esophageal cancer doubt for my father

Greetings!

My father has undergone CT chest and the report reveals:

1. multiple discrete homogenous enlarged pretracheal & paratracheal lymphnodes are seen. largest measuring 24x12mm

2. there is short segment asymmetric mural thickening involving the mid esophagus over a segment of 2.8cm. maximum mural thickness measures 11mm. fat planes with surrounding structures is preserved.

3. rest all organs ans systems are fine.

but the radiologist says that the impression of carcinoma esophagus.

Earlier to this, his barium x-ray revealed irregular filling defect and endoscopy revealed mild ulceration, but not from inside the esophagus. So the doctors did not go for biopsy at that time.

Symptoms: he doesn’t have any other symptoms except that when he eats, he feels the food passes through esophagus while touching its lining. No pain. No appetite or weight loss.

Latest: samples have been taken for biopsy through endoscopy. But the doc is convinced of a cancerous growth.

Request if someone can please help me know;

1. Does this indicate esophageal carcinoma?

2. If yes, what possible stage we can predict before confirmatory tests?

3. Is there a possibility of Benign tumor?

4. Can this be only because of infection (possibly bacterial infection)?

5. What can be the possible confirmation tests apart from biopsy?

6. Any possibility of complete removal and no reoccurrence?

Regards,

 

Your asking a lot of questions covering a lot of ground.  And I'm not sure anyone can answer all without further testing.  I would think a PET/CT scan would be in order as this would show cancer activity, if present.

 Also, IF the lymph glands are involved from CA of the esophagus, it might seem to indicate a stage 3 cancer which means it has grown through the wall of the esophagus.  The fact that nothing was commented on for the liver or other abdominal organs MIGHT indicate it has not reached stage 4.   But I wouldn't rely on anyone's response here for action.  It's fine to get informed... as a matter of fact, it's imperative, but you need to be pressing for further more direct testing.  I suppose a bx would be hepful, but biopsy of what?  The esophagus?... the lymph nodes?  IMHO, a PET scan would be helpful.

God speed.

Begging your pardon for NOT completely reading your posting before responding the first time. 

Re-reading, I see that the endoscopy didn't reveal a tumor but, rather, ulceration.  To me this might seem to be a good sign.  My endoscopy demonstrated a clear adenocarcinoma that was biopsied at that time for confirmation.  This, coupled with 'hot' activity in a lymph node shown on the PET/CT scan led to my stage 3 diagnosis.

You may be looking at a different, hopefully better, outcome given that the endoscopy didn't show tumor.

What symptoms led him to have the CT workup?

 

On 9/3/2009 iluvlinda wrote:

Begging your pardon for NOT completely reading your posting before responding the first time. 

Re-reading, I see that the endoscopy didn't reveal a tumor but, rather, ulceration.  To me this might seem to be a good sign.  My endoscopy demonstrated a clear adenocarcinoma that was biopsied at that time for confirmation.  This, coupled with 'hot' activity in a lymph node shown on the PET/CT scan led to my stage 3 diagnosis.

You may be looking at a different, hopefully better, outcome given that the endoscopy didn't show tumor.

What symptoms led him to have the CT workup?

Hello,

Thanks a lot for your response!!

I'll reiterate the steps for you:

1. my father appeared with a symptom of swallowin problem (which was that he felt the food passes down by touching the esophageal wall - no pain) 

2. Barium x-ray was done- it showed irregular filing defect and possibly malignant etiology

3. Doctor suggested Endoscopy - which revealed ulcerated infiltration of about 3cm in area in mid esophagus.

3. before biopsy doc suggested for CT scan - which revealed

a. multiple discrete homogenous enlarged pretracheal & paratracheal lymphnodes are seen. largest measuring 24x12mm

b. there is short segment asymmetric mural thickening involving the mid esophagus over a segment of 2.8cm. maximum mural thickness measures 11mm. fat planes with surrounding structures is preserved.

c. rest all organs ans systems are fine.

even the CT scan report din't say carcinoma as confirmation but with a question mark.

