Chemotherapy has difficult side effects, and the radiation causes a burning sensation that makes swallowing difficult. “The food won’t go down,” said Ms. Mordecai. “You just feel lazy.”
The next step is major surgery. A doctor removes most of the patient’s esophagus, with the tract going from the mouth to the stomach. He then grabs the stomach, pulls it up, and attaches it to a leftover esophageal stump.
The result is a stomach that is vertical rather than horizontal and that lacks the sphincter muscle that normally prevents stomach acid from leaking out. For the rest of their lives, patients can never lie flat – when they do, the contents of their stomach, including acid, flow down their throats. They can choke, cough, and aspirate.
Recovery is difficult and morbidity and mortality are high. But most patients do the surgery once they have weighed their options. Refusing treatment means giving up and letting the cancer close the esophagus so much that some cannot even swallow their own saliva, said Dr. Paul Helft, professor of surgery and ethicist at Indiana University School of Medicine.
The treatment is so long and harrowing that Dr. Often used to help educate medical students and other trainees about informed consent – how patients need to be fully informed before starting any given treatment. In particular, patients with esophageal cancer should be warned that they are likely to recur within the first year.
Ms. Mordecai said that her husband had an operation in late September 2008. By December 6th, he had untreatable metastases in his liver. Now, she said, the patients might have a glimmer of hope.
Dr. Ilson, who has spent his career developing therapies to help patients with esophageal cancer, said he did not expect this treatment to be successful: “We all become nihilistic after years of negative study.”
“This is really a milestone,” he added, and the drug “will set a new standard for care.”