1. < Esophageal Cancer

On long term dialysis, diagnosed with Stage 1/2 oesophageal cancer

Posted by asapienlessordinary @asapienlessordinary, Jan 9 12:03am

I have been on dialysis for 27 years now. During my workup for a kidney transplant, they found a polyp in the GE junction. A biopsy and a Contrast enhanced CT scan revealed a malignant tumour. A PET CT revealed this was early stage and not spread anywhere else. I have portal hypertension and a liver with severe fibrosis due to Hepatitis C which was treated after 12 years with the disease in 2017.

The doctors are considering 3 options:

1. Endoscopic removal - They are planning an Endoscopic Ultrasound to determine the feasibility of removing the tumour endoscopically.

2. Immunotherapy - They have asked the lab to check the biopsy sample for MMR which will let them know the chance of success of Immunotherapy.

3. Surgical removal - Last option as the surgery can be complicated with a lot of bleeding due to the liver issue. Liver decompensation is also a risk with this.

I was wondering if there was anyone here who had a similar problem and what they did and how did it turn out? Anyone on dialysis and a liver issue and oesophageal cancer?

Thanks so much!

Interested in more discussions like this? Go to the Esophageal Cancer Support Group.

mrgvw | @mrgvw | Jan 9 8:25am

Not being an oncologist or a thoracic surgeon to be capable of weighing your comorbidities against your recent EC dx... I can't really say.

But... in general... even if only stage 1 or 2... whether going thru chemotherapy and radiation first (as I did)... having the esophagectomy is the odds on favorite of never seeing your cancer again (I had this too, plus a year of immunotherapy). If left alone... no doubt it will kill you. I can't say whether that means in 6 months or two years... but it will grow... spread... and it will win. That's why, in general, our tumor boards do what gives us our best chance of survival. Now which is the more pressing issue for you... and which are even possible... the kidney transplant or the esophagectomy or some lesser ablation technique... I'm not sure.

Should ESD or EMR be possible for your stage of cancer... that would surely buy you time. And if it recurs, will most likely stay within the esophagus... with treatments to then begin... or an esophagectomy be done a year or two from now. Could it spread by then... when a recurrence is seen... and you be deemed stage 4 now? Yes, a possibility... but maybe not a probability. And I have no clue, in your current state, what chemoradiation treatments would do to your insides. Seek other opinions if possible. I'm guessing you are not in America.

On Sunday, Jan 19th, at 9am Eastern (2pm in the UK)... we're having a renowned Mayo thoracic surgeon on our free Zoom calls... to talk about esophagectomy surgery. She's no longer with Mayo Rochester and has moved back to Texas (Baylor)... but she's something special! Maybe you come talk to her on our call. She takes on very difficult EC cases... from a surgical standpoint. Let me know and I'll send you the one-touch Zoom link. And 27 years on dialysis... holy cow... is that a world record? How old are you?

Gary

REPLY
1 reply
v132077 | @v132077 | Jan 10 10:22am

Wow. 27 years on Dialysis. Has it all been Hemodialyses, or some Peritoneal Dialysis. My wife did Peritoneal while waiting for a transplant, and Hemodialysis after the surgery and the transplant failed because of an infection from the surgery.
Good Luck with the EC battle. I was diagnosed in 2019 and went through 7 chemo treatments and 32 radiation treatments and then surgery.

REPLY
1 reply
asapienlessordinary | @asapienlessordinary | Feb 1 8:06pm

Thanks for the responses. Sorry for the delay in reading these messages and getting back. Here's an update: they did an ESD on the 27th of January. Only about 75% of the tumour was removed becasue there was severe bleeding from the varices that I had (from an old liver issue). They put a stent and had to withdraw. They plan to do an endoscopy on Wednesday, 5th February to assess and then take a call on the next steps.

I am from India. Too bad I missed the call with the Mayo surgeon.

The doctors say they will decide if attempting to remove the remaining 25% of the tumour would be safe or they should opt for some chemo to try and clear out the remaining.

I got tested for Mismatch Repair protein status in the biopsied tissue. It came back negative. They plan to test for PLD-1 and TMB apart from HER2/Neu. Are these tests that will help determine if Immunotherapy will have a better chance to work?

Thanks for responding to my questions!

REPLY
1 reply
asapienlessordinary | @asapienlessordinary | Feb 2 5:06am
In reply to @v132077 "Wow. 27 years on Dialysis. Has it all been Hemodialyses, or some Peritoneal Dialysis. My wife..." + (show)
@v132077

Wow. 27 years on Dialysis. Has it all been Hemodialyses, or some Peritoneal Dialysis. My wife did Peritoneal while waiting for a transplant, and Hemodialysis after the surgery and the transplant failed because of an infection from the surgery.
Good Luck with the EC battle. I was diagnosed in 2019 and went through 7 chemo treatments and 32 radiation treatments and then surgery.

