Esophageal Cancer Archive Questions

Below are Dr. Battafarano’s answers to Esophageal Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 7 of 7.

1

---

Q : 1 07/11/2009	I had cancer 11 years ago. It was a soft tissue sarcoma located behind my left knee. I had a resection, chemo, and radiation treatments. I have been cancer free for almost 11 years. I recently had my gall bladder removed and have been feeling discomfort post surgery. My Dr. sent me for a CT scan of my abdomen to see if they could find any abnormalities. The CT scan indicated I had a 2mm nodule in my left lung. My oncologist told me after 5 years there was a 95% chance my cancer was cured. What are the odds that the nodule is cancer? As CT Scanners improve in quality, we are now identifying many small nodules of uncertain significance. The best course of management is to follow this nodule with repeat CT scans to see if the nodule changes in size or appearance. It is possible that this very small nodule has been there all the time, but it was below the limit of detection of the older CT scanners.
Q : 2 05/11/2009	Hi Dr. I am a lung cancer survivor; had a lung and 2 ribs removed. My last CT scan was in late '08. My last PET scan was in July '08. I am experiencing some pain in my chest/upper back as well as some discomfort in my stomach area. My doctor has ordered a CT scan, but I want a PET/CT scan because I am under the impression that a PET/CT scan will be required anyway, should a problem be detected. (I prefer to minimize the amount of radiation I am exposed to.) My doctor is refusing to provide it. Is it really that bad a thing to go directly to a PET/CT scan without doing the CT scan first? What should I be concerned about losing out on by not doing the CT scan first? In my practice, I also would get a diagnostic CT scan first, and only would obtain a PET scan to further examine something on the CT images. Although it seems logical just to proceed with the PET CT scan all at once, in reality, the diagnostic CT scanner associated with most PET scanners is significantly inferior to the vast majority of diagnostic CT scanners. This is assessed by the number of "detectors" in the CT scanner. Most PET/ CT scanners are 4 detector scanners, while most diagnostic CT scanners have at least 16 detectors and the newest models have 64 or 128 detectors. For this reason a standard diagnostic CT scan is much better than the CT images obtained during a PET/CT scan.
Q : 3 04/19/2009	I was diagnosed w/stage 1a lung cancer and had the lower lobe of my left lung removed and told I was cured. 2 years later, however, I developed brain tumors which were removed and biopsies done determining that they were indeed metastatic lung cancer. At that time scans revealed "activity" in 5 lymph glands. Over the next 3 years I have had every chemotherapy available to treat these lymph glands with no change whatsoever in their appearance and no involvement of any other organ, bone or gland. Other than the effects of the chemotherapy I am in excellent health and have never had any symptoms of the disease. Is it possible that the scans are showing something other than active cancer in these lymph glands? The only way to know if these lymph nodes contain metastatic cancer at this time is by direct biopsy, but I can understand why your doctors did not pursue a biopsy originally in light of your brain metastases. It is possible that the lymph nodes contained cancer, but have responded well to the chemotherapy that you have received. Often these lymph nodes shrink when the cancer cells are killed by the chemotherapy, but sometimes they just stay the same size and are filled with scar tissue. If the lymph nodes in question can be biopsied without significant risk, this information might be helpful to the medical oncologists who are caring for you.
Q : 4 02/26/2009	I am 45, Type 2 diabetic. I have had severe pain in between my shoulder blades favoring the left side for over a month now. No obvious injuries noted. The pain comes through into the chest and is near the heart and it feels like a tightening, almost like heart attack pain. I also have a problem swallowing, having the feeling that everything is going to get stuck (food ,pills, etc.) and hiccup after meals on a regular basis. I walk 3 miles a night w/o any problems. I am leary of esophagus cancer, and I am considering seeing a specialist. I haven't been to my primary care doc yet because I am not sure what is going on and I don't want to be embarrassed to go in and say I want to be checked for cancer. I think that it is a good idea to have this problem with your swallowing fully evaluated. Although esophageal cancer is probably the most serious esophageal problem that could cause your symptoms, other non-cancerous diseases of the esophagus can also be responsible for symptoms such as those you describe. Importantly, heart disease can also cause the symptoms that you describe. If you go to your primary care physician and describe what you are experiencing, he will be able to help determine the possible causes.
Q : 5 12/31/2008	My Mother has Stage IV Adenocarcinoma, two tumors in one lung and one in the other, but no where else in the body. At time of diagnosis in July they measured 2.2cm, 1.3cm, .86cm - after 4 chemo treatments (which have been tolerated well) they measure 2.2, 1, & 8. The doctor says cancer is 'stable' and we will watch and wait. She first said they would monitor with CT's every 6-8 weeks, but is now saying CT's have too much radiation and will monitor with X-rays. Next X-ray is scheduled in Feb - this will make 3 months since she has had any treatment and 8 weeks since last scan. Is this to long of a 'break' from treatment? Are x-rays an effective way to monitor? Only one of three nodules even ever showed up on the x-ray. There is some controversy about the role of surgery in the management of patients with multifocal lung cancer like your mother has, but patients with node-negative disease appear to benefit the most from the surgical resection. If she is otherwise fit and has normal lung function, it might be reasonable systematically evaluate whether surgery might be useful in this instance. The most important factor in this evaluation is the absence of cancer anywhere else in the body.
Q : 6 12/02/2008	My friend was just diagnosed with metastatic lung cancer stage IV. Given your expertise, what do you feel his life expectancy could be? None of us can ever predict life expectancy for our patients. Everything depends on how strong the patient is and whether his tumor responds to the treatments. He does have a difficult problem, but again, it all depends on whether his cancer responds to the treatment.
Q : 7 03/28/2007	My Dad has advanced esophageal cancer (andenocarcinoma) with lesions in his liver. We know this is a very diffcult situation but of course there's always hope. To that extent, are there any new clinical trials that are ongoing now that are worth investigating? My Dad just went through 6 months of chemo with Taxol and Carboplatin (his initial diganosis was in Sept.) and has just started this week a new regimen with Oxaliplatin and 5-FU with Leucovorin. The first 6 months of treatment showed some shrinkage of the liver lesions and the esophageal tumor has nearly disapeared, though there's still slowed activity. There is however a new spot showing on his liver, hence the reason for switching to the new chemo regimen. He's able to eat very well and has not lost weight. He's 72 and has always been in amazing physical shape and eaten properly, exercised. We were shocked with the diagnoses. Any information that you might have on new treatments even if only in the clinical trial developmental stage, would be of great interest. The treatments that your father has received so far are the best that we have at this time for metastatic esophageal cancer. Many patients have responded well to oxaliplatin-based chemotherapy which he has just started. For this reason, I believe that it would be best to continue this therapy for now. If he develops disease progression, then it might be reasonable to investigate other clinical trials.

1