serious heart surgery then stomach cancer - please help

 Has anyone ever heard of a person having triple by-pass surgery and then six months later being diagnosed with stomach cancer.  I can't find any information on how this would impact on a medical treatment plan or prognosis.   This is my first post and I am still in shock so sorry if this is rambling.

 I do not live near my parents but we are a very close family and we talk a few times a week and visit about 4 times a year. In the past six months my dad had triple by pass heart surgery.  When my husband (who is a doctor) was ill llast month my mum and dad visited. I was pleased to see how well my Dad had recovered from the surgery but I was concerned that he was restricting his diet so much and not doing any of the exercises.  I also noticed he was still sleeping a lot and that he got exhausted doing a simple errand. I did not for one second think he had stomach cancer. 

Last week he was admitted to hospital for a bleeding ulcer and had lost a lot of blood.  He had a blood transfusion and when I spoke to him said he felt a million dollars and was almost running around the hospital with energy.  Therefore, to then be told 3 days later that he had stomach cancer was a complete shock.  My mum is still in such shock that she decided not to tell anyone in the family.  The only reason I know is because my husband is a doctor and I was challenging what I was being told because it didn't fit with their explanation.  she is still not telling me everything she knows.  I respect, particularly in these early days, their right to restrict who and what they tell people but not the decisions they are taking as they don't appear to be informed decisions.

I can't find any information on whether the fact he had heart surgery and is diabetic is why he the Oncologist has decided to refer him to surgery next week to remove 'part of his stomach' and see if it has spread anywhere.  It is 4 cm and located at the top of the stomach. He is 71 and Eastern European. There has been no discussion by his treating doctors of chemotherapy or other therapies - only of removing part of his stomach, having a look around and that the prognosis is 'very serious'. 

I am worried they have so little information (or are not telling me) to be making decisions.  There is no treatment plan. They are just being told what to do and not being presented with any other options such as chemo or radition.  English is not my father's first language and whilst very proficient in it even my mum thinks he only understands about 90% of what is going on.  He is also very 'old school' in that you do what the doctors tell you to do. 

I have so many questions but am isolated with parents who won't tell me much, will not allow me to speak to the doctors or even tell my siblings and I don't want to disturb them by asking questions they clearly don't want the answers to yet.  They just want to spend a week together absorbing the news and enjoying themselves alone. From what I have read this is a horrible incidious cancer. This is selfish but I accept he is gong to die but I am primarily concerned with his quality of life. It's not my decision but I don't want his life extended at the expense of quality of life.  I don't want treatment just because it exists and he has good private health insurance.  I want to travel with them whilst he is well enough rather than rushing into removing his stomach without any treatment plan or explanation of why other adjunct therapies have not been considered or what after care is required.

It has been very helpful reading these postings.  I am in Australia so if anyone knows of any trials etc please let me know.

 

I am sorry to hear about your father.  I am attaching my wife's history to this message as it contains alot of information for you.  I would be concerned that they are recommending surgery PRIOR to diagnostic testing in order to establish where it may be.  In my wifes case, there were differing opinions on whether surgery was appropriate and we decided against it once it had been established as Stage IV.  My wife continues in good health today.  As for the complicating factor of his heart surgery, I do not know how that affects his options.

Good Luck!

My 43 year old spouse was diagnosed with Stage IV in March of 07.  She initially presented with acute pain at her GI Junction that was relieved with over the counter prilosec and diet modification; however, we were not satisfied that the pain was simply caused by reflux and demanded an endoscopy which identified the stomach cancer.  The news got worse as further scans revealed a single tumor in her liver; they were 3cm and 4cm respectively. Wow, moving from Stage I to Stage IV sure did not take long.

She immediately started on ECF (Epirubicin, Cisplatin, and 5FU) and after four rounds (each three weeks long) the tumors were no longer detectable on scans and she was classified as being in remission.  After many second (and third and fourth) opinions it was decided not to do surgery in her case and she continued on ECF for another two months.  She experienced nausea with these treatment but a drug called Emend worked really well to decrease the symptoms. 

Post her initial round of treatments the scans were still clear and we changed her chemo regimen to Oxaliplatin and Xeloda (initially 5,000mg/day but quickly reduced to 4,000mg/day); she continued on this regimen for another 4 months before switching to just 5FU delivered every two week through her port (she was on this for the next 4 months). 

After more than a year of chemo, our oncologist suggested a break and to 'see what happens,' however our second and third opinions disagreed and she started again on Xeloda (also known as capecitabine) which she takes orally.  Unfortunately about 8 months into her treatments she developed a blood clot on her pancreas and had to start on coumadin - this was not a problem until we switched back to Xeloda which cannot be combined with coumadin so now we inject her daily with a lovenox type drug (this drug cost a pretty penny).

So here we are, two years plus post diagnosis and she remains on chemo with the advice of multiple oncologists (from Dana Farber, Sloan Kettering, Yale New Haven, and Columbia) all suggesting that she basically stay on a chemo treatment for as long as her body can tolerate it.