Now all these indicated towards possible carcinoma. so biopsy samples have been taken. we expect report by monday.

I agree with you that we shall wait for the biopsy results and a confirmation, but I wanted to utilise the time byt finding out more about this and possible cure or treatment options - that we may have. This will help us save time and start the treatment as soon as we get the results.

can you please share your experience and case for my knowledge? I wish you are fine and having a good time!!

I pray, not to get a carcinoma positive report!!

Sincere Regards,

 

Hope your Dad's biopsy is negative. A CT cannot determine if there is carcinoma or not, and will never positively determine that. They only state impressions. Only a biopsy can positively tell you whether there are cancer cells present in the tissue. The CT is generally used to look for signs of metastasis to other organs to help with staging. A PET or PET/CT shows metabolic activity and there is generally a lot of that at a cancerous site, but even PET can miss things which have diffused through the body. PET/CT overlays the CT and PET films so they can see masses over a certain size on CT and can see if there is metabolic activity at the site for a more accurate idea as to whether or not the mass is cancerous. If it is cancer, it could be squamous cell cancer or adenocarcinoma, and that would also be determined by the biopsy. It is generally adenocarcinoma at the junction with the stomach and seems to be squamous more frequently when it is higher up, but until it biopsies no one can say for sure. My husband's gastroenterolgist was sure it was EC the day he scoped him, and told us he would not believe the biopsy report if it came back negative but the mass was large enough to block the opening to his stomach, so they may be able to tell up to a point but generally wait for confirmation. He had been complaining to his PCP for months so the gastro was in a major rush to get him staged and into treatment. It had metastasized to his lungs and lymph nodes, but after chemo and radiation cleared up the lung mets and esophageal mass, he was scheduled for surgery. His next PET/CT is in about 2 weeks, and he is heading towards a 4 year anniversary from dx in less than 3 months. There have been good and bad times, as the lung mets have come and gone a few times but we will fight it again if need be. He was 49 and in good health otherwise when diagnosed.

I am praying that you get a "negative" no cancer report.  However, if it is positive, it sounds like it is in the very early stages.  There are some wonderful laser treatments to treat Barretts esophagus and early stage carcenomas of the esophagus.  Let's hope that Monday all your fears will be relieved and you will have some answeres.

Hello All, Thank you so much for your responses! I received my father's biopsy report today nd it is positive for carcinoma. it says "moderately differentiated non keratinising squamous cell carcinoma" we will consult the doc tomoro and will try to decide the course of action asap. as far as it looks to me he is having either late stage 1 or stage 2. is this is so, then we can go for surgery first and then chemo/radio. do you agree with this? or you have any other suggestions? Sincere Regards,

You are definitely asking a lot of very specific questions, that's for sure.  I can tell you my husband had an accidental finding of his EC by a biopsy that was done through an EGD.  This was because his symptoms resembled a hiatal hernia with the pressure in his chest and swallowing though feeling like his food got hung up somewhere.

His had already metastasized so they called it EC, stage 4, mets to the liver.  They followed up the EGD by doing a CAT scan that showed the mets in the liver.  They said it was inoperable.  That was the last of March this year.  Since then he has gone through six cycles of chemo and now I'm going to take him for a second opinion to the Fred Hutchinson Center in Seattle.  A second CAT scan said that the thickening that was in the esophagus had shrunk and that all the mets in the liver or what they were seeing in the liver had shrunk or were no longer detected.  This could not be confirmed to be either cancer scar or active cancer without a biopsy.

We want the second opinion to see if now that everything has shrunk is there hope for a partial resection of the liver to get rid of what residual may be there and perhaps extend his life and improve quality. 

You do need to get the proper staging of your father's disease however, so you too, can proceed with whatever steps you might want to take.  I don't think you can get the answers to all your questions without a lot more steps being taken first. 

I would definitely suggest a second opinion, and don't be afraid to ask your physician all these questions.  They are perfectly normal questions and you and your father have a right to know exactly what is going on so you can make good decisions for his future.  Quite often cancer goes into remission so don't give up hope.  Just keep fighting the battle and he must also. 

Good luck,

Pam