Stomach cancer removed - eating problems 9 months later

My father was diagnosed with stomach cancer in October 06 when 57 years old and otherwise healthy. It was adenocarcinoma, but hadn’t spread.  When the surgeon did exploratory surgery, he discovered that the lower part of Dad's stomach was hard with cancer. He removed the gallbladder (not due to cancer) at the time, but not the stomach. He decided to treat it with pre-op chemo. This worked wonders. When they finally did the surgical rescission, there was no more evidence of cancer. They still removed 80% of his stomach (and some duodenum). He had post-op radiation. For 9 months, he did great-eating almost normally.  Then trouble. Symptoms were similar to original cancer. After many tests, docs determined he’s still cancer free. But, he can’t eat. He gets fluids via an arm port, and is weak/thin. Surgeon recommends going back on the stomach feeding tube. Chemo doctor agrees. A doctor also performed an endoscopy. He could not move the scope very far (afraid to push too hard through a narrow esophagus and juncture w/the stomach - probably some kind of "kink"). Basically, we’ve determined that my father might have a narrowing in his esophagus or a flabby area at the bottom. Based on his symptoms (bile vomiting) we wonder whether he might have afferent loop syndrome too. The endoscopist did a dye test and found his stomach actually working (fluid moving through) but that was months ago. Dad can barely take a drink now w/o throwing up bile. He has NEVER been able to get a gastroenterologist to review the findings and answer questions about symptoms and potential causes. No local gastro doctors will see him because his primary doctors have recommended the stomach tube. Are there NO options? What about jejunal pouch reconstructive surgery? Doctors seem to think that a stint in the esophogus or surgery could perforate something and kill Dad. My parents need to hear from a gastro doctor with some knowledge of post-stomach removal eating problems. Help!

[Kevin Pho, MD]

Difficult to say for sure without evaluation.  

If you are not comfortable with the treatment course, I would suggest obtaining another referral at a major academic medical center.  

However, if several doctors agree with the tube, there is a good probability that another opinion may not be different.

I cannot comment on surgical options without reviewing the case personally.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com