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Looking for thoughts on 2nd recurrence of cancer
Background: Husband was diagnosed with Esophageal cancer in 2021 (T1bN0 - Grade 2). Had surgery to remove 7-8" of his esophagus with no follow up chemo or radiation at that time. First recurrence was 2 years later & was treated via endoscopy, chemo & radiation. 2nd recurrence was diagnosed 3 months ago. Doctor was only able to remove part of the tumor via endoscopy despite using 2 different procedures because it is in scar tissue and doing any more increased the risk of perforating the esophagus. Also, prior to the 1st recurrence my husband was treated for prostate cancer with both radiation and hormone therapy. He also has gastroparesis from the surgery which makes eating a sufficient quantity of food a daily challenge.
We are waiting to hear from the oncologist to discuss potential and/or recommended treatments going forward. I'm looking for thoughts/suggestions from anyone who has been in a similar situation. We don't know yet if more radiation is even a possibility or not. Has anyone had success with proton beam therapy, targeted therapy or immunotherapy in this situation?
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Initially diagnosed (7/2021) with stage 3 esophageal squamous cell cancer (ESCC) with lymph node involvement and successfully treated with Proton beam and Folfox chemo. Cancer returned in 7 weeks in two new locations (stage 4b), but not in the esophagus. Started next series of treatments (12/2021) with chemo plus immunotherapy (Opdivo). Added monthly Signatera blood biopsy testing to determine presence of the primary tumor's DNA. First (1/2022) Signatera blood draw had a score of 117, evidence of a high level of cancer DNA in my blood. By the completion of chemo/Opdivo treatments at the end of March 2022 that score dropped to "0". Continued to take Opdivo immunotherapy infusions for about 22 additional months. Four years and 3 months after the first "0" score, I'm still a "0"! Immunotherapy was the critical component for me, albeit a statistical outlier for cancer free survival. I should note that Opdivo immunotherapy was not approved by the FDA until almost the end of my first series of chemo, so it was not approved in time for my initial treatment.
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2 ReactionsThe prognosis depends on where spread is seen. If still within the esophagus... while at the anastomosis presents treatment problems (radiation may be ruled out)... more (different) chemo/immuno regimens may be tried... but a revision esophagectomy could maybe be his best bet (colon or small intestine interposition). Has a thoracic surgeon and/or the tumor board weighed in? You are at a Mayo facility... correct?
Gary
@mrgvw
Both recurrences have been in the same general area of the esophagus as the original tumor. Husband has been deemed as not a candidate for any additional surgery with agreement of the thoracic surgeon. We are still waiting for an appointment to be scheduled with oncology to discuss options/recommendations. We are with Kaiser Permanente in Oregon. They do have a group of doctors that discuss patient's situation and confer regarding treatment options/recommendations.
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1 ReactionI also am waiting. I didn’t have a second case of my cancer, but some did spread. Coming up I meet with the Radiology Oncologist to see how she wants to proceed and then my regular oncologist to begin my after surgery chemo. I was originally told I would have chemo surgery and chemo. That is their process. Just waiting to hear what path they take.
The thing I think I learned more and more is that life is not a straight line there’s all sorts of curves
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1 Reaction@jaym47, how are you and your husband doing? Did you meet with his cancer team? What is the recommendation for next steps?