Jump to this post

Mostly Hemodialysis. 6 years on Peritoneal.

REPLY
asapienlessordinary | @asapienlessordinary | Feb 2 5:07am
In reply to @mrgvw "Not being an oncologist or a thoracic surgeon to be capable of weighing your comorbidities against..." + (show)
@mrgvw

Not being an oncologist or a thoracic surgeon to be capable of weighing your comorbidities against your recent EC dx... I can't really say.

But... in general... even if only stage 1 or 2... whether going thru chemotherapy and radiation first (as I did)... having the esophagectomy is the odds on favorite of never seeing your cancer again (I had this too, plus a year of immunotherapy). If left alone... no doubt it will kill you. I can't say whether that means in 6 months or two years... but it will grow... spread... and it will win. That's why, in general, our tumor boards do what gives us our best chance of survival. Now which is the more pressing issue for you... and which are even possible... the kidney transplant or the esophagectomy or some lesser ablation technique... I'm not sure.

Should ESD or EMR be possible for your stage of cancer... that would surely buy you time. And if it recurs, will most likely stay within the esophagus... with treatments to then begin... or an esophagectomy be done a year or two from now. Could it spread by then... when a recurrence is seen... and you be deemed stage 4 now? Yes, a possibility... but maybe not a probability. And I have no clue, in your current state, what chemoradiation treatments would do to your insides. Seek other opinions if possible. I'm guessing you are not in America.

On Sunday, Jan 19th, at 9am Eastern (2pm in the UK)... we're having a renowned Mayo thoracic surgeon on our free Zoom calls... to talk about esophagectomy surgery. She's no longer with Mayo Rochester and has moved back to Texas (Baylor)... but she's something special! Maybe you come talk to her on our call. She takes on very difficult EC cases... from a surgical standpoint. Let me know and I'll send you the one-touch Zoom link. And 27 years on dialysis... holy cow... is that a world record? How old are you?

Gary

Jump to this post

I am 49 years old

REPLY
mrgvw | @mrgvw | Feb 2 6:56am
In reply to @asapienlessordinary "Thanks for the responses. Sorry for the delay in reading these messages and getting back. Here's..." + (show)
@asapienlessordinary

Thanks for the responses. Sorry for the delay in reading these messages and getting back. Here's an update: they did an ESD on the 27th of January. Only about 75% of the tumour was removed becasue there was severe bleeding from the varices that I had (from an old liver issue). They put a stent and had to withdraw. They plan to do an endoscopy on Wednesday, 5th February to assess and then take a call on the next steps.

I am from India. Too bad I missed the call with the Mayo surgeon.

The doctors say they will decide if attempting to remove the remaining 25% of the tumour would be safe or they should opt for some chemo to try and clear out the remaining.

I got tested for Mismatch Repair protein status in the biopsied tissue. It came back negative. They plan to test for PLD-1 and TMB apart from HER2/Neu. Are these tests that will help determine if Immunotherapy will have a better chance to work?

Thanks for responding to my questions!

Jump to this post

I've talked with a few from India before. Our call times never change... our next Zoom call starts in about 1 hour... 6am for me in California... but 7:30pm for you. These are our Sunday calls. Our Wednesday calls are 3pm for me, but 4:30am for you (Thursday). Our Zoom codes are:

ID - 455 028 4795
Passcode - tuiBE5

Be well. You are so young... oh my. We have thoughts about your ESD procedure as well as ability to start treatments... but curious as to what you've been told as to factoring in with your comorbidities.

Gary

REPLY
asapienlessordinary | @asapienlessordinary | Feb 2 10:06pm

Oh I saw your message only now - about 15 hours after you posted. I will try to join the one next Sunday. Thanks Gary!

REPLY
asapienlessordinary | @asapienlessordinary | Mar 21 6:40am

Hello!
An update on my situation. The doctors believe it is too risky (life-threatening) to attempt another ESD to remove the tumour. They have asked me to explore other options. I met my oncologist and he suggested we start radiation. Luckily, there is a hospital with an MR LINAC machine in my city and I registered for treatment there. They did a CT scan and an MRI and also prepared the mould.

I am scheduled to begin on Monday (24th March).

I was wondering if anyone here underwent radiation therapy on an MR LINAC machine? I did feel a little uneasy during the MRI and also during a trial run on the MR LINAC machine. The ceiling of the bore was very close to my face and I couldn't wait for it to finish.

I am just nervous I have to undergo this 5 times a week for the next 5-6 weeks. Any tips on how you coped with this?

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