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Thread: Treatable but not curable Esophagus Cancer

  1. #1

    Treatable but not curable Esophagus Cancer

    Hello,

    I wondered if anyone could help me. Any assistance or suggestions that can be provided would be greatly appreciated.

    My mother is 86 years old and was diagnosed with esophageal cancer in February. She had a PET Scan done in February and another PET Scan done recently in August.

    The initial PET Scan showed that she had cancer in the mid esophagus area with thickening of the esophageal wall.

    However, it also showed that the cancer had spread to a large area of her chest between the lungs and showed multiple enlarged lymph nodes in that area.

    The doctor recommended that she have chemo. He didn’t want to give her radiation because the cancer had spread to an area near her lungs, and he was afraid that radiation could possibly damage her lungs. He also mentioned that since the cancer had spread outside of the esophagus and due to her advanced age, surgery was not an option.

    My mother received the FolFox treatment (Oxaliplatin and Fluorouracil).

    She was supposed to get the treatment every other week. However, since chemo was very difficult for her, after the first session, she asked to have treatment once every three weeks. Her doctor did not object.

    After 3 sessions of chemo, however, she experienced a major problem with her eye and needed to have surgery. She therefore stopped chemo for 2 months so she could regain her strength and have eye surgery done.

    She returned for more chemo after a 2 month break and continued with the Folfox treatment for another 3 sessions. Thus, she had chemo for a total of 6 sessions once every three weeks over about a 5 and a half month period.

    She recently had a PET Scan done, and the results were about the same as the PET Scan that was done about 6 months ago. Everything was “stable” or “not significantly changed” compared to the prior PET Scan.

    The index lesion had changed somewhat. The size of the index lesion from the first report and second report was reported as follows:

    8/21/2011: 21 x 15 mm (3-253 contrast study)
    2/24/2011: 19 x 15 mm (3-129)

    The second PET Scan also found that she now has a blood clot in her lung for which the doctor has given her a medicine called Cumaden.

    Quite frankly, I have been extremely worried and terrified for quite some time. I had several questions, and if anyone could answer any of them, I would deeply appreciate it.

    1. When I asked her doctor about the stage of the cancer, he said it was hard to interpret the results. He guessed that it’s somewhere between a stage 3 and a stage 4.

    Can’t they give a more definite assessment of the stage of the cancer? How does “staging” take place?

    2. My mother was receiving chemo over a 2 and a half day period. In other words, she received chemo at the hospital for about 2 and a half hours or so, then they attached a pump to her which she took home, and she received chemo through the pump for another day and a half.

    Is that how chemo is normally given? I’ve heard that most people have chemo over a 4 or 5 day period.

    3. The doctor said that overall he thought the second PET Scan indicated good news since the cancer had not spread and it was less active.

    Would you agree that this is good news? I was hoping for better results given that she had gone through 6 chemo sessions.

    4. Her doctor is not sure what to do next. He said he may try some radiation on her esophagus area but he wanted to consult with another doctor first.

    Does anyone have any ideas what could be tried now?

    5. From the beginning the doctor mentioned that her condition is not curable, but that it is treatable.

    Does anyone think that she can eventually be cured?

    6. If her condition is treatable, what would that entail?

    In other words, would she have to continually go in for 6 sessions of chemo, have a break for a month or so, and then go in for another 6 sessions of chemo?

    That sounds like a very depressing way to live for the little time one has available.

    Thank you for taking the time to read this. If you have any answers or thoughts, I would appreciate hearing from you.

  2. #2
    Administrator Top User brainman's Avatar
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    Hi Tom. I am very sorry about your mother's advanced Esophageal Cancer. I know very little about this type of cancer so my answers can only be of a general nature.

    1. When I asked her doctor about the stage of the cancer, he said it was hard to interpret the results. He guessed that it’s somewhere between a stage 3 and a stage 4.

    Can’t they give a more definite assessment of the stage of the cancer? How does “staging” take place?
    I really do not understand this but that might just be a difference in how Esophageal cancer is staged vs other cancer types. Most other cancers would be staged at IV since it has spread beyond its nearby location. Maybe the chest lymph nodes are "local" for Esophageal cancers.

    2. My mother was receiving chemo over a 2 and a half day period. In other words, she received chemo at the hospital for about 2 and a half hours or so, then they attached a pump to her which she took home, and she received chemo through the pump for another day and a half.

    Is that how chemo is normally given? I’ve heard that most people have chemo over a 4 or 5 day period.
    Treatment plans can vary from one person to the next. Maybe because of your mother's age, they want to give it to her slowly. It is not unusual for a person to go home with a chemo pump.

    3. The doctor said that overall he thought the second PET Scan indicated good news since the cancer had not spread and it was less active.

    Would you agree that this is good news? I was hoping for better results given that she had gone through 6 chemo sessions.
    Well, it is certainly good news as compared to showing new growth! At least the treatment is not letting the tumors grow... in fact, there is a little decrease in one!

    4. Her doctor is not sure what to do next. He said he may try some radiation on her esophagus area but he wanted to consult with another doctor first.

    Does anyone have any ideas what could be tried now?
    Radiation on the tumor that is located in her Esophagus will not cure her and probably not extend her life very much since it does not kill the cancer cells that are in other parts of her body. However, this does not mean that it is useless. Local treatment can be used for palliative reasons... maybe to decrease the tumor to help her swallow better.

    5. From the beginning the doctor mentioned that her condition is not curable, but that it is treatable.

    Does anyone think that she can eventually be cured?
    I NEVER use the word "cure". The closest thing a curable cancer is some forms of Breast Cancer. For others, the term Remission or No Evidence of Disease (NED) was more appropriate. However, I do not think that any of these are appropriate in your mother's situation and it seems like I am in agreement with her doctor. This does not mean that she will die soon. If her current treatment keeps working, she could still have many months if not years of life. Unfortunately, if she does not die of something else, the cancer will take her. Sorry for being so blunt

    6. If her condition is treatable, what would that entail?

    In other words, would she have to continually go in for 6 sessions of chemo, have a break for a month or so, and then go in for another 6 sessions of chemo?
    It sounds reasonable for her chemo to continue. It seems to be effective in keeping the tumors in check. Of course, there are other factors to take into account but that is the main one.

    Sorry that I could not be more encouraging. You and your mother are in my thoughts and prayers.
    Jim
    Long-term cancer survivor
    1992 Astrocytoma grade 2, left motor strip
    2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
    http://cancerforums.net/viewtopic.php?t=2405
    My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
    My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
    My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029

  3. #3
    Thank you for your detailed responses. I greatly appreciate your kind help!

    I was told by someone on the internet that an endoscopic ultrasound would provide a definite answer regarding the stage of her cancer.

    But, as you say, since according to the PET Scan, the cancer has already spread to her chest area, it probably is a stage 4. Perhaps that’s why they don’t want to have her go through an endoscopic ultrasound.

    You are certainly correct in saying that the fact that the cancer has not spread is good news compared to the alternative.

    However, I guess after all she has gone through, I was hoping the cancer would have decreased even more. Still, I guess it could have been worse…much worse!

    Sounds like my mother will have to go through chemo and continue suffering.

    Anyway, I very much appreciate your thoughtful answers and your kind assistance.

    Thank you!

    Tom

 
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