Dear Dr. Roach: After seeing many specialists, I received the diagnosis of esophageal cancer T4b N2. The PET scan shows thickening of the lower esophagus of 4.1 cm in diameter and local nodal disease, but no distant metastatic disease. They say I am not a candidate for surgery, and chemo and radiation are the only treatments. I have had five days of chemo with a pump 24/7. I have suffered this past week with mouth and throat sores, making it very hard to talk, eat and drink. One week from today, I begin seven weeks of radiation, and then more cycles of chemo.
I have asked numerous questions of my doctors and get vague answers as to my chances of beating this. I have been told that this treatment is aggressive and will be rough. They tell me I will have damage to my esophagus, lungs and spine. The oncologist says I am stage 3B. What, in your professional opinion, are my chances?
I want to know the likelihood of a cure. I have an 88-year-old mother with dementia. I am an聽only child, so her well-being and care is my sole responsibility. I had hoped I would outlive her so she could stay in her home as long as possible. Having said that, I聽will be truthful: It makes me very nervous to know my chances of survival.
Anon.
I am very sorry to hear of your diagnosis, and hope I will be able to help.
Your doctors are vague because physicians are not very good at making these predictions. Our 鈥渃rystal balls鈥� are cloudy, and they can be biased by our desire to be optimistic. However, there is聽some information I can give you, but I also will discuss its limitations.
First off, the treatment for esophageal cancer is improving, and newer treatments are associated with better prognosis. The聽statistics I am giving you are聽from studies more than 10聽years old now, but they are the best available, so it鈥檚 likely your prognosis is likely to be somewhat better.
I can give you the answer in two ways. The first is to say that roughly 10 to 20 per cent of people with your stage cancer will be alive in five years, and we generally say that five years represents a 鈥渃ure,鈥� since it is likely that all cancer will be gone in people who survive so long. The second way is聽to say that the median survival is 15 months, meaning half of people with your stage esophageal cancer will live longer than 15聽months, and half will not. These are both accurate statements, as best we know.
It鈥檚 important to recognize that there are outliers. Some people will succumb quickly, within a few months, whereas one person in five will be able to successfully overcome the cancer.
Because of聽this uncertainty, it聽would be wise to make plans for聽your elderly mother in case things don鈥檛 go聽well, which may聽give you some peace of mind and confidence to spend your energy on getting through the treatments to try to cure the cancer, or at least give you as much time as possible. I truly wish you the best with this difficult diagnosis.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
