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In 2016 my husband was diagnosed w/barretts esophagus, after 3 ablations was diagnosed as cancer free. Then 2 1/2 months ago diagnosed again with the same but surgeon unable to do anything from within the esophagus stating ” it has grown toward the wall of esophagus & afraid I may perforate the esophagus wall if I try to remove”. So we were sent to a thoracic surgeon who proposes a esophagectomy with FLOT chemo before surgery & then again after surgery, all provided that my 77 yr old husband is healthy enough to survive all this, ( yet to be determined.) So, they send us for a PET SCAN to stage & I’m assuming to check for any possible spreading. Amazingly pet scan revealed no abnormal radiotracer uptake. So, thoracic surgeon tells me not to get excited that pet scan are not 100% accurate , says he has stage 2 EC & pushes to proceed with chemo, that in his words may leave husband to weak for surgery. My husband & I are very reluntant to proceed with any of this & seeking a second opion of which surgeon refuses to give us a referral stating “it would be unprofessional to refer us to another endoscopist since we where referred to him by an endoscopist”..what ???
Looking for another endoscopist to confirm cancer diagnosis & treatment options. Is Histotripsy offered anywhere for EC ? Looking for natural holistic options etc…..ANY ADVICE ??
Thanks in advance
Hi Ricochet-
Several issues. First, yes, please get a second opinion. My understanding is that Barrett’s Esophagus is NOT cancer. It may increase the risk of an esophageal cancer diagnosis. Was your husband formally diagnosed with EC? A 77-year-old person may have a difficult time with surgery and chemo. Please get a second opinion. Good luck.
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After ultrasonic exam on my tumor today the results were T3, N0 Mx by endosonographic criteria. Scheduled for a PET scan on Tuesday? My Oncologist is suggesting Chemo/Radiation followed by surgery. My tumor is located at the junction of esophagus/stomach. Do you feel this an accurate stage? Having really hard time swallowing. I’m a whit male 65 years of age.
Reply Hi Ed,
I am sorry to learn of your EC diagnosis. Keep in mind however, that you have been staged with early EC so your prognosis should be much better than otherwise.
To answer your question “Do you feel this an accurate stage?” While there is/are always diagnostic factors that I don’t know without seeing you, the articles linked and excerpted below speak to your situation. The first article explains why the EUS is the standard for diagnosing early EC and why your oncologist may choose to also have a PET scan.
The second article, if I read it correctly, says that EC is a difficult to treat cancer with a poor five-year survival average. My guess is that your oncologist is working hard at the diagnosis stage (both EUC and PET) and is also treating your cancer aggressively (chemo, radiation and surgery is aggressive and may cause short, long-term and late stage side effects) but by being so aggressive, your chances of beating the odds are pretty good.
The most important point is that a key factor in your diagnosis is that your cancer is local- no lymphnode or distand mets involvement. My guess is that your oncologist wants to confirm this with a PET scan.
I hope this answers your question. Let me know if you have any other questions.
Hang in there,
David Emerson
Esophageal cancer: staging system and guidelines for staging and treatment
“As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers…
Esophageal cancer: staging system and guidelines for staging and treatment
Recommended treatment is primarily dictated by stage, tumor location, and patients’ medical fitness for receiving a particular therapeutic modality. However, definitive data from randomized trials to guide the treatment of esophageal cancer is lacking for many clinical situations. Outcomes also generally are relatively poor with many treatment strategies, so establishing optimal treatment for different clinical situations remains an area of active research (28). The NCCN guidelines reflect the lack of definitive evidence and often allow a spectrum of potential treatments for many clinical situations. Given both the generally poor overall prognosis and the potential morbidity associated with therapy, multidisciplinary evaluation by surgery, medical oncology, and radiation oncology should be considered for all patients before a treatment strategy is initiated…”
Reply Thank You David for the quick reply. I start Chemo/radiation the week of April 8,2019 here in Chattanooga, TN. I’m not looking forward to it but want the best chance of beating this. I realize each individual is different and each case as well, so will stick to this and then rest up for surgery probable sometime late June. I really appreciate the info you provided and will try to stay in touch to let you know the progress.. Thanks Again, Ed
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I feel the surgeon that was recommended to me is taking too long to schedule my surgery.
Reply Hi John,
Waiting for a surgeon to schedule your surgery can cause real anxiety. What stage of EC were you at diagnosis? Have you undergone any therapies at all at this point? Would you consider “pre-habilitation” to prepare for your surgery?
Let me know, thanks.
David Emerson
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