Category: Esophageal Cancer

At the beginning of last week, my wife had THE Surgery. The cancer was located about an inch above her stomach. Due to the chemo and radiation, the tumor shrank from 6 cm to 3 cm in height. The surgeon went 8 cm above this point to cut the esophagus. The bottom cut removed the top part of her stomach. The remaining tissue was the sewn together. Thus about 5 ½ inches of her esophagus was removed.

If you’re a fan of Forged in Fire and like the part when Doug Marcaida whacks on ballistic dummies with large swords and then states, “It will kill.” Then you might have some idea of how the incisions on my wife looked when the bandages came off. She had a vertical cut from the middle of her chest to the top of her belly button sealed by 25 fairly evenly placed staples. Not to be out done, under her right armpit she had a diagonal incision sealed by another 20 staples. Total staple count was 45.

Prior to beginning the surgery, my wife had an epidural inserted in her back, about even with her shoulder blades. She kept this anesthesia for most of her stay in the hospital. At the conclusion of surgery, she had two drain lines in her chest. One was about ½ inch in diameter and the other was about a 1/8 diameter line. She also was given a catheter. A myriad of IV solutions were given to her thru the tops of her hands. She had a handy dandy port installed about two months ago in hopes that it would be used in the surgery. Sadly, it was ignored for her entire stay in the hospital, and she came home with the bruises on her arms to prove it. She also had a drain tube entering her nose and going into her stomach to keep her stomach empty. Simultaneous with that, oxygen was being given to her via her nose.

Her vitals were monitored via various instruments as well. My wife referred to the whole group of tubes, hoses, wires, and the like as “her spaghetti”.

We arrived at the hospital at 4:45 AM on the day of the surgery. She was prepped and on her way to surgery about 7:30 AM. The surgery was completed about 1 PM. Around 3:30 PM, I caught up with her in the Intensive Care Unit. I got there just in time to hear the following questions asked of my wife:

• Do you know your name?
• What is your date of birth?
• Do you know what has happened to you?
• Do you know where you are?

After three days in ICU, my wife was moved to a regular room on the floor for surgical recovery. Two days later, the doctor authorized a leak check of her stomach. The following day, she began a liquid diet. This was the first food or water that she had had since the day prior to the surgery. The seventh day of her stay, the large drain tube and her epidural were removed (in that order).

On her eighth day in the hospital, she was authorized to be discharged. About three hours before discharge, the small drain tube was removed. I got to witness this bit of torture as about 10 inches of medical grade aquarium tubing was pulled out of her side.

Mama now has a walker to help her navigate around the house and a special pillow to hug when she coughs–which is often. When properly medicated, she does ok, and the pain is manageable. After walking for a bit, she needs to stop and catch her breath. Her lungs and stomach are still coming to terms learning to share her chest cavity.

If everything goes as scheduled, the next steps are going to happen next week, the pathology report and several doctor visits.

As always, thanks for your prayers and we’ll check in as events unfold.

The past few weeks have seen a gradual but steady improvement of my wife’s health. We were able to make another road trip to Idaho to attend to our property and see some old friends.

The hair loss that my wife has experienced after chemo and radiation has slowed. It’s thin but uniform. Sometimes it gets covered with a wrap/scarf sort of thing.

Eating food is better but she avoids spicy things and some types of menu items.

The second PET/CT scan was done about a week ago. The tumor is about 1/3 as bright as it was initially. Her SUV rating went from 18 to 6. (SUV is not a tiny Humvee driving around your innards blasting cancer cells with a microscopic .50 Cal machine gun; instead, it’s a measure of how much radioactive material accumulated in the tumor and its intensity on the scan.) This is good and the expected result of the treatment thus far. In addition, no cancer was detected elsewhere in her body during the scan.

Many days later, we did have a meeting with her oncologist. At the meeting, the oncologist said that a pathology report would be done on the tissue removed during her upcoming surgery. This is the first mention of a pathology report that I have hear from her medical team. The report would follow within two weeks of the procedure. The oncologist said that if the pathology report detects cancer cells—which is likely—then a follow-up treatment of immunotherapy would likely start in January. This also is the first admission that cancer will remain in my wife after the surgery.

