Esophageal Cancer discussion re stages & treatments & informative videos for Ellie1229

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LorettaMarshall
LorettaMarshall Member Posts: 662 Member
in Esophageal Cancer #1

Dearest Ellie,

First, let me say that I am putting this answer to your entry https://csn.cancer.org/node/310205

on a separate post for this reason.  My answer is extremely detailed, and others who come here for info will benefit by being able to read its contents more quickly if it is on a separate line by itself, rather than having to “search for info" like this.  Moreover, it has been my experience that many write here with what seemingly requires an urgent reply.  Then we spend our time trying to help them only to find that they NEVER return to read our replies.  Undecided So since the info I’m sharing with you today is appropriate for others as well and could help to them also, that is my reasoning for this separate topic. 

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You wrote here:

https://csn.cancer.org/node/310205

"Eating Solid Food

Ellie1229

Posts: 1
Joined: Jun 2017

Jun 13, 2017 - 8:06 am

My husband was diagnosed with esophageal cancer last month. The doctor told us it was stage 3 that he's treating as stage 4, but then told me it is stage 4. He has a tumor at the base of the esophagus right where it meets the stomach. He can't eat anything and hasn't for about 2 months now. At first he could eat broth and drink some thin liquids. Now he can't do that. He gets his nutrition through a feeding tube. He had his first chemo in the doctor's office on June 5th. Then he wore a continuous feed pump for 5 days. He goes back to start round 2 on June 26th.  My heart breaks for him because he can't eat. Yesterday he told me he was thinking about what he ate for lunch last summer.  I'm wondering if anyone in this same situation could tell me how many rounds of chemo before they could tell the tumor had shrunk enough for them to eat; or is this going to shrink it enough to eat without surgery to remove the tumor?"

 

Now Ellie, let me say that I’m sorry that you have had the sad experience of knowing that your husband has Esophageal Cancer.  We wouldn’t wish that on our "worst enemy" as the old saying goes.  The situation you and your husband face is truly heartbreaking.  I’ve always said, “When my husband has cancer, I have cancer.”  Once you enter the “cave of cancer” you’re in it together.  I’ve only encountered only one self-centered lady who wrote here to talk about her husband’s cancer.  She had at some previous time had something wrong with her health, minor in comparison to her husband’s cancer.  I can’t remember what her malady was, only that she said in so many words,  “He didn’t help me when I was needed help.  I don’t give a d_a_m_m!  And now, he’s a big boy and can take care of HIMSELF!”  Surprised

We corresponded with another young woman who was about to divorce her husband when she found that he was diagnosed with Esophageal cancer.  Thankfully, he was Stage II and able to have surgery.  She “stuck with him throughout his treatments and recovery period—then divorced him!” So for some it means indifference, for others it means showing compassion like that of the “good Samaritan”,  while for others it means total commitment to your vows to walk together, arm in arm, through Hell and high water! And for that couple, it will give a new depth to their relationship that will make both of you “even more in love” and able to realize what it means to be a “helpmate”, and especially be more appreciative of LIFE and good health,

Fifty-five years ago, we took a marriage vow “For richer or for poorer"  more seriously.  In that day, we could buy almost a week’s worth of groceries for $10.  We never had a choice, "paper or plastic".  Groceries were put in a big brown paper bag.  So much for memories and nostalgia.  So that let’s you know how old I am.  (I’m 78 and my husband is 80.)  My wise mother coined a phrase that I’ve used as a gauge for problems.  “If money can fix it—it ain’t a problem.”  Well now Ellie, both you and I have a problem that “money can’t fix!”  Cancer fits into that category of things that “money can’t buy.”    We really come to a new realization that “a man’s life consisteth not in the abundance of things which he possesseth!” (Luke 12:15)  All of a sudden, all our earthly goods (stuff) really doesn’t matter—it’s our health that demands center stage.  If money could “fix it, we would go bankrupt in order to buy the cure!”  All else means little.  You’ve chosen the good part Ellie, and both of you will be “richer for it in all the ways that count.  Many a tear is shed when we hear the word cancer, and we own it! 

