Stage IV- Liver involved

Elizabeth700 · June 2017

Hello.

My husband was diagnosed with stage 3 esophageal in September 2016.

He had 5 weeks of radiation and 5 chemo infusions.

The follow up PET scan showed clean esophagus/ stomach junction/ lymph nodes however there were spots on his

liver. He's in the 6th cycle of 1 infusion (oxaliplatin) followed by 2 weeks of 4000 mg xeloda daily for two weeks, 1 week off, then repeat. Recent scan showed a clean liver.

My concern is since the liver became involved, surgery doesn't seem to be an option.

Has this been the case with anyone else?

Thank you for any info you may have.

LorettaMarshall · June 2017

"Liz"-Exhaust all options B4 accepting verdict of no surgery!

Hello Elizabeth –

My husband was diagnosed with Stage III Esophageal Cancer, T3N1M0. This meant that all four walls of the Esophagus were cancerous, plus 2 local lymph nodes but there was no metastasis (spread). The “M” stands for metastasis, and thankfully the “zero” meant no spread to lymph nodes near another organ or in another organ.

He was successfully treated with 5-FU and Carboplatin as well as having 25 rounds of radiation prior to having an Ivor Lewis MINIMALLY INVASIVE ESOPHAGECTOMY (totally laparoscopic) at the University of Pittsburgh Med. Ctr. By Dr. James D. Luketich, on May 17, 2003. My husband is still cancer free and now into his 15^th year of survival with no recurrence. This is an absolute miracle for which we thank the Lord.

May I ask, exactly what the official diagnosis of your husband is before he began the chemo/radiation treatments? Was there an “M” with a number beside it? This would have indicated that there was cancer in another organ at time of original diagnosis.

May I also ask if you’ve had a SECOND OPINION? And if I may be so inquisitive—what medical facility is treating your husband presently?

If the liver has been successfully treated, I’m questioning why the doctors are not going to consider an Esophagectomy, or is that just your thinking?

I know that the “Oxaliplatin” is a “wicked” chemo but an effective one. And the Xeloda, is the pill form of 5-FU. Can you give us a bit more info? You know there are just absolutely some hospitals that are better than others. I would certainly want a SECOND opinion from a major hospital who specializes in Esophagectomies before I would discount the option of surgery.

You know SECOND opinions differ OFTEN!! Note the first reference of April of 2017 by Mayo Clinic.

Loretta (wife of William Marshall)

P.S. I recommend Dr. Luketich. I trust him with my life.

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1. https://www.studyfinds.org/second-opinion-doctor-diagnosis-study/

Second Opinion from Doctor Nets Different Diagnosis 88% Of Time, Study Finds

8Apr - by Daniel Steingold - 232 - In Health Studies

ROCHESTER, Minn. — When it comes to treating a serious illness, two brains are better than one. A new study finds that nearly 9 in 10 people who go for a second opinion after seeing a doctor are likely to leave with a refined or new diagnosis from what they were first told.

Researchers at the Mayo Clinic examined 286 patient records of individuals who had decided to consult a second opinion, hoping to determine whether being referred to a second specialist impacted one’s likelihood of receiving an accurate diagnosis.

The study, conducted using records of patients referred to the Mayo Clinic’s General Internal Medicine Division over a two-year period, ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time.

A new study finds that 88% of people who go for a second opinion after seeing a doctor wind up receiving a refined or new diagnosis.

Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded.

“Effective and efficient treatment depends on the right diagnosis,” says lead researcher Dr. James Naessens in a Mayo news release. “Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling ─ not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all…”

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2. https://qz.com/949860/get-a-second-opinion-doctors-usually-arent-right-the-first-time/

“…Misdiagnosing a patient can sometimes be fatal, but how often is unclear. Last year, a controversial study from Johns Hopkins University said that medical error—which includes mistakes in diagnosis—are the third-leading cause of death in hospitals behind cancer and cardiovascular diseases in the US. As ProPublica notes, doctors don’t list medical errors on death certificates, so counting the actual number of deaths presents its own set of challenges. That said, the National Academies of Medicine estimates (pdf) that diagnostic errors lead to up to 10% of all patient deaths, and up to 17% of all hospital complications…”

