Dad Diagnosed with Esophagael Adenocarcinoma Ca, HELP Please!

paul61 said:

Your Dad's case is a bit similar to mine
Arjun,

Welcome to our group. I am sorry you found us under difficult circumstances for your Dad and your family. I think my history with esophageal cancer may be similar to your Dad’s. Like your Dad, had surgery prior to any chemotherapy or radiation therapy. In my case they originally thought I was in Stage I because the initial diagnostic tests did not show any lymph node involvement. Unfortunately for me, the post surgical pathology showed cancer cells in one of the lymph nodes removed, so I required adjuvant chemotherapy.

Your Dad was more fortunate than me in the respect that he had a minimally invasive surgery while I had an Ivor Lewis surgical approach which is much more invasive and has a longer recovery period. But, as I am sure your Dad will tell you, all esophagectomies are major surgery and take significant recovery periods.

Like your Dad I lost quite a bit of weight after the surgery.

I am glad to see your Dad has a J-tube. That will be very helpful to him in maintaining the caloric intake he will require to complete his recovery from surgery and complete his adjuvant chemotherapy. Even if you Dad reaches a point where he does not need the support of the J-tube as he completes his recovery from surgery I would recommend he discuss keeping the tube in through chemotherapy with his oncologist. Chemotherapy can present its own issues with eating and digestion.

But let me get to your questions:

1) How many Cycles can my dad undergo at a stretch (i mean after 6 cycles are over) and if the chemo has not responded well, or may be it has and the cancer cells comes back again how many times i can have him undergo the chemo process?

How much chemotherapy one can undergo is a function of the person’s health profile, the drugs used, and that person’s personal response to the drugs.

I can tell you in my case I had six rounds of Cisplatin, Epirubicin, and 5 FU. The Cisplatin and Epirubicin were given via infusion every 21 days. The 5 FU was given via a portable IV pump continuously over an 18 week period. I had a CT scan after three infusion cycles to evaluate my response to the chemotherapy and a CT scan at the end of the 18 weeks. I was fortunate enough to be found “in remission” with no evidence of disease in subsequent CT scans.

Your Dad had clear margins after surgery and the three affected nodes have been removed so one can be hopeful the follow up chemo will be successful in placing him in remission as well.

2) how does chemotherapy respond to adenocarcinoma cells?

Chemotherapy is designed to kill fast reproducing cells. Ideally any adenocarcinoma cells remaining are killed. Unfortunately the cells in the lining of the digestive system are also fast reproducing cells so there will be some side effects. Your Dad’s oncologist will have medications to deal with the side effects. The side effects I had were some nausea and diarrhea. My oncologist prescribed medications that minimized those issues.

3) Is radiation required along with chemotherapy?

I did not have radiation therapy. The cancerous tumor and affected lymph nodes were removed at that point so there was really nothing to target and irradiate.

4) what are the precautions i should take when my dad will be going through chemotherapy?

Your Dad’s immune system will be weakened by the chemotherapy. I would avoid large groups of people were he could be exposed to various germs.

Many of the chemotherapy drugs will cause dehydration. Be sure your family supporting your Dad’s knows the signs of dehydration (nausea, dizziness, fatigue, etc) and if necessary take your Dad in for IV hydration. It is hard to drink enough liquid on a daily basis to maintain enough hydration. I found that if I went into my oncologist’s office for IV hydration two days after each IV infusion I had an easier time with the side effects.

Be sure your Dad takes his anti-nausea medications even if he does not feel nauseous. It is easier to stay ahead of nausea if you don’t wait until it occurs to take your medication. Some people on this site have found it helpful to take their morning nausea medication before they get out of bed and allow it an hour of so to begin working before they get up.

Tell your Dad not to eat his favorite foods during chemotherapy, many of the drugs change the taste of food and after chemotherapy is finished he will tend to associate how those foods tasted during chemotherapy and may not be able to enjoy them after chemotherapy. I waited until a month after I finished chemotherapy and then rewarded myself with my favorite foods.

Suggest your Dad eat soft foods that are high in calories. Be careful of foods that are high in sugar content or simple carbohydrates. One of the common issues for people who have had gastric surgery is “Dumping Syndrome”.

I have included some references to helpful documents in this area below:

http://www.upmc.com/HealthAtoZ/patienteducation/Documents/Esophagectomy.pdf

http://www.upmc.com/HealthAtoZ/patienteducation/Documents/DumpingSynDiet.pdf

5) what all should i be prepared for in the future as my dad undergoes the treatment?

Your Dad’s appearance will change as he goes through chemotherapy. He may lose his hair, he will probably lose some weight, and he will feel and look frail. These changes are temporary and will change after he finishes his treatment. He will probably not be particularly interested in eating. You should encourage him to eat but try not to nag him about how much he eats. Continually telling a patient who is undergoing chemotherapy that “ you have to eat or you will lose too much weight” will just raise that person’s anxiety level. There will be some days when getting out of bed and to his favorite chair is all he can do that day. I found that when I received chemo in three week cycles the first week after an infusion was the worst, the next week I felt slightly better, and the third week I felt almost normal again. Then it was back to the oncologist’s office for another infusion. After a few cycles I knew what to expect and the side effects did not concern me as much. Chemotherapy has a cumulative effect so the last three cycles were more difficult than the first three but the side effects were manageable with appropriate medications.

6) What precautions should i take in order to avoid the side effects of chemo?

Sherri has given some excellent advice in her post above. Hydration is important. Taking nausea medication proactively is important. Keeping a log of side effects and how your Dad’s feels generally each day will help your oncologist manage your Dad’s side effects.

It sounds like your Dad has the support of a loving family and access to excellent medical care. He is very fortunate.

I will be hoping for a positive outcome from his tests and treatment plan.

Best Regards,

Paul Adams
McCormick, South Carolina

DX 10/22/2009 T2N1M0 Stage IIB
12/03/2009 Ivor Lewis
2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
6/21/2010 CT Scan NED
3/14/2011 CT Scan NED

Life may not be the party we hoped for, but while we are here we might as well dance!