esophageal cancer-treatment after unsuccessful surgery

  Dear Dr.
  The surgeon was unable to remove his tumor which was located at the junction of the esophagus and stomach.  it could not be removed because of an infected lymph node between the stomach and heart.  Yesterday, the cancer doctor told him he had 6-12 months to live and did not recommend the radation and chemo because of the side effects and that it would only prolong his life 3 months.  it would take 3 months to see if he would be able to eat and then it still might not work. they decided not to do the treatment.   the next day, my dad went to the surgeon and he advised the chemo/rad. says he can eat anything in 2 weeks.  my parents are in their 70's and very confused and scared.  what would your best suggestion be to them?  i know there is no cure, but we are just looking for a way for him to eat.....can laser be used to remove the tumor in the esophogus even though the lymph nodes are affected just to help him eat?  if this is possible are there side effects and often would it need to be done.  sorry this is so long, its been a long couple of days...thank you again, mrs bells (and dad)
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Dear Mrs. Bells,
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.  Laser treatment can be used to maintain an esophageal lumen.  This approach will require frequent endoscopic procedures and is associated with a small risk of esophageal perforation ( a serious and possibly fatal complication).  If you want to provide a means to prevent dehydration and possibly for your father to increase his caloric intake, I would suggest the placement of a feeding tube into the stomach via the anterior abdominal wall.  This treatment can be done by your gastroenterologist or an interventional radiologist.  The procedure takes 10-15 minutes.  After tube placement, your father will be able to take water or high caloric supplements via the tube without coughing, aspiration or food sticking in the esophagus.  Side effects of tube placement are unusual but include skin infection, aspiration with pneumonia, and peritonitis.  Bleeding has also been reported.  The better the physical condition of your father, the less the risk of the procedure.
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.
If you would like to be seen at our institution in order to obtain additional information regardingendoscopic placement of feeding tubes, please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in the placement of these tubes.  He can evaluate your father and then discuss the benefits and risks of the procedure with you and your parents
HFHSM.D.-rf
*keywords: esophageal cancer, feeding tube, PEG tube
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