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3. http://www.upmc.com/Video/Pages/default.aspx?vcat=937;#3753ef4c-73b8-4be7-b0c7-9c5fd91b952c|Lung+and+Thoracic+Surgery

This is a video by my husband’s thoracic surgeon, Dr. James D. Luketich at UPMC

“Esophageal Cancer: Surgical Innovations

James D. Luketich, MD, highlights advances in esophageal cancer treatment through innovative surgery. The UPMC Esophageal and Lung Surgery Institute is a leader in developing novel surgical approaches to minimize recovery time and scarring while maximizing results and quality of life for patients after surgery. "

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4. http://www.upmc.com/Video/Pages/default.aspx?vcat=937;#3753ef4c-73b8-4be7-b0c7-9c5fd91b952c|Lung+and+Thoracic+Surgery

Video by Dr. Inderpal Sakaria talking about treatment at UPMC for MIE procedures (He is now located elsewhere but he trained under Dr. Luketich at the time of this video)

_________________________________________________________

5. http://www.upmccancercenter.com/find/providers/james-luketich-439

“James D. Luketich, MD

Physicians

Biography

James D. Luketich, MD, is the Henry T. Bahnson Professor of Cardiothoracic Surgery in the Department of Cardiothoracic Surgery at the University of Pittsburgh School of Medicine, chairman of the Department of Cardiothoracic Surgery at the University of Pittsburgh School of Medicine, chief of the Division of Thoracic and Foregut Surgery at the University of Pittsburgh School of Medicine, director of the Thoracic Surgical Oncology program at UPMC and co-director of the Lung Cancer Center at UPMC. He specializes in all areas of thoracic oncology, including lung cancer, mediastinal malignancies, and esophageal cancer, as well as multidisciplinary management (combined chemotherapy/radiation/surgery) of esophagogastric carcinoma and lung cancer, and benign esophageal disease…”

_____________________End of references___________________

Elizabeth700 · June 2017

Deathorglory said:
Hello Elizabeth
Hello Elizabeth,

My case isn't a direct parallel of your husband's, but I'll share anyway and if you draw something from it, then great. I was Stage IV my second time around in 2011, with a recurrence in a lung. I was offered only chemo, since tageted therapies like surgery and radiation weren't useful once the cancer was "on the loose". I was very upset about this and sought a second opinion at another top cancer center and was told the same thing by those folks. It just so happened to work out wonderfully for me, but I can feel your sense of wanting to do more. I'd probably go get a second opinion from a top surgical cancer center to see if there's anything more that can be done.

Best wishes,

Ed

No Surgery?

hello Ed.

thank you for your response. I plan on checking out the minimally invasive procedure that Loretta discussed and perhaps other opinions as well.

you message made me feel so much better . I'm so glad it worked out for you and, if that's our option,it will for us as well. you've given me hope. I feel so helpless but chatting with you and Loretta has brought my brain back into focus.

Thank you.

Very much.

Deathorglory · June 2017

Hello Elizabeth

Hello Elizabeth,

My case isn't a direct parallel of your husband's, but I'll share anyway and if you draw something from it, then great. I was Stage IV my second time around in 2011, with a recurrence in a lung. I was offered only chemo, since tageted therapies like surgery and radiation weren't useful once the cancer was "on the loose". I was very upset about this and sought a second opinion at another top cancer center and was told the same thing by those folks. It just so happened to work out wonderfully for me, but I can feel your sense of wanting to do more. I'd probably go get a second opinion from a top surgical cancer center to see if there's anything more that can be done.

Best wishes,

Ed

Sharonrey · June 2017

Hi Elizabeth,

Hi Elizabeth,

My mom was diagnosed the same as your husband except the nodes were involved in the clavical area. Given taxon and carbon for 5 weeks and radiation..No surgery because of a suspicious spot on lung which as since started to grow..Diagnosed Feb. Of 2016. Recently positive lymph node by liver. That received radiation. Now pet scan and ct show liver involvement. Waiting on biopsy results. No recurrence in esphogus although there is pain in the same spot mid way down. Surgery was ruled out from the get go because of the lung... Dr. Talking lifetime chemo. Scared but grateful that she's been able to have a period of time of having a normal life. Hang in there hun, it's a rollercoaster ride.

Sharon

Stage IV- Liver involved

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