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Which type of chemo treatment would be best?

TomM1956728
Posts: 64
Joined: Apr 2011

Hello,

I wanted to ask for your kind help.

My mother is 87 years old and has had esophageal cancer for over a year and a half.

She was told that her cancer had spread outside of the esophagus to multiple lymph nodes.

My mother had chemo for about a year (Folfox), and that stopped the cancer outside the esophagus from spreading any further.

However, when they did an endoscopy after a year of chemo (in February 2012), it showed that the tumor in the esophagus had grown slightly larger.

At that time, (in February), she refused to get any more chemo cause it was making her so weak.

So in March they gave her 3 weeks of radiation targeting the esophagus. Apparently, the radiation worked well and many cancer cells died or became dormant.

After that she stopped having any treatment. She stopped chemo in February 2012 and radiation in March 2012.

So she has not had chemo for about 7 months and she hasn’t had radiation for about 6 months.

She had a PET Scan a week ago, and it showed that, although the cancer outside the esophagus still had not spread any further, the cancer in the esophagus had become a little more active.

Because of that and because of the fact that my mother’s weight has decreased (she has lost about 15 pounds over the past 8 months), her oncologist wants to start chemo again.

The oncologist told us that she has 3 choices:

1. Get the treatment she got before. That’s the Folfox treatment, and involves getting an infusion (about 2 hours) and going home with a pump for about 2 days.

Since the treatment was difficult for her, she received Folfox once every three weeks instead of once every two weeks over a one year period.

Apparently, this treatment worked in that the tumor only grew slightly larger after a year.

2. Another option is to get a new drug they never gave to my mother before instead of Folfox. (I’m sorry the oncologist didn’t tell us the drug’s name).

This involves coming to the clinic every week for a 1 hour infusion 3 weeks in a row with a 1 week break.

The doctor prefers this treatment since it involves a new drug but my mother doesn’t want it since she was told it would cause hair loss.

3. The last option the doctor gave was to take pills. This would require that she take 3 or 4 pills at home twice a day. (Again, I apologize but I didn’t get the name of the drugs). We were told that the major side effect of this treatment is diarrhea and redness in the palm of the hands.

I wanted to ask: Which treatment do you think would be best for my mother. I know it’s hard to give an opinion based on the few details listed above but I’m totally lost as to what may be best for her and I'm not knowledgeable about chemo treatments. And I'm very worried.

Any help, suggestions and recommendations would be deeply appreciated.

Thank you very much for your time and kind assistance.

Tom

TerryV's picture
TerryV
Posts: 916
Joined: Jul 2011

Tom,

I understand your mother's concern about hair loss, but if the doctor believes that the new treatment would be effective in slowing the cancer......

Surely your mother values her life more than her hair?

Just a passing comment. Best wishes to your mother for positive results whatever her choice for next treatment.

Terry
PROUD wife to Nick, age 49
lost battle to EC, 06/19/12

Read more about my amazing husband on my About Me page.

TomM1956728
Posts: 64
Joined: Apr 2011

Hello Terry,

Thank you for your kind response.

That is an interesting point. I never thought of it that way!

I know my mother doesn’t want anyone to know that she has cancer.

But what you say makes perfect sense. I think she should value her life more than her hair.

I will be sure to mention what you said to my mother. I hope that will help change her mind.

Thank you once again for your time and thoughtful comment.

Tom

have2believe
Posts: 135
Joined: Dec 2010

Folfox will probably keep it stable. As a far as the other drug that has not been tested before, that can be promising but also have no effect. My suggestion if you were to go to #2 would be to get scanned after 2 cycles and be alert with the symptoms. The reason I'm optimistic but cautious is because my mom also tried a new drug (taxotere/ docetaxel) and after 3 rounds, she ended up with blood clot and the mets spread. In hindsight, I wish we scanned her after 2 rounds. Also, are there any markers like CEA that have shown to be helpful in detecting disease? The third drug is probably xeloda...if it is, then you should know that it's the pill form of the 5fu in folfox that's pumped for 48 hrs. It's convenient, but has a high chance of having really bad side effects. Also, your mom would have to make sure she takes the drugs on time.

TomM1956728
Posts: 64
Joined: Apr 2011

Hello,

Thank you for your kind response.

I greatly appreciate your advice. I didn’t know that if the new drug fails to work, it can possibly spread so rapidly. If my mother does decide to try the new drug, I will definitely ask that she be scanned after two cycles.

I also was not aware that there are markers such as CEA that can help detect the disease. Thank you for pointing that out, and for letting me know that the pill is probably xeloda.

Thank you once again for your time and assistance.

