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Cancer Gastro esophagus junction

Q: My Father is the patient Age 67. Disease: Cancer Type : Gastro esophagus junction Operation: esophagectomy Feb-2001 Chemotherapy : 8 cycles completed. Cisplatin for first 4 cycles. Tumor reappeared.Complaints of Stomatch irritation + too much fatigue + nervous weakness reported. Administered Mitotax 250. Responded well in the beginning but at the end of 8th cycle , tumor reappears. Endoscopy could not be completed as the tumor abstructed the camera tube. Admitted for vomitting blood in small quantities. As even half a glass of water cannot go inside,the intestine was punctured and a plastic tube runs from outside for administering food. I understand from Doctors attending that as and when his general health improves he can be given radiation. As of now, since 2 MONTHS,he is very weak. Will always be sleeping on bed (except for toilet).Semi solid food is being administered only through the pipe. There is no sign of any improvement in his weakness. Vomitting is very frequent and painfull. In vomitt, little amout of bile juice (+ blood stains) are seenThis is matter of worry for all the family members.We want radiation to be given , but his general health is not improving at all. My questions are as follows: 1) Do U agree with the radiation being planned for now at this situation? 2) What are the chances of zeroing in on the tumors? 3) What is his life expectancy? 4) Any new medicines / methodologies? 5) What are the other options open in this regard?

A:1. It appears that the primary tumor was at the gastro-esophagealjunction. This is usually (but not always) an adenocarcinoma. Theaseadeno-carcinomas are not usually responsive to radiation therapy. So thedecision about radio-therapy depends on what the pathology of the resectedtumor showed. 2. I am not sure what this question means. 3. Limited to months not years on an AVERAGE. Some patients may live longer. 4. See answer to question 5 5. I would consider placement endoscopically of a stent if this is feasible. This will improve his quality of life and allow him to take something by mouth. However, this procedure will not do anything to the tumor itself. I think at this stage it is more important to consider improving quality of life rather than only prolonging life (which may mean more suffering).


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