Prognosis for esophageal cancer diagnosis

Ask Dr. Keith Roach M.D

Prognosis for esophageal cancer diagnosis

DEAR DR. ROACH: After seeing many specialists, I received the diagnosis of esophageal cancer T4b N2. The PET scan shows thickening of the lower esophagus of 4.1 cm in diameter and local nodal disease, but no distant metastatic disease. They say I am not a candidate for surgery, and chemo and radiation are the only treatments. I have had five days of chemo with a pump 24/7. I have suffered this past week with mouth and throat sores, making it very hard to talk, eat and drink. One week from today, I begin seven weeks of radiation, and then more cycles of chemo.

I have asked numerous questions of my doctors and get vague answers as to my chances of beating this. I have been told that this treatment is aggressive and will be rough. They tell me I will have damage to my esophagus, lungs and spine. The oncologist says I am stage 3B. What, in your professional opinion, are my chances?

I want to know the likelihood of a cure. I have an 88year-old mother with dementia. I am an only child, so her well-being and care is my sole responsibility. I had hoped I would outlive her so she could stay in her home as long as possible. Having said that, I will be truthful: It makes me very nervous to know my chances of survival. — Anon. ANSWER: I am very sorry to hear of your diagnosis, and hope I will be able to help.

Your doctors are vague because physicians are not very good at making these predictions. Our 'crystal balls' are cloudy, and they can be biased by our desire to be optimistic. However, there is some information I can give you, but I also will discuss its limitations.

First off, the treatment for esophageal cancer is improving, and newer treatments are associated with better prognosis. The statistics I am giving you are from studies more than 10 years old now, but they are the best available, so it's likely your prognosis is likely to be somewhat better.

I can give you the answer in two ways. The first is to say that roughly 10 to 20 percent of people with your stage cancer will be alive in five years, and we generally say that five years represents a 'cure,' since it is likely that all cancer will be gone in people who survive so long. The second way is to say that the median survival is 15 months, meaning half of people with your stage esophageal cancer will live longer than 15 months, and half will not. These are both accurate statements, as best we know.

It's important to recognize that there are outliers. Some people will succumb quickly, within a few months, whereas one person in 5 will be able to successfully overcome the cancer. Because of this uncertainty, it would be wise to make plans for your elderly mother in case things don't go well, which may give you some peace of mind and confidence to spend your energy on getting through the treatments to try to cure the cancer, or at least give you as much time as possible. I truly wish you the best with this difficult diagnosis. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.co rnell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.