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Esophageal Cancer Surgeon Advice

Old 12-30-2019, 07:47 PM
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Default Esophageal Cancer Surgeon Advice

I'm devastated by this for a very close friend. He has none of the risk factors. 60ish years old, 5'9" 175 pounds... non-smoker, non-drinker no tobacco use,

He has been a close friend for 20 years,... kids grew up together and we coached ball together with our kids.

He is getting radiation and chemo here at a very good cancer care center now... for 5 more weeks. Surgery is planned for March after the pre treatment.

Surgery seems very complicated and I want him to get a second opinion from a surgeon who specializes in this... as opposed to a general oncology surgeon here in town.

Any recs on the top surgeons/facilities for this exact procedure?

Pic of the procedure he is going to have. Going to pull his stomach up into his chest.

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Last edited by HeadHunt; 12-30-2019 at 08:00 PM.
Old 12-30-2019, 08:02 PM
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Every case is different, hard to predict outcome, could take months to heal, g-tube in the mean time? Pet scan to check for mets? Hope he does well
Old 12-30-2019, 08:12 PM
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How far is he willing to travel? Dana Farber in Mass is world class. Mass General is also very good.

Regardless I would definitely get a 2nd opinion asap
Old 12-30-2019, 08:13 PM
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Engineered treatments.

I know a guy who was in year 2+ of esophageal cancer, and nothing was working. They were running out of options, on top of the tumor was starting to press on his heart and other vitals. During all of this he was also diagnosed with prostate cancer.
The docs did a last set of radiation rounds to shrink the tumor enough to operate and remove it, similar to the surgery in the pix. During and after surgery, there were problems with his larnyx - he couldn't speak. Really down to no options other than immunotherapy.

They did immunotherapy and 8-12 month later, he is completely 100% cancer free, including the prostate cancer. Voice returned. His stamina wasn't great, but he is doing very well all things considered, and has a great prognosis.

Good luck to your friend. I would definitely investigate newer engineered treatments such as immunotherapy.
Old 12-30-2019, 08:23 PM
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Originally Posted by CAP1 View Post
Engineered treatments.

I know a guy who was in year 2+ of esophageal cancer, and nothing was working. They were running out of options, on top of the tumor was starting to press on his heart and other vitals. During all of this he was also diagnosed with prostate cancer.
The docs did a last set of radiation rounds to shrink the tumor enough to operate and remove it, similar to the surgery in the pix. During and after surgery, there were problems with his larnyx - he couldn't speak. Really down to no options other than immunotherapy.

They did immunotherapy and 8-12 month later, he is completely 100% cancer free, including the prostate cancer. Voice returned. His stamina wasn't great, but he is doing very well all things considered, and has a great prognosis.

Good luck to your friend. I would definitely investigate newer engineered treatments such as immunotherapy.
Thank You. If you can remember any more details on the therapy or clinic I would appreciate it.
Old 12-30-2019, 08:25 PM
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My friend in Ohio just found out last week he had the same. He is flying out to Newport Beach, CA. to Hoag Memorial and seeing Dr. Lipham.

I have another friend who was treated by Dr. Lipham at Hoag 5 yrs ago with stage 3 esophageal cancer and is alive and doing great. Cancer free.
Old 12-30-2019, 08:37 PM
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Originally Posted by The Kook Abides View Post
My friend in Ohio just found out last week he had the same. He is flying out to Newport Beach, CA. to Hoag Memorial and seeing Dr. Lipham.

I have another friend who was treated by Dr. Lipham at Hoag 5 yrs ago with stage 3 esophageal cancer and is alive and doing great. Cancer free.
Thank You
Old 12-30-2019, 08:39 PM
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Originally Posted by doublerunner View Post
How far is he willing to travel? Dana Farber in Mass is world class. Mass General is also very good.

Regardless I would definitely get a 2nd opinion asap
Not sure how far but for the best surgeon in this particular field I would give him my best sales pitch to go for it.
Old 12-30-2019, 08:45 PM
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Go to the nearest large academic institution for a second opinion. First question for any surgeon should be how many of these have you completed in the last 12 months. If less than 50 then move on.
Old 12-30-2019, 08:55 PM
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Also this is the route I would take - ESD procedure. This procedure does not need to remove the whole esophagus, they just remove the tumor through a scope vs surgery. They can only do this if the tumor is not all the way through the muscle wall which they can find out by doing an ultrasound on the tip of a GI scope. Many community hospitals do not have this capability (called EUS procedure). Also only a few can perform the ESD procedure if he is a candidate. I would start at Hopkins.