It was at this point that the words of the oncologist got very close to using the “cure” word. The little yellow flags went up in my mind as I heard her say this. Such a promise is not what I have found in my reading of the literature on esophageal cancer. I can only reconcile the two opposing views as meaning that we can buy you a few years more if everything goes your way.

I have written elsewhere in this series about the surgery, so I won’t rehash that now; but I did need to get into the latest with Covid restrictions. The most important thing is that nobody with the initials M.D. after their name can tell you what the Covid testing rules are. We ended up being told to talk with the security guards at the hospital and find out.

What we learned is that there is no formal way required to prove that you had a recent Covid test. My two upcoming appointments at CVS or wherever it is, won’t get me very far. The security guys at the hospital will accept a home test if you bring it to them in the hospital. Please note this is a medical determination made by people that just might have a Red Cross First Aid certificate if you’re lucky and are probably the lowest paid folks in the hospital not changing bedpans. Also, they kept saying something about 72 hours but whether the test must be within that interval, or they only let you use it for that long; both or neither, I guess I will find out next week. Oh, I plan to have the home version of the Covid test in my car or on my person. I guess once they document my quickie test, I can trash it until I need another.

This brings up my next question which is why are face masks and Covid quickie tests just common garbage? If Covid is really so bad, then shouldn’t anything Covid related be biohazardous? Yeah, I know it’s not but if Dr. Fauci and the rest were serious then wouldn’t disposal be an important issue to prevent the spread? (Sorry I assumed for a minute that they might follow at least the easy science related to virology and contamination.)

Oh, lastly, when in the hospital, my wife is allowed one visitor per day. We are having sign-ups at our Thanksgiving celebration to let our relatives get in line. However, and isn’t there always one of those somewhere, the security folks will allow more people to visit if the nurses on her floor say that its ok. How this is communicated to the security guys was not explained. Also, minors are not allowed to see their moms in the hospital. Wanna bet it’s a Covid rule too?

Anyway, I’m thankful to have my wife and I’m glad see her doing better, even if it’s all about to be undone by the forthcoming medical procedure. Have a good Thanksgiving and expect to hear from me again after the surgery.

When we last left my wife, she was getting her potassium back into the normal band. Since then, about two more weeks have passed. She is still dealing with nausea and occasional vomiting. She is eating three small meals a day; think mashed potatoes, ice cream, oatmeal, and other fairly soft foods. In addition, she is getting saline added to her via the port about twice a week.

She says that it hurts to swallow many types of food but that it no longer is getting “stuck” on the way down. Speaking of down, she said that she is down 40 lbs. from the time of her first chemo treatment until now. Another symptom that she is now experiencing is that much of her hair has fallen out. Its not all gone but is very thin compared to what it was back in July. Ironically, the hair loss didn’t start until chemo and radiation were concluded.

In other developments, my wife wants to make a short road trip before her next PET/CT scan scheduled in mid-November. Yep, cancer patients get cabin fever too. Surgery is scheduled following Thanksgiving.

As I have previously mentioned, this procedure is not one I enjoy contemplating. It will forever change her lifestyle and maim her for the rest of her days. As a refresher, let me briefly explain the surgery.

The esophagus is about 9-10 inches (25 centimeters) long and less than an inch (2 centimeters) in diameter when relaxed. It is located just posterior to the trachea in the neck and thoracic regions of the body and passes through the esophageal hiatus of the diaphragm on its way to the stomach.

Esophagus

As previously blogged, the “height” of her tumor is 6 cm or about 2.4 inches. Per what I have read on medical websites, the upper incision of an esophagectomy is 3 inches above the top of the cancer.

If the cancer is in the lower part of the esophagus (near the stomach) or at the place where the esophagus and stomach meet (the gastroesophageal or GE junction), the surgeon will remove part of the stomach, the part of the esophagus containing the cancer, and about 3 to 4 inches (about 7.6 to 10 cm) of normal esophagus above this. Then the stomach is connected to what is left of the esophagus either high in the chest or in the neck.

Surgery for Esophageal Cancer

Ok taking the above quotations, let’s do some simple math.

We know that my wife’s cancer is in the lower third of her esophagus. Let’s say that the tumor is one inch above her stomach’s sphincter. (This is a guess and the only part of my math that is an estimate.)

Length of Esophagus (10.0”) minus distance above stomach (1.0”) minus height of tumor (2.4”) minus additional three inches (3.0”) leaves 3.6” of esophagus.

