Background- dad 49, diagnosed esophageal ca - adenocarcinomaT3N1M0 6 weeks chemo 31 days rad. Esophagectomy Feb 2014. Given NED status. No scans pet/CT till this October 2015, clear small soft tissue density/poss neoplasm at anastimosis site from surgery. Follow up CT scan in january 2 liter pulmonary effusion. 1.5 liters drained. Oncologist says cancer returned. Thorecentisis- negative for malignancy (I understand most are) set for minimally invasive VATS procedure by Dr.V at KU med and pleurax cath placement. My questions:
1. Likely hood of biopsy coming back positive.
1a. Even if negative still most likely cancer?
2.even if negative should we start treatments
3. Would going to a major cancer treatment center be benefiting
4. Our drs says chemo 2 days a week continuous, then rest two weeks and repeat until treatment not effective- does this sound right.
5. Are there any immunology treatments avail for this, any stories of people "beating" this or finding out it truly isn't cancer, stories of people living several years after diagnosis
pleural effusion post EC 2014 - 1272711
mrsmack
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Reply # - January 25, 2016, 12:06 PM
Hi mrsmack,
Hi mrsmack,
Welcome to GRACE. I'm sorry that we seemed to have missed your question, and I apologize for the delay in responding.
In the context of an existing cancer diagnosis, findings such as these are suspicious for recurrence, but no one can say what the chances may be that the cancer has recurred or the biopsy will be positive, or even that the biopsy will be determinative, since false negatives do occur. Whether your dad should start treatment even if the biopsy is negative would be a question best left to his local doctors, who have the best information and are able to examine the scan images.
I think a second opinion at a major academic cancer center is always a good idea, especially when there is some doubt about the direction to take.
There are various chemo regimens, and many use a cycle of one week on, two weeks off, so the proposed treatment schedule does sound reasonable.
There is not a great deal of evidence for efficacy of immunotherapy agents in esophageal cancer, but as Dr. Weiss said:
"I don’t know a lot (I’m not sure that anyone knows a lot) about MEDI4736 or other PDL1 agents in esophageal cancer specifically. But, in general, drugs in this class seem promising for a variety of cancers, especially if the cancer in question is positive for PD1. My personal opinion on both this class of agents and MEDI4736 specifically is very positive." - http://cancergrace.org/topic/medi4736-trials-for-esophageal-cancer#post… (The remainder of the thread also contains useful information).
JimC
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Reply # - January 25, 2016, 01:28 PM
Seems I let your post sit at
Seems I let your post sit at my computer long enough for Jim to answer excellently, however I did finish the though so I'll let it stand.
Hi mrsmack,
I'm so sorry about your dad's diagnosis. We don't have specialist on faculty who specializes in esophageal cancer. But the question I can most definitely answer is whether or not a 2nd opinion is in order. Yes, anytime you're dealing with difficult health issues a specialist in the field is always a good person to consult with. They have the most experience with the type of case, day after day so they naturally have the best info available.
The first link is info on immunotherapy for esophageal cancer.
the second is an excellent post on all the good reasons why a 2nd opinion is never a bad idea.
http://www.cancerresearch.org/cancer-immunotherapy/impacting-all-cancer…
http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
All the very best,
Janine