https://www.hopkinsmedicine.org/gast...issection.html
Old 12-30-2019, 09:01 PM
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Mayo in Rochester MN. Have him do a consultation.
Old 12-30-2019, 09:01 PM
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Second opinion with a specialist in this type of cancer.
FWIW. If I get cancer, it is time to plan for the end. I have no plans to make more $$$$ for big pharma.
Old 12-30-2019, 09:02 PM
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Originally Posted by cjlukens View Post
Also this is the route I would take - ESD procedure. This procedure does not need to remove the whole esophagus, they just remove the tumor through a scope vs surgery. They can only do this if the tumor is not all the way through the muscle wall which they can find out by doing an ultrasound on the tip of a GI scope. Many community hospitals do not have this capability (called EUS procedure). Also only a few can perform the ESD procedure if he is a candidate. I would start at Hopkins.

https://www.hopkinsmedicine.org/gast...issection.html
I saw this in my research... I'm pretty sure he is advanced stage two and not a candidate for this procedure but I will verify.
Old 12-31-2019, 08:21 AM
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Originally Posted by HeadHunt View Post
I'm devastated by this for a very close friend. He has none of the risk factors. 60ish years old, 5'9" 175 pounds... non-smoker, non-drinker no tobacco use,

He has been a close friend for 20 years,... kids grew up together and we coached ball together with our kids.

He is getting radiation and chemo here at a very good cancer care center now... for 5 more weeks. Surgery is planned for March after the pre treatment.

Surgery seems very complicated and I want him to get a second opinion from a surgeon who specializes in this... as opposed to a general oncology surgeon here in town.

Any recs on the top surgeons/facilities for this exact procedure?

Pic of the procedure he is going to have. Going to pull his stomach up into his chest.

Attachment 1109259
CJLuken made a comment about volume that is on point.

My father had the same procedure about three years ago and is doing well; however, his malignancy was caught early and by accident, and he did not require chemotherapy or radiation before the surgery. It is a long and complicated procedure, and your friend should be consulting with a major teaching hospital and surgeon that conducts many of these surgeries per month and per year. These institutions take a multi-disciplined approach to care, and there should be an entire team of physicians and nurses consulting on his case to develop his treatment plan, see him through surgery and establish a plan for follow-up and survivorship.

This is also a pretty uncommon procedure in a lot of places, and you want to make sure you have inpatient care available by a team that is familiar with the procedure and can help facilitate a faster, more comfortable recovery. For example, one of our larger, local hospitals which has a very good reputation, only sees about 12 of these cases per year. The nursing staff and in-house physicians would likely have no experience in dealing with a post-operative patient of this nature. Compare that with an institution that does 70-100 cases per year - the surgeon has established relationships with in-house staff, expectations are clear, and after surgery the patient is sent to a unit where the nurses see this case all the time. It makes a big difference in overall comfort for the patient, being able to set expectations and communicate what's "normal" after the procedure, and when dealing with potential complications.

Please PM me with specific questions, and I'll be happy to share more about my father's experience. Many of my family members are experienced health practitioners, including at the executive level. A lot of detailed research was done on this procedure and overall outcomes.
Old 12-31-2019, 09:22 AM
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Drive to the triangle and hit Duke University and UNC. Pick the one you like the most, and roll out. One of the benefits of living in central NC is 2 competing world class cancer centers. the guy that did my dads prostate surgery did the same operation on the King of Saudi Arabia.
Old 12-31-2019, 09:41 AM
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My neighbor just went through this. Ironically, he started choking on a champaign toast at a new years eve party. Felt like he was being stabbed in the neck with an ice pick. Went to the doctor and was referred to an oncologist who diagnosed esophageal cancer. He ended up going to MD Anderson in Houston for treatment. When i asked why Houston and not a local doctor he replied.... Local oncologist see maybe 2 dozens cases a year. Docs at MD Anderson see 1,000+

Good luck to your friend.
Old 12-31-2019, 10:49 AM
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Might want to read this so he can ask more questions


https://www.cancer.org/cancer/esopha...g/surgery.html
Old 12-31-2019, 11:00 AM
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I have a buddy who I grew up with who had esophagus cancer. I believe he was operated on at Hopkins and don`t know what the did but he went through hell, lost about 40#s. I have lunch with him and some of my other buddies once a month. He can`t eat much at sitting but he does OK.
Old 12-31-2019, 11:02 AM
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I went through this. After Chemo and Proton radiation I had my surgery July 2017.

I went to Pittsburgh, UPMC, James D. Luketich. https://www.upmc.com/media/experts/james-d-luketich One of the best in the field, if you elect the minimally invasive procedure. He has done more than 1500 of them.

Unfortunately for me the doc was called away for an emergency surgery, in the middle of my procedure. I ended up with a student of his doing most of the surgery, resulting in some complications.

I don't know how to prevent what happened to me, but I was assured Luketich was going to do the surgery, but in the end that didn't happen.

I'm not sure I would recommend him, based on my case, but it provides another choice for your friend to consider.
Old 12-31-2019, 11:03 AM
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Good suggestions here. The other side of the world is not too far away. Expertise, NOT locale should form the decision.

Best wishes for your friend.

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