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Dean was diagnosed with esophageal cancer the end of June. This all started with his dermatologist realizing Dean was anemic and after eventually having an endoscopy and colonoscopy, the cancer was discovered.
We met withDr. Knox, the oncologist, on 7/3/18, and she said the scans looked really good. Cancer has not spread, not in any lymph nodes nor in the bones. Those scans cannot, however, show them how deep into the lining of the esophagus the cancer has gone. To figure this out, they need have a Gastroenterologist do an endoscopic ultrasound. He will be able to determine whether the cancer is just in the lining (and fairly easy to remove) or if it’s deeper, and Dean would have to have a more involved surgery to remove part of the esophagus.
Dr. Knox mentioned several times what EXCELLENT health Dean was in, and that with most 89 year olds, they wouldn’t even be discussing any of these options. She also said that even with a healthy 89 year old, once you start “poking around,” it can really cause them to age quickly. Sometimes they do chemotherapy before surgery, but again because of his age, they’ve found that can cause them to fail quite quickly and then be too weak for surgery. Esophageal surgery is apparently quite difficult and dangerous. There is only 1 surgeon in Lincoln and 1 in Omaha that does this type of surgery. Dean was then scheduled for an endoscopic ultrasound on 7/17/18.
After the ultrasound, Dr. Bowman that Dean's tumor was a much more limited type of tumor than he usually sees. The rating scale for tumors is T1, T2, T3 or T4. T stands for tumor. T1 is the tumor is not adhered at all. T2 is is it slightly adhered (growing into the muscle) but not through the muscle. He would rate Dean’s a T1b since it’s between 1 & 2, so it was caught very early.
Then we met with the cancer navigator, Lisa. She will be a resource throughout this entire process to answer any questions we have and give tips on patient care. She said the #1 concern right now is nutrition. The cancer is taking Dean’s nutrition, so he needs to eat about many small meals during the day.
Of course, everyone is amazed with Dean. The cancer navigator refused to believe he was 89!
On 7/23/18, we met with the surgeon, Dr. Oberlding. He was wonderful and seemingly had all the time in the world to visit with us. He said “Dean’s case proves challenging but nothing is off the table.” With any other 89 year old, he would say not to do anything, but Dean is in pretty darn good shape.
The only curative treatment for esophageal cancer is surgery, and they wouldn’t know all the risks until they get in there especially because of Dean’s past surgery, but he thinks he has a good shot especially because of a new device he is now using called the Davinici Robot which allows him to do the entire surgery with 4-5 small incisions and get up into the esophagus with much more precision. He did later say, though, that he would have to be joined by a thoracic surgeon in the surgery, and he may need to make a large incision. The two things that are very hard to work around in this surgery are the liver and the aorta (hence the thoracic surgeon.)
They would remove 10 centimeters of the esophagus and while Dean was still in surgery, they would have that area tested to see if they need to remove more. This type of cancer tends to spread along the esophagus instead of outside of it, but the problem is that you can’t actually “see” the cancer. The surgery would take 4-5 hours and require a 5-8 day hospital stay. You have the normal risks associated with any surgery but also the risk of a “leak” from where they reattach the esophagus to the stomach once they pull the stomach up.
Almost all of these cases are treated with chemo/radiation and then surgery, but in this case he would recommend surgery first since you don’t know how much the chemo would take out of him. They don’t really have numbers on how well people do with no surgery & just chemo/radiation because most don’t do it that way.
Dr. Oberlding will present this to a cancer panel of 12 doctors in the morning (which also includes Dean’s oncologist) to get their opinions, but he said he would be pushing for surgery. But, he wanted to be upfront and say that life won’t be the same after surgery. His stomach will be VERY small after surgery, so he’ll need to eat 6 small meals a day. His esophagus sphincter will be gone so no eating/drinking within 3 hours of lying down, and he’d always need to be elevated. He also will not be able to bend down to tie his shoes afterwards because the contents of his stomach will come up.
On July 24th, Dr Oberlding called after the cancer panel. They are recommending NO surgery because of Dean’s previous trauma (bull, tree.) They’re just afraid of the scar tissue they’ll find when they get in there. They are recommending chemo/radiation. On July 27th, Dean had his port put in.
On July 31st, Dean met with Dr. Knox to get his Chemo education and 1st Chemo treatment. They plan to give him 3 treatments, (possibly 4), scheduled every 2 weeks. At the end of the Chemo treatments, he'll have another ultrasound scope done by Dr. Bowman to determine how much the tumor has shrunk. If it's dwindled to the size they want, then he'll have a radiation treatment with Dr. Chu where a radioactive endoscopic probe is put into his esophagus to irradiate and "zap" what's left of the tumor. The Doctors all feel this is the best opportunity to minimize and hopefully get rid of the cancer without having to resort to surgery. Dr. Knox was honest in sharing that they don't really have solid statistics on this kind of a plan since the vast majority of the cases all opt for surgery, (which Dean just wasn't a good candidate for because of his "run-ins" with Steer and Tree). Still, she was very positive that we'd have a good prognosis after this treatment because of how early they had caught the cancer.
The first treatment went well and Dean didn't have any immediate adverse reaction. Typically, with this treatment, the patients are very sensitive to cold and have nausea and diarrhea. Dean had just a bit of the third, but no nausea yet, and even had a milkshake on the way home yesterday. It sounds like he's starting to be a bit more sensitive to cold this morning and mentioned some "hot flashes". As Dean says, "I've gone through a lot in my life, but I never thought I'd have to go through menopause!" Dean's spirits remain good but he's "tired of being tired".