For starters, here is one of the most heart-wrenching videos by the wife of an Esophageal Cancer patient that I have listened to.  It brings tears to my eyes every time I listen to what she has to say.  So have a handkerchief handy when you listen to it.  I don't even know this lady but my heart aches for her every time I read it.  And my heart aches for all that write here and tell us that they too have been diagnosed with Esophageal Cancer. There are stories of victories here, and they are ever so much a welcome relief.  But then there are stories of sorrow like this J Kerry and her husband Paul.  Cry  https://www.youtube.com/watch?v=so9Yhh__c-8

So it really hurts to say “hello Ellie”.  That said, now I have a few questions.

  1. How much have you researched this cancer?  You’ve described Esophageal Cancer at the GE (Gastroesophageal junction) which constitutes most of the esophageal cancers here in the states.

  2. Where is your husband being treated? 

  3. Has he been tested to see whether or not he is HER2 positive? This is an oncogene which some EC patients have and if they do, the cancer will spread more quickly.  A separate drug (not a chemo) has been approved for EC patients.  This drug targets that specific gene and stops its ability to “over-express” itself.  So it’s important that your husband be taking this drug along with his chemo if he has that particular gene that causes the cancer to spread even more rapidly. 

  4. Are you at a major medical hospital that specializes in performing Esophagectomies, and especially the Ivor Lewis Minimally Invasive Esophagectomy (MIE) which is preferable?

  5. Does he have other medical problems that would prevent him from being a candidate for surgery?

  6. What do your husband’s medical records say?  Either it is Stage III which is advanced, yet potentially operable.  If it is already Stage IV, that means that the cancer is in lymph nodes NEAR another major organ or IN another major organ.  Which category is it Ellie?

  7. What kind of chemo has been prescribed?  My husband had 2 different infusions of chemo via “fanny pack hooked up to his medi-port” for 96 hours each, but you say 5 days with the pump at one interval.    That is 120 hours!

  8. Exactly, what is the total treatment that is scheduled for your husband? How much, what and how often?

  9. Exactly what kind of a feeding tube does your husband have?

  10. Have you had a SECOND OPINION?  If not, you should as soon as possible.

These are always the questions that I need to ask in order to be more precise when I share with you the things I’ve learned from my husband’s diagnosis of Esophageal Cancer, Stage III (T3N1M0) first diagnosed in 2002 when he was 65.  He had successful pre-op (neo-adjuvant) chemo of Carboplatin and 5-FU via “fanny pack”, 25 consecutive radiation treatments, and then an MIE!  Pathology reports indicated no residual cancer in the 23 lymph nodes removed during surgery for examination, so no post-op (adjuvant) treatments were prescribed. 

Also I remember that Dr. James D. Luketich doesn’t like to prescribe more rounds of radiation after an esophagectomy.  He only prefers additional chemo, for post-op treatments if they’re already had a series of radiation treatments.  Radiation can damage the heart as well as other tissue as many here can attest to.   It can be overdone much to the detriment of the patient.  But the wonderful thing about our personal saga is that we are now into the 15th year of celebrating a successful surgery with no evidence of recurrence.  Smile Dr. James D. Luketich pioneered the laparoscopic minimally invasive esophagectomy in the mid-90s and it is the best one to have unless there are prevailing medical problems that would prohibit that type from being performed.

Lastly, Ellie, your husband’s not being able to eat is a real tragedy and one of the hallmarks of this cancer that finally sends us to the doctor to find out what’s happening!  With chemotherapy, it is designed to circulate throughout the entire body, while radiation concentrates on the tumor itself to eliminate and/or shrink it.  There is such a great thing as “targeted radiation” today which was not prevalent or available back in 2002 here in our hometown of Virginia Beach, VA back then.  Since then one of our major hospitals purchased one of those “million dollar machines” (Cyberknife) and it can treat the exact spot where the tumor is without damaging delicate surrounding tissue.  Most often both neo-adjuvant chemo/radiation are prescribed for EC cancer patients unless it is in the very earliest of stages.  It is rare to find esophageal cancer “early”.  However, sometimes it is discovered during examination for other problems.  My husband went to our GP to check on a persistent hiccup and came out with a Stage III EC diagnosis.

Ellie, you’ve asked only one thing.  “I'm wondering if anyone in this same situation could tell me how many rounds of chemo before they could tell the tumor had shrunk enough for them to eat; or is this going to shrink it enough to eat without surgery to remove the tumor?”