Tom
.

ptom
Posts: 36
Joined: Jun 2012

Tom,

Your CEA number does not always indicate esophageal cancer, and like everything else, it all depends on the individual. 1 to 5 is considered normal (3 to 5 for a smoker). My CEA number rose dramatically when I was diagnosed with colon cancer. It went from 3.5 to 89 then back to 3.5 after surgery. When I was diagnosed with esophageal cancer the doctors checked my CEA several times but it never went above 3.5.

ptom

TomM1956728
Posts: 64
Joined: Apr 2011

Thank you. I didn't know how to interpret CEA numbers. Thanks for your kind help. Tom

TomM1956728
Posts: 64
Joined: Apr 2011

Hello William,

Thank you so much for taking the time to respond to my post in such detail.

I learned a great deal of new information from reading your thoughtful reply. I have tried my best to do some reading about esophageal cancer, but I didn’t realize that there still is so much I don’t know.

When we first met with the oncologist in February 2011 (about a year and a half ago), he told us that my mother could not have surgery since the cancer had spread outside of the esophagus.

He said that the cancer had spread to an area near her lungs.

I asked the oncologist if he could point to the area where the cancer had spread. He moved his fingers to a large area in the upper chest. More specifically, he moved his fingers to the area about midway between the breasts and shoulders on both sides of the upper chest. He claimed the cancer had spread to lymph nodes in that region.

I asked the oncologist what stage the cancer was at, and he said somewhere between a stage 3 and stage 4 since it was "hard to interpret the results.”

So I’m not sure what stage her cancer is. I have heard that to do proper staging, they would have to do an endoscopic ultrasound. But they never did that and only performed PET Scans.

I did get a copy of the first two PET Scans. (I think she has had five PET Scans by now).

However, I don’t understand even basic biology and I couldn’t understand the terminology and medical details listed in the first two PET Scans. The only thing I understood was that in the second PET Scan, it stated that the cancer had not spread and had shrunk slightly.

From what the oncologist mentioned, the cancer outside of the esophagus has not spread at all over the past year and a half due to the chemo treatments.

However, my mother refused to have any more chemo about 7 months ago. I am really surprised that after almost 7 months of stopping chemo, the latest PET Scan done this month showed, according to the oncologist, that the cancer outside of the esophagus has not spread at all. I thought that if you don’t have chemo for 2 months it would definitely spread.

The PET Scan done this month only showed that the cancer cells in the esophagus have become more active.

I am therefore hoping that maybe the areas that lit up outside of the esophagus in the various PET Scans were due to inflammation and/or infections.

The Oncologist mentioned that the surgery is a monster surgery and given that my mother is 87 years old, he thought that the surgery would be really too much for her.

Given what I have been reading about the surgery on the internet, I must say that I also fear that she may not survive the surgery due to her advanced age.

My mother had great difficulty handling the many side effects of the FolFox treatment. The nausea medicine she was taking helped her a lot and the constipation medicine also helped her so she never had much of a problem with those side effects.

However, my mother could not deal with the many other side effects, such as fatigue, weakness, etc. The side effects became harder and harder for her to handle and, after a while, she had new and more severe side effects, such as experiencing some difficulty walking without losing her balance.

Due to the side effects, after the first 2 months of chemo, she changed her chemo schedule and dosage. She was initially getting chemo once every 2 weeks at normal doses.

However, after 2 months, she started receiving chemo once every 3 weeks at a lower dose. The oncologist said he was concerned that this would not keep the cancer at bay. However, she continued having chemo once every 3 weeks (instead of once every 2 weeks) at a reduced dose and it worked. Most of the period she was receiving chemo, she had chemo at this less frequent intervals and lower dosage.

The problem is that after almost a year of chemo and 3 weeks of radiation, she has less appetite, has lost about 12 pounds and has very little energy.

A year and a half ago, prior to starting treatment, she easily walked about 45 minutes a day. Today, she is so tired that she stays home and doesn’t walk at all.

Thank you also for letting me know the type of chemo treatment you were getting. It’s helpful to know what has worked for others.

My mother does have a port-a-cath (or is it called a line?) She received infusions through the port.

Thank you for the information about Xeloda. Based on what you mentioned, I think my mother will continue with the infusions rather than the pill since it worked well for you and for others on this site as well.

Thank you for your advice about getting a wig and not forgoing treatment just because of hair loss. I will ask the oncologist about shops that offer cancer patients wigs.

My mother was not offered a J-tube or G-tube. Due to her swallowing difficulties, her oncologist offered to put in a stent. However, based on highly valuable information I received from you and several other members on this site, my mother refused getting a stent. (Thanks so much for opening my eyes as to the risks of getting a stent).

Your response really gave me a great education. I’m going to read the links you provided since I realize that there is so much I don’t know.

Thank you once again for your time, attention and assistance. I greatly appreciate your concern and help!

Thank you!

Tom

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