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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18771
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have had RT treatment (two sessions a week for three weeks)

Resolved Question:

I have had RT treatment (two sessions a week for three weeks) the tumour in the oesophagus is still there and I still have difficulty swallowing sometimes. The oncologist does not feel chemotherapy would be suitable, but instead wants to insert a stent. This I understand is like a coiled spring which will expand and so make swallowing easier. My question is: since this does not remove the cancer which the RT did not, is the cancer going to continue to grow in the tumour (and possible let the cancer occur in other parts of the body). I think this just "sweeping the dust under the carpet", the cancer is still there and this is not "treatment". I am very fit, don't smoke and rarely have a drink. I am very active in gardening and walking. The negative point is that I am 90 years of age but don't feel or look like it.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information.
How much difficulty swallowing are you having?
How often does it bother you?
Is this better than prior to the RT?

Customer: replied 3 years ago.

 


I eat my breakfast , two slices of slightly toasted bread with marmalade and fruit - a banana and a grapefruit with black tea. No ploblem. For lunch I have a bowl of soup, a little cheese with a cracker and some dark chocolate and a buscuit - no problem, Sometimes after dinner I get a complete blockage, my mouth then fills up with saliva and I have had to cause myself to vomit to get my oesophagus clear. It happened once last week. When it is stuck I cannot drink at all, even mineral water. I try to avoid the blockage by chewing well and swallowing in small portions, and drinking while eating if I think I am gong to get a blockage.


I don't actually notice any change since I had the RT. However, I am more aware of the presence of the tumour these past couple of weeks, sometimes mild pain, but not relly what I would callpainful. The RT treatment finished on March 27. The oncologist feels that since the RT did not work there is nothing more to be done, i.e. not more RT.


 


Additional question: If I had the stent put in, presumably the tumour would grow more but not obstruct the oesophagus - how long would I have left to live (difficult question!)

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There are a couple of issues to consider in this situation.

You are correct that placing a stent will not affect the growth of the primary tumour or the likelihood that it will grow in distant locations (metastasise). However, it also is not considered as sweeping the dust under the rug, because the stent is treating a particular symptom.

When treating cancer, the first question is whether it would be possible to achieve a cure of the cancer. If the situation is such that a cure cannot be achieved, then it is appropriate to only perform interventions that ease symptoms.

If you are not ready to agree that curative treatment is not possible, the usual next step would be to seek a second opinion.

Once it is decided that curative treatment is not possible, then the severity of the symptoms that you describe would justify the placement of a stent to facilitate swallowing.

The length of survival would not be indicated by the fact that placement of a stent is needed. The extent of the disease would indicate an average survival, but that is not apparent from the fact that a stent is needed. If the cancer is localized to the oesophagus, the 5 year survival is 39%. If there is regional spread, the 5 year survival drops to 21%. If there is distant metastases, the 5 year survival drops to 4%.

If I can provide any clarification, please let me know.

Customer: replied 3 years ago.

Thank you for your explanation. Just the question regarding Chemo. Do you think I am too old to have Chemo. as I suppose it relates to ones ability for the good cells, which are destroyed in the Chemo, to grow back while the bad cells are destroyed.


 


Thank you

Expert:  Dr. D. Love replied 3 years ago.
In this country, age alone is not considered a contraindication to chemotherapy, although age and the expected potential survival if no cancer is present is one of the factors that is considered when deciding whether to perform chemotherapy.

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