Let me be honestly frank.  Usually patients exhibit the inability to swallow much of anything and that is how they come to know they have a problem.  Many find it difficult to swallow certain kinds of foods.  They go to a doctor finally when weight loss and inability to eat properly becomes a problem.  Too often the doctor sends them home with a prescription for “omeprazole” and does NOT order an endoscopy.  The story too often ends up that the patient actually has Esophageal Cancer, and only worsens even while they are taking some form of omeprazole.  In fact, it has been noted that the famous purple pill (NEXIUM) for instance, can actually often mask the symptoms of Esophageal Cancer, and many ultimately are diagnosed with an advanced stage of EC or even Stage IV Esophageal Cancer, Surprised although their heartburn or acid reflux has improved!   (See article listed below)

As I’ve said, chemo is designed to circulate throughout the entire body in search of cancer cells to kill.  It will not necessarily cause the tumor inside the esophagus to shrink enough that he will be able to eat again, without surgery.  Sometimes radiation can shrink the actual tumor itself enough to enable the person to eat some soft foods, but it will not eliminate the problem short of a surgical solution. 

You haven’t mentioned radiation, but it’s not a magic bullet.  With Stage IV patients, often chemo and radiation and a feeding tube are used to alleviate (palliate) the problem as much as possible, but without surgery there will not be a marked improvement. Sometimes a “stent” is inserted into the diseased Esophagus, but that comes with many possible complications which I will not go into here.  Most EC patients here through the years would not recommend having a stent put in.  This is my assessment now having interacted with other Esophageal cancer patients for 14 years.  Please remember that the purpose of our discussion link here is to share experiences not prescribe treatments.  So everything I share is by reputable research sources or actual interactions with other EC patients, both personally and on the web.

So Ellie, please be certain that you have done due diligence to pursue proper treatment for your husband.  And if you want to write us or talk to us personally, I will send you some personal info via private e-mail.  It’s good to have a “shoulder to cry on” and that’s why we’re here.  Rest assured you will be in my prayers.  Ideally, we would wish that all EC patients would ultimately arrive at the place where their lives could return to normal.  Sometimes that is the case—sometimes not.  But in the meantime, you need to be able to have the best treatment possible, and be able to talk with others who have “been there—done that!” 

Most sincerely,

Loretta

1.  http://www.gomn.com/news/mayo-clinic-says-get-a-second-opinion-first-ones-are-frequently-wrong/

“Mayo Clinic says get a second opinion – first ones are frequently wrong

by Melissa Turtinen - April 4, 2017 12:17 pm…

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2.  http://www.post-gazette.com/home/2011/08/01/Heartburn-meds-tied-to-cancer/stories/201108010183

“Drugs such as Nexium, Prilosec and Prevacid that control production of stomach acid and treat heartburn, reflux, peptic ulcers and related conditions are some of the most popular medications on the market.  But long-term use of these drugs, known as proton pump inhibitors, can have unexpected consequences, a new study shows.

Blair A. Jobe and his research team at the University of Pittsburgh School of Medicine say the severity of symptoms for GERD, or gastroesophageal reflux disease, has an inverse relationship with the presence of Barrett's esophagus, a precursor to a lethal form of esophageal cancer known as adenocarcinoma.  The concern is that good symptom control does not reduce cancer risk but actually increases it…”

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3.  My husband William’s treatment schedule was as follows:  (Started Feb. 10, 2003 & completed March 17, 2003.)

  ·       Week 1 ~ (02-10-03) Chemo 96-hr. continual infusion of Carboplatin/5-FU (via Fanny pack)

  ·       Weeks 2, 3, and 4 ~ (02-17-03) Five days-a-week radiation treatment.  (No CyberKnife equipment (targeted radiation) in this area in 2003, but now we do have one in our Tidewater area.)

  ·       Week 5  ~ Combination radiation plus SECOND chemo continuous 96-hr. infusion (via Fanny pack)

  ·       Week 6 ~ (03-17-03) Final week of radiation.

   ·       Repeat PET Scan on 04-28-03 ~ results - COMPLETE ERADICATION OF TUMOR in Esophagus and the 2 affected lymph nodes.

           Laparoscopic surgery was scheduled for May 17, 2003 at the University of Pittsburgh Medical Center (UPMC) by the pioneer of the Ivor Lewis Minimally Invasive Esophagectomy (MIE) by Dr. James D. Luketich, approximately 3 weeks later after successful pre-op treatment.  Radiation does cause scar tissue, so the sooner the surgery after the pre-op treatments—the better.

