Re: post-esophageal resection

Posted By HFHSM.D.-rf on June 04, 1998 at 07:38:52:

In Reply to: Re: post-esophageal resection posted by jen on June 02, 1998 at 14:05:23:






My father was diagnosed with esophageal cancer in February 1998. He is 56 and otherwise in fine health although he has been a smoker for years and has had problems with acid reflux for as long as I can remember.  After chemo (5-FU and cisplatin) and radiation treatment which were deemed successful (the tumor shrunk) he has just undergone surgery to resect his entire esophagus.  He is recovering well from the surgery, but he is very concerned about his future.  The surgeons removed his entire esophagus and 20-30% of his stomach (his tumor was right at the junction) and then tubularized part of his remaining stomach and moved it up into his chest, leaving a small pouch of stomach to act as his "regular stomach" in the future.  He has an enteral feeding tube (a "j" tube I believe) and he is starting to try liquids(water, juice, jello).  He is very concerned because he can't seem to keep anything down his new apparatus.  With no valve in place, everything comes right back up if he coughs or lies down.  Will this improve?  How will his body adjust?  His doctor just keeps telling him that he is doing great, and I believe he is in regards to recovery from surgery, he will be coming home after less than two weeks in the hospital, but what does this new stomach have in store for him?  Can you give us any idea what to expect?  And also, is this really a cure?  There was no residual tumor (I assume this means the chemo and radiation did their job) and with complete resection I am thinking they were going for a cure, not just palliative treatment.  So, what are his chances?  Is this going to show up again in 6 months or a year or 5 years?  Any help would be greatly appreciated.  Thank you for your time.  jen
6/2/98
Apparently there WAS residual tumor.  The original tumor was 6cm and after the surgery the tumor was 1.5cm.
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Attached was my response to your initial letter.  The presence of residual tumor is worrisome.  Has your physician discussed the possibility of laser therapy or some other form of photodynamic treatment if the tumor is within the gastrointestinal tratc.  If the tumor is not reachable by an endoscope, then you must ask the oncologists about the benefit of additional chemo- or radiation therapy.
Dear jen,
You ask several important questions regarding esophageal cancer.  Your father has been treated aggressively with combination therapy (chemotherapy, radiation and surgery).  Hopefully, all tumor has been removed although only in retrospect will you know for certain.  It is not helpful to provide statistics regarding possible tumor recurrence because these probabilities are true for populations of patients but are not necessarily valid for individual patients.
Regarding the issue of keeping food down and I suspect limited appetite, it is difficult to predict what will happen.  Your father's appetite should gradually improve.  If he has substantial reflux, he could try a prokinetic agent such as Propulsid in an attempt to diminsh this symptom.  In addition, your father should eat slowly and not lie down for several hours after he eats.  If coughing with eating is a constant problem, ask the doctor about the possibility of a tracheo-esophageal fistula, that is a connection between the GI tract and the breathing tube so that food or saliva enters the lungs.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
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