How quickly does esophageal cancer develop?

jmbowers

Hi all,

I am new to this forum, unfortunately not new to having cancer. I had a stage III melanoma in 2005, then stage III NSLC in 2008, and beat both. After chemo and radiation for the lung cancer I had a PET every 6 months for 3 years, then another after 4, then this past June I had a final followup scan, a regular CT. It came back clean.

In August I started having difficulty swallowing occasionally. By Octoober it was happening frequently, so I saw my oncologist and got a referral to a GI doc. A barium swallow showed something in my esophagus, so had an upper GI endo done. My esophagus was almost entirely closed off. The biopsy came back as squamous cell esophageal cancer.

Had a PET a little over a week ago, and there's a good sized mass on the esophagus. One lymph node. But there is also an area on the top of my lung. It is also pretty large. I was in such shock looking at the scan with my doctor that I didn't ask how big these are, and the PET report doesn't say. I'll ask him at my next appointment. I'm guessing at 3-5 cm easy.

My oncologist says the lung mass could be a metasteses of the esophagus cancer, or it could be a recurrence of the lung cancer, no way to tell from a PET. I'm going to have to get a biopsy to determine what it is. He says his gut feeling is that it is the esophagus cancer.

I asked him how this could not have been seen in the CT 5 months earlier? He hemmed and hawed a bit and said the esophagus was hard to image in a CT. Basically avoided a direct answer. Same for the lung mass. He's a great doc, but I've been around enough to know these guys cover each other's backs. I work for a large hospital organization and deal with the culture daily.

So a few questions:

Has anyone had their cancer discovered on a CT at a fairly early stage?

How fast does this cancer develop? If the lung mass is in fact esophageal cancer then this is stage IV. If it was too small to be seen 5 months earlier in a CT could it possibly have grown and spread that fast?

I am going to ask the imaging center to have the CT looked at again, but it will be a radiologist in the same group and I don't expect s straightforward answer. Does anyone know how I would go about having an independant radiologist review the CT?

I just have a feeling that this might have been noticed if the CT had been looked at carefully. If the reading radiologist screwed up then he needs to be made aware of it.

As far as treatment, I am basically screwed. Two surgeons looked at the scan and said it can't be operated on unless it can be shrunk. I had radiation to esophagus in 2008 for the lung cancer and can't get more. I start chemo tomorrow and my oncologist says there's a 30% chance it will shrink the tumor and we csn see if we can find a surgeon willing to operate. No discussion on the lung yet, guess we are waiting on the biopsy.

 

Thanks,

Mark

 

 

 

 

 

 

paul61

MY EC was discovered via EGD but CT showed nothing

Mark,

I was referred to a gastroenterologist by my PCP because I was complaining or recurrent acid reflux. I did not have problems swallowing, and had none of the normal symptoms of esophageal cancer. Even the GI that did the EGD said he saw lots of inflammation but “nothing that would indicate that I had cancer”. He took biopsies “as a precaution” and was surprised when they came back positive for esophageal cancer.

They then did a follow up CT scan and an endoscopic ultrasound and told me if they did not have the biopsies from the EGD they would not have known I had cancer. They said “you are in luck, you are Stage 1, we are going straight to surgery”. So three weeks later I was in surgery.

When they did the pathology they found cancer cells in one of the lymph nodes that were removed in surgery. They now said, “Sorry; you are really Stage IIb and will need to have six rounds of aggressive chemotherapy while recovering from surgery. When I asked them how the CT scan and EUS missed the involved lymph node, there was lots of shrugging and mumbling about how “medicine is not an exact science”.

 While I was in the hospital I got a massive infection in my surgical wounds and had to have my incisions re-opened and be put on IV antibiotics for three days in order to bring things under control. When I asked how I got a massive infection in what was supposed to be a “sterile” environment; there was lots of shrugging and mumbling about how “medicine is not an exact science”.

I guess what I am trying to say in my long winded fashion is that you will probably never know if, or how, the esophageal cancer was missed in your scans a few months ago. The important thing is that esophageal cancer can be very aggressive and treatment in a medical facility that specializes in esophageal cancer is the priority at this point. Surgery could be more difficult for your particular form of esophageal cancer because squamous cell EC normally occurs higher in the throat than adenocarcinoma EC.

 You will find a number of people on this forum who are not candidates for surgery and are dealing with EC through chemotherapy alone. Many of them report shrinkage of the tumor during chemotherapy. Of course there are various levels of success.

 Since you have beaten cancer before you know that a positive attitude is key and that ignoring the statistics is a requirement.

 Best Regards,

 

Paul Adams

McCormick, South Carolina
DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009
Cisplatin, Epirubicin, 5 FU - Three Year Survivor

MrsL

scans

My dad had Hodgkins lymphoma 5 years ago and returns to MD Anderson for his scans and bloodwork to make sure it hasn't returned.  

In May 2013 had a CT scan at MD Anderson as well as bloodwork.  Everything was fine. 

In mid October he was at MD Anderson again for bloodwork (no scan).  Everything was fine.  But, he was staying at my home while in town for this and was very fatigued.  My husband and I saw him again in late October and he was having difficulty swallowing and again was very fatigued.  He went in and had the procedures you mentioned.     He is stage IV with lymph node involvement.  They did a biopsy Friday to rule out lymphoma again, but the doctor feels it is the EC, not the lymphoma since all his past tests were clear.  We will know those results this week.

I also wondered why the EC wouldn't show up in a CT scan.  My husband, who is an acute care nurse practitioner said the same thing to me what your doctor told you about how the esophagus is hard to image in a CT.  I don't know if my dad asked his doctor the same thing, but  if he did, I now want to know what his doctor said. 

I hope to hear if you are able to get your CT read again.

 

JKGulliver

Hope this helps

We had a similar experience.  We have a report in our hands, from my husband's upper endoscopy that says there is no sign of cancer.  EC was discovered when a GI doctor did a biopsy to determine what FOODS allergies he had that might cause his 20 drop in weight and difficulty with swallowing, sleeping, drinking and eating.  By the time the tumor was found, it was 8 cm, stage IIB N0 M0.  I don't know if this will help, but at the time, we were told an EC tumor doubles in size every 2-3 months.  We feel luncky to have caught this when we did.

Best of luck to you.

3xsurvivorMona

esophageal cancer and growth

I have a similar situation as some here as I have had previous cancers two lung cancers one in 06 and another in 08. Recently dx with esophageal cancer.  I too feel it was missed by many, first by my primary dr who over a year ago dx GERD without ordering a endoscopic procedure, with my history of cancer I feel that should have been done  Two years ago I had a ctscan apparently there was a small growth that was missed.  Finally after going to dr and complaining of severe indigestion tests were done and I have stage 3 esophageal cancer.  I was first told I had cancer by my primary dr after my first endoscopic procedure in mid to late may I was referred to a surgeon who thought it wasn't cancer when the 1st pathology report came back it didn't show cancer But the surgeon decicided to do a Ct which showed a possible lymph node involvement a pet scan determined it.  So now I will need chemo and radiation with surgery to follow  I am concerned that the chemo and radiation won't start until the 20th of July which is two months in, I don't want this cancer to grow while I am waiting for treatment.  I'm very frustrated it wasn't caught sooner.