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4.  http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/cancer-drugs/trastuzumab

           “What Trastuzumab is

 Trastuzumab is a monoclonal antibody – a type of targeted treatment. It has the brand name Herceptin. It is used for cancers that have large amounts of a protein called HER2 (human epidermal growth factor receptor 2). Some breast cancers and stomach cancers have large amounts of HER2 and they are called HER2 positive cancers. HER2 makes the cancer cells grow and divide. When HERCEPTIN attaches to HER2 it can make the cells stop growing and die.”

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 5.  http://www.cancer.net/cancer-types/esophageal-cancer/diagnosis

 “Esophageal Cancer - Diagnosis - Approved by the Cancer.Net Editorial Board, 10/2015

  ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

 Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread.

 This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

 Age and medical condition - Type of cancer suspected - Signs and symptoms - Previous test results

 In addition to a physical examination, the following tests may be used to diagnose esophageal cancer: Barium swallow, also called an esophagram. The patient swallows a liquid containing barium and then a series of x-rays are taken. An x-ray is a way to take a picture of the inside of the body. Barium coats the surface of the esophagus, making a tumor or other unusual changes easier to see on the x-ray. If there is an abnormal looking area, your doctor may recommend an upper endoscopy and biopsy to find out if it is cancerous (see below).

  • Upper endoscopy, also called esophagus-gastric-duodenoscopy, or EGD.

  • An upper endoscopy allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus while the patient is sedated. Sedation is giving medication to become more relaxed, calm, or sleepy. If there is an abnormal looking area, a biopsy will be performed to find out if it is cancerous. An endoscopy using an inflatable balloon to stretch the esophagus can also help widen the blocked area so that food can pass through until treatment begins.

  •  Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound, (EUS) sound waves provide a picture of the wall of the esophagus and nearby lymph nodes and structures. During an endoscopic ultrasound, an endoscopic probe with an attached ultrasound that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound is used to find out if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures. An ultrasound can also be used to help get a tissue sample from the lymph nodes.

  •  Bronchoscopy. Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient’s tumor is located in the upper two-thirds of the esophagus to find out if the tumor is growing into the person’s airway. This part of a person’s airway includes the trachea, or windpipe, and the area where the windpipe branches out into the lungs called the bronchial tree.

  •  Biopsy. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A biopsy is the removal of a small amount of tissue from the suspicious area for examination. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

  •  Computed tomography (CT or CAT) scan. A CT scancreates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail. This dye is generally injected into a patient’s vein.

  •  Magnetic resonance imaging (MRI). An MRIuses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A contrast medium is usually injected into a patient’s vein to create a clearer picture.

  •  Positron emission tomography (PET) scan. A PET scanis a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
  •  After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

 The next section in this guide is Stages and Grades, and it explains the system doctors use to describe the extent of the disease…”

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  6.       http://www.cancer.net/cancer-types/esophageal-cancer/stagesEsophageal Cancer - Stages

  “Approved by the Cancer.Net Editorial Board, 10/2015

 ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition to stage, a cancer’s growth may also be described by its grade, which describes how much cancer cells look like healthy cells. To see other pages, use the menu on the side of your screen.

 Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

           TNM staging system

 One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  1.  Tumor (T): How deeply has the primary tumor grown into the wall of the esophagus and the surrounding tissue?

  2. Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  3. Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

     The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

     Here are more details on each part of the TNM system for esophageal cancer:

               Tumor (T)

     Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the tumor, including whether the cancer has grown into the wall of the esophagus or nearby tissue, and if so, how deep. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

     TX: The primary tumor cannot be evaluated.

    T0: There is no cancer in the esophagus.

    Tis: This is called carcinoma (cancer) in situ. Carcinoma in situ is very early cancer. Cancer cells are in only one small area of the top lining of the esophagus without any spread into the lining.

     T1: There is a tumor in the lamina propria and the 2 inside layers of the esophagus called the submucosa. Cancer cells have spread into the lining of the esophagus.

     T2: The tumor is in the third layer of the esophagus called the muscularis propria. Cancer cells have spread into but not through the muscle wall of the esophagus.

