Esophageal/stomach cancer with malignant ascites

Tonio

My brother James, age 63 was diagnosed with esophageal/stomach cancer (at the upper stomach sphincter) around Sept/Oct 2010 after experiencing swallowing difficulty. He had chemo and radiation shortly thereafter. He was soon thought to be cancer free with a Pet scan early February 2011. They were prepared to do surgery to remove damaged area (esophagus and half the stomach) but he started having bleeding at the juncture site. This was apparently due to irritation from food passing the damaged junction. He started being fed through a tube in his nose but his albumin level was low and he was never able to get the albumin level high enough to qualify him for the needed surgery. On March 25th he had an examination due to abdominal bloating and they found him to have ascites. A CT scan at that time indicated spots in the abdominal area and a small spot in the liver and his "stage" was moved to stage IV. We are still awaiting findings from looking at the abdominal fluid but the doctor feels sure the cancer has spread and causing the ascites.

We just took him off the intestinal feeding tube (from the nose) and have inserted a "PEG" tube for direct stomach feeding and improved nutrition.

The doctor is no longer even discussing surgery due to the apparent matastases. I feel that the doctors have given up on him and are only trying to make him comfortable. I want to know what others think we should be expecting from the doctors as to more chemo and what Meds they have used to reduce the ascites fluid buildup.

Also, has anyone used albumin supplementation to reverse the effects of ascites? I know that albumin has been trialed for ascites related to liver damage, cirrhosis, etc. I was thinking that low albumin contributes to "leakage" and portal hypertension, so why would it not be a culprit in fluid "leakage" in malignant ascites? Also, what about Avastin and Lentinan or are these just different chemo options?

Any help you can give will be greatly appreciated. (My brother and I are two years apart but I feel connected to him like a twin!)

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