported in approximately 2/3 patients taking the medicine.  The other complications are much rarer.  CPT-11 is a new chemotherapeutic agent that kills cancer cells by causing breaks in the DNA strands of these cells.  The drug has shown activity in leukemia, lymphoma, and cancers of the colorectum, lung, ovary, cervix, pancreas, stomach, and breast.  I was unable to find any published articles regarding efficacy for esophageal cancer.  Remember, we are not talking cure of the cancer but only shrinkage.  
Insertion of the feeding PEG tube can be done even though your mother has phlebitis.  The physician has to verify that the blood is not too thin, i.e. her risk of bleeding is not great.  A temporary alternative to PEG placement is to pass a tube from her nose into her stomach and too feed her or give fluids via that route.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
HFHSM.D.-rf
*keywords: esophageal cancer
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