Radiation Oncologist

We just met with Dr. L., the radiation oncologist.

Dr. L. reviewed E.'s history . . . the tumor is located at the very end of the esophagus (called a Gastro-Esophageal Junction tumor) and some of the stomach is involved too. It appears though that the tumor originated in the esophagus and not the stomach. Because of this, they will treat the cancer as if it is esophageal cancer rather than gastric (stomach) cancer (treatments are different for the two cancers).

Dr. L. explained that the preferred course of treatment for this stage of EC is a combined treatment of radiation and chemotherapy. As indicated previously, the advanced stage of the cancer and the involvement of the lymph nodes does not make E. a candidate for surgery.

E. is scheduled for another CT scan on Thursday. The purpose of this CT is to look at the tumor in 3-D and plan the radiation beams in relation to the other organs. While the radiation will have to travel through other organs to reach the tumor and affected lymph nodes, they want to minimize the intensity of the radiation through healthy organs. E. will then have to be TATTOOED. (Ha! I told him I'd talk him into a tattoo one of these days!) He will be tattooed with several "dots" to mark where the radiation beams will be directed. Depending on the consultation with the doctor this afternoon, E. could tentatively begin radiation by the middle of next week. Radiation would be daily (Monday through Friday) for about 5 to 6 weeks.

Because E. will most likely be facing chemotherapy at the same time as the radiation, the side effects will probably appear quicker and be more intense than if he were to receive only one type of treatment at a time. His pain will increase immensely. He will be extremely fatigued. His throat will be EVEN sorer and swallowing will most likely be the biggest problem. Nausea and bowel irratibility are also common side effects, especially with the chemotherapy. Dr. L. indicated that 75% of patients undergoing this treatment will require a PEG-tube (feeding tube). Most patients wind up on a strict liquid diet, although some still manage to eat soft foods.

E.'s recovery from treatment will be very slow. After radiation alone, it usually takes a patient 4 to 6 weeks to recover. That recovery time is extended if chemotherapy is done concurrently. E. will most likely feel his worst at the conclusion of treatment. Other risks were discussed, as well as possible long-term effects.

Also, one of our concerns was that once E. underwent radiation treatment, there would be certain time periods that he wouldn't be allowed to be around children or pregnant women . . . we were relieved to find out that is NOT the case.

E. was also referred to yet another doctor, Dr. B., a palliative care specialist. Because his cancer is in an "advanced state," Dr. B. would be the doctor to assist with pain management.

E. is anxious to just get his treatment started. Next up . . . chemotherapy oncologist.

S.