     T3: The tumor is in the outer layer of the esophagus called the adventitia. Cancer cells have spread through the entire muscle wall of the esophagus into surrounding tissue.

     T4: The tumor has spread outside the esophagus into areas around it. Cancer cells have spread to structures surrounding the esophagus, including the large blood vessel coming from the heart called the aorta, the windpipe, diaphragm, and the pleural lining of the lung.

               Node (N)

     The “N” in the TNM staging system stands for lymph nodes. In esophageal cancer, lymph nodes near the esophagus and in the chest are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

    NX: The lymph nodes cannot be evaluated.

     N0: The cancer was not found in any lymph nodes.

     N1: The cancer has spread to 1 or 2 lymph nodes in the chest, near the tumor.

     N2: The cancer has spread to 3 to 6 lymph nodes in the chest, near the tumor.

     N3: The cancer has spread to 7 or more lymph nodes in the chest, near the tumor.

               Metastasis (M)

     The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

     MX: Metastasis cannot be evaluated.

     M0: The cancer has not spread to other parts of the body.

     M1: The cancer has spread to another part of the body.

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               Grade (G)

     Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

     G1: The tissue looks more like healthy cells, called well differentiated.

    G2: The cells are somewhat different than healthy cells, called somewhat differentiated.

     G3: The tumor cells barely look like healthy cells, called poorly differentiated.

     G4: The cancer cells look almost alike and do not look like healthy cells, called not differentiated.

               Cancer stage grouping

     Doctors assign the stage of the cancer by combining the T, N, and M classifications. There are separate staging systems for the two most common types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. The staging system for each is described below.

              Staging of squamous cell carcinoma of the esophagus

     In addition to the TNM classifications, for squamous cell carcinoma, the stages may be subdivided based on whether the tumor is located in the upper, middle, or lower section of the esophagus, as well as the grade (G) of the tumor cells.

     Stage 0: This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

     Stage IA: This is the same as T1 cancer, in which the cancer is located in only the 2 inside layers of the esophagus (T1, N0, M0, G1).

     Stage IB: Either of these conditions:

  1.  The cancer is located in only the 2 inside layers of the esophagus, but the tumor cells are less differentiated (T1, N0, M0, G2 or G3).

  2. The tumor is located in the lower part of the esophagus, and the cancer has spread to either of the 2 outer layers of the esophagus, but not to the lymph nodes or other parts of the body (T2 or T3, N0, M0, G1).

     Stage IIA: Either of these conditions:

  1.  The tumor is located in the upper or middle part of the esophagus, and the cancer is in either of the 2 outer layers of the esophagus (T2 or T3, N0, M0, G1).

  2. The tumor is located in the lower part of the esophagus, and the cancer is in either of the 2 outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).

     Stage IIB: Either of these conditions:

  1.  The tumor is located in the upper or middle part of the esophagus, and cancer is in either of the 2 outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).

  2. Cancer is in the inner layers of the esophagus and has spread to 1 or 2 lymph nodes near the tumor (T1 or T2, N1, M0, any G).

     Stage IIIA: Any of these conditions:

  1.  Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor (T1 or T2, N2, M0, any G).

  2. Cancer is in the outside layer of the esophagus and has spread to 1 or 2 lymph nodes (T3, N1, M0, any G).

  3. Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

     Stage IIIB: Cancer is in the outside layer of the esophagus and in 3 to 6 lymph nodes (T3, N2, M0, any G).

     Stage IIIC: Any of these conditions:

  1.  Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in 6 or less lymph nodes (T4a, N1 or N2, M0, any G).

  2. Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).

  3. Cancer has spread to 7 or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

     Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

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               Staging of adenocarcinoma of the esophagus

     For adenocarcinoma, doctors use the T, N, and M classifications, as well as the grade (G).

     Stage 0: This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

     Stage IA: This is the same as T1 cancer, in which the cancer is located in either of the 2 inside layers of the esophagus only (T1, N0, M0, G1 or G2).

     Stage IB: Either of these conditions:

  1.  The cancer is located in either of the 2 inside layers of the esophagus only, and the tumor cells are poorly differentiated (T1, N0, M0, G3).

  2. The cancer has spread to an outer layer of the esophagus but not to the lymph nodes or other parts of the body (T2, N0, M0, G1 or G2).