Through it all she has completed her Master's in early childhood education, received her teachers certificate and started back to work fulltime.  She remains in good health, has lost no weight and is motivated to continue the battle.  Initially she did have some nausea but a drug called emend took care of that, lost her hair (and has now grown it back and she used a good quality wig which helped her deal with it), lost layers of skin on her feet (this grew back to), lost some sensation in her hands and feet (feeling came back but not to where it was prior to seeking treatment).  As important as anything, her attitude has remained strong with a confidence that she can BEAT IT.  So far she has.  Praying hasn’t hurt her any either. 

That is her story so far.  She is very lucky as we caught it early and have had access to multiple professional opinions from leading cancer centers.  Also, that my mother in law (her mom) is an organizational wiz and we all have color coded binders with every test, every scan, every physician note, and every step of her treatment – this is a MUST HAVE to keep track of it all and be able to present the entire case study to physicians for their opinions (they will only be as good as the information they have to review). There are other success stories on this site.  We continue to take it a day at a time.  Since August of 07 we have had no signs of the cancer returning and sincerely hope it never does.

I hope this information helps: 

Mar 07  - Diagnosed with Stage IV (two tumors stomach 3cm – liver 3-4cm)

Apr 07  - Starts Chemo ECF (Epirubicin, Cisplatin, and 5FU

Aug 07 - Scans clear, continues ECF

Oct 07  - Changes to Oxaliplatin and Xeloda (xeloda is pill form of 5FU)

Nov 08 – Scans clear, continues Oxaliplatin and Xeloda

Mar 08  - Switches to just 5FU (delivered through port)

Aug 08 – Switches to just Xeloda (oral chemo); scans clear

Aug 09 - Remains on Xeloda; scans clear

 

STEVE (aka momwithkids)

 

Linda-mary, I had extensive discussions with my oncologist and surgical oncologist consultation from Sloan Kettering, one of the most famous cancer hospitals on the east coast of USA and I would take the recommendations for your father as very very good news. Surgery is a treatment plan. Surgery is the only hope for a "cure" -- chemo and/or radiation can be done after the surgery to "mop up" cancer cells that remain. If your father is young enough healthy enough and cancer is small and self-contained-appearing enough, surgery would be the best option for the first step from what I understand. I WISH I was a candidate for surgery, but I am not. It would not appear to me that the diabetes or heart surgery is related to this decision at all, it would appear that the decision for stomach surgery is related to the size and progression of the stomach cancer itself. Also, gastric oncologists and gastric surgical oncologists have all said to me that the only way to really see what is going on in terms of cancer inside the body to open up the body and see it. Scans can only show so much, and size that is detectible on scan is not very small either My impression from what I've been told is for the doctor to see for him or herself as much preferred for better treatment. Jeanne

On 9/26/2009 Linda-mary wrote:

 Has anyone ever heard of a person having triple by-pass surgery and then six months later being diagnosed with stomach cancer.  I can't find any information on how this would impact on a medical treatment plan or prognosis.   This is my first post and I am still in shock so sorry if this is rambling.

 I do not live near my parents but we are a very close family and we talk a few times a week and visit about 4 times a year. In the past six months my dad had triple by pass heart surgery.  When my husband (who is a doctor) was ill llast month my mum and dad visited. I was pleased to see how well my Dad had recovered from the surgery but I was concerned that he was restricting his diet so much and not doing any of the exercises.  I also noticed he was still sleeping a lot and that he got exhausted doing a simple errand. I did not for one second think he had stomach cancer. 

Last week he was admitted to hospital for a bleeding ulcer and had lost a lot of blood.  He had a blood transfusion and when I spoke to him said he felt a million dollars and was almost running around the hospital with energy.  Therefore, to then be told 3 days later that he had stomach cancer was a complete shock.  My mum is still in such shock that she decided not to tell anyone in the family.  The only reason I know is because my husband is a doctor and I was challenging what I was being told because it didn't fit with their explanation.  she is still not telling me everything she knows.  I respect, particularly in these early days, their right to restrict who and what they tell people but not the decisions they are taking as they don't appear to be informed decisions.

I can't find any information on whether the fact he had heart surgery and is diabetic is why he the Oncologist has decided to refer him to surgery next week to remove 'part of his stomach' and see if it has spread anywhere.  It is 4 cm and located at the top of the stomach. He is 71 and Eastern European. There has been no discussion by his treating doctors of chemotherapy or other therapies - only of removing part of his stomach, having a look around and that the prognosis is 'very serious'. 

I am worried they have so little information (or are not telling me) to be making decisions.  There is no treatment plan. They are just being told what to do and not being presented with any other options such as chemo or radition.  English is not my father's first language and whilst very proficient in it even my mum thinks he only understands about 90% of what is going on.  He is also very 'old school' in that you do what the doctors tell you to do. 

I have so many questions but am isolated with parents who won't tell me much, will not allow me to speak to the doctors or even tell my siblings and I don't want to disturb them by asking questions they clearly don't want the answers to yet.  They just want to spend a week together absorbing the news and enjoying themselves alone. From what I have read this is a horrible incidious cancer. This is selfish but I accept he is gong to die but I am primarily concerned with his quality of life. It's not my decision but I don't want his life extended at the expense of quality of life.  I don't want treatment just because it exists and he has good private health insurance.  I want to travel with them whilst he is well enough rather than rushing into removing his stomach without any treatment plan or explanation of why other adjunct therapies have not been considered or what after care is required.

It has been very helpful reading these postings.  I am in Australia so if anyone knows of any trials etc please let me know.