Chemotherapy Oncologist

We met with Dr. B., the chemotherapy oncologist, this afternoon.

He agreed with Dr. L. that a combination of chemotherapy and radiation was the best course of action for E.'s situation. According to the National Cancer Institute guidelines, esophageal cancer at this stage is best treated by a.) 3 cancer drugs or b.) a combination of chemotherapy and radiation.

Dr. B. stated that the goal of treating EC at this stage is not usually curing the disease, as being "cured" would require surgery. And as stated many times previously, surgery is not an option at this point. Dr. B. informed us that after this course of treatment, E. would undergo more scans to "re-stage" the cancer. The goal is to eliminate the cancer from the lymph nodes and shrink the tumor in the esophagus, thereby making E. a candidate for surgery after all. As always, risks were discussed as well as potential long-term side effects.

The two courses of chemotherapy recommended by Dr. B. are as follows:

* Cisplatin - given via IV on day 1 (course #1) and again on day 29 (course #2)

* 5-FU (Fluorouracil) - given via IV on days 1 through 5 (course #1) and again on days 29 through 32 (course #2)

Day 1 would coincide with the first day of radiation . . . tentatively scheduled to begin next Wednesday, March 4th.

Some of the common potential side effects of the chemotherapy include: hair loss, mouth sores, sores in the lining of the digestive tract, nausea, diarrhea, decreased blood counts (risk of infections, risk of blood transfusions, rare risk of death). Side effects specific to Cisplatin include neuropathy (damage to certain nerves, most times resulting in painful tingling in fingers and toes), hearing loss, and kidney damage. Side effects specific to 5-FU include rashes on the palms and soles, and in rare cases, heart attacks.

Dr. B. informed us that these are the "big guns" of chemotherapy and this is very aggressive treatment. After treatment is complete, if the cancer is re-staged and it is determined that surgery is still not an option, more chemotherapy might be in E.'s future. It is likely that radiation would no longer be part of the treatment plan as there is a limit of radiation a person can receive.

The referral to UCDavis is still in the review process and we are hoping to hear something from them in the next couple of days too.

S.

P.S. For all those sick guys at work who think E. has butt issues . . . Boy, does he have a poop story for you! I'll have to let him tell it, because there is no way I could do it justice.