     Stage IIA: Cancer is in an outer layer of the esophagus, and the cells are poorly differentiated (T2, N0, M0, G3).

     Stage IIB: Either of these conditions:

  1.  Cancer is in the outside layer of the esophagus but not beyond (T3, N0, M0, any G).

  2. Cancer is in an inner layer or the muscularis propria of the esophagus and has spread to 1 or two lymph nodes (T1 or T2, N1, M0, any G).

     Stage IIIA: Any of these conditions:

  1.  Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor (T1 or T2, N2, M0, any G).

  2. Cancer is in the outside layer of the esophagus and has spread to 1 or 2 lymph nodes (T3, N1, M0, any G).

  3. Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

     Stage IIIB: Cancer is in the outside layer of the esophagus and in 3 to 6 lymph nodes (T3, N2, M0, any G).

     Stage IIIC: Any of these conditions:

  1.  Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in 6 or less lymph nodes (T4a, N1 or N2, M0, any G).

  2. Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).

  3. Cancer has spread to 7 or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

     Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

     Recurrent: Recurrent cancer is cancer that has come back after treatment. It may come back in the esophagus or in another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

     Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition published by Springer-Verlag New York, www.cancerstaging.net.

      Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.”

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    7.  https://www.youtube.com/watch?v=FvgEaDVCKfA

    Esophageal Cancer - Published on Jan 29, 2014 - http://www.nucleusmedicalmedia.com/

    This 3D medical animation shows the anatomy of the esophagus and the two common types of esophageal cancer: Adenocarcinoma and squamous cell carcinoma. Common treatment options and risk factors are also shown.

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    8.  https://medlineplus.gov/esophagealcancer.html

    Extensive info re Esophageal Cancer and its treatment.

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    9.  https://www.youtube.com/watch?v=mFboj87THJE

    Encouraging video by our thoracic surgeon Dr. James D. Luketich

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    10.  https://www.youtube.com/watch?v=cjB3w7ovgNE

    May 31, 2013 – Lecture from Dr. Luketich from the 2013 meeting of the General Thoracic Surgical Club's 26th annual meeting in Naples, FL

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     11.  http://www.upmcphysicianresources.com/cme-course/minimally-invasive-esophagectomy/item/1

    Minimally Invasive Esophagectomy

    Drs. James D. Luketich and Katie S. Nason discuss minimally invasive esophagectomy.

    Educational objectives: -   Upon completion of this activity, participants should be able to:

  • Describe how risk factors for esophageal cancer are currently understood
  • List barriers to early detection
  • Discuss how early detection of esophageal cancer can be improved
  • Define minimally invasive esophagectomy (MIE)
  • Describe evolution of technique
  • Discuss results of MIE

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12.  http://www.youtube.com/watch?v=hx4hS21AbuI&feature=related

 "Due to the graphic nature of this video, viewer discretion is advised.
  Minimally Invasive Esophagectomy featuring Ninh T. Nguyen, MD, Professor of Surgery Chief, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center (SDMK13CD0800259)"

[My note here:  Dr. Ninh Nguyen worked with Dr. James D. Luketich, the pioneer of the Ivor Lewis MINIMALLY INVASIVE ESOPHAGECTOMY (MIE) in the mid-90’s at the University of Pittsburgh Medical Center.  If anyone is on the west coast, they should contact Dr. Nguyen at UCIrvine.  He is excellent.

You will be watching a 46 minute video tape of an actual MIE surgery, narrated by Dr. Nguyen.  Obviously, these are incremental excerpts as the operation proceeds.  My own husband’s MIE surgery at the University of Pittsburgh Medical Hospital back in 2003 took approximately 7 hours.  The surgery time will differ from patient to patient depending on the individual condition of the patient.  My husband’s diagnosis was Adenocarcinoma at the GastroEsophageal junction (GE), Stage III (T3N1M0).  He was only in the hospital for 5 days.  No anastomotic leaks—that was great news.  He had a “J” tube which for nutritional purposes while he acclimated to a “new way of eating”.  We were downtown shopping in Pittsburgh on Day 8.  So I like to say that my husband William (Bill) is definitely a “poster boy” for the Ivor Lewis Minimally Invasive Esophagectomy.  We thank God daily for Dr. James D. Luketich.  As of this date, June 13, 2017, Bill is still cancer free. ] 

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