Thus, the likely outcome of the surgery is that my wife will get to keep about 1/3 of her esophagus (3.6 inches) plus, the top of her stomach will be removed. The remaining parts will then be sewn together. This surgery takes about seven hours.

Folks, the above scenario and a “successful” surgery involve many things going right and none going sideways.

I’m not sure that my wife has the stamina to take a road trip in mid-November but I’m willing to let her try. I don’t think you will hear from me again on this subject until we get the scan results. Until next time…

This week started out where the last ended and much on the same downward trajectory. Even though chemotherapy is over, we spent several hours at the infusion center on Sunday trying to get hydration and potassium into my wife. After about 3 bags of potassium solution and some saline, we headed for home; however, we did schedule a return trip the next day for more hydration. While this sounded like a good plan, Monday found a way to go off the rails.

My wife started hydration at 8 AM at the infusion center. While there, she also had a blood draw for lab work. Then shortly after 10 AM hydration was stopped, and she got her usual radiation treatment. Having completed her business at the hospital, my wife got in her car to head home only to get a call from her oncologist instructing her to check herself into the emergency room and get her potassium levels up.

At the ER, they did another blood draw for lab work. Her potassium level was in the basement. They hooked her up to an EKG machine and started pumping more potassium into her. The doctor also decided to add magnesium to the mix as well. After many hours they did another blood sample for lab work. Finally, my wife was .01 below the normal band for potassium. The doctor made her promise to fill a prescription for a potassium supplement at a local 24-hour pharmacy and take it immediately and then sent her home. She got home sometime after 7 PM. After a few minutes to refresh, we jumped into the car and set off to get the prescription filled.

The potassium supplement “tastes like the strongest orange whiskey that you can imagine. It is very salty and burns all the way down.” My wife vomited this stuff up several times over the course of the week.

Nevertheless, the remainder of the week was better for my wife. She had another IV bag of fluid on Tuesday and was feeling even better on Wednesday. She was able to eat mashed potatoes and ice cream in addition to “smoothies”. Her favorite treat this week was a concoction of ice cream and lemonade from Chick-fil-A. On Wednesday, she even broke out the Cricut Maker to craft t-shirts for the radiation crew since the next day was her last radiology treatment. This week, the radiological oncologist warned her that the full effects of the radiation treatment will not be felt for another two weeks. My wife has to take several medicines to ease the pain enough so that she can swallow anything. It hurts from the throat to her stomach and without the medicine, eating and drinking would be almost impossible.

My wife has been in good spirits this week and tried to eat several new things; however, it was not unusual for her to be unable to keep them down. The sores in her mouth have gone away.

Saturday, we had a family gathering at the house to belatedly celebrate her birthday. It was a fun time, and she did very well. For much of the gathering, it was hard to tell that she was even ill.

While this week started badly, it finished in a happy Norman Rockwell sort of way. Sunday (tomorrow) is the next blood draw and I expect that it will show improvement in her lab results.

This week started out with a bizarre but happy twist to my wife’s chemotherapy regiment. On Monday, she met with the Oncologist who informed my wife that she’s done with chemo. Our understanding of what was going to happen was upended by this announcement. So, no more pumps or all-day trips to the Infusion Center each week.

We were left wondering why? If you recall, the chemotherapy was supposed to be done concurrently with the radiation treatment. My guess is that the new chemo drug was so strong that users need to take a break before having another round of treatment. Since the next round of treatment would be after the radiation, there is no need for more.

Meanwhile, my wife is having much difficulty keeping anything down, even water. She is miserable much of the time. As a result of her treatment, she has developed sores in her mouth and pain in swallowing. As expected, her esophagus also hurts because of radiation and acid reflux. Coughing fits were common during this week. Several nausea medications were given to her along with mouth rinses and other concoctions. While not having infusion this week, my wife did go to the infusion center on Friday to get some saline because she thought she might be dehydrated.

A few times during the week, she was able to eat scrambled eggs—many of which were from the local Costco. Specifically, she likes Three Bridges Egg Bites which come in Eggs Whites with Bell Peppers and Scrambled Eggs with Cheese and Uncured Bacon. Of the two, the egg whites were her preference as the bacon bits in the other “were like little pebbles as they were going down.” By Saturday morning she was able to eat two pancakes for breakfast and about 1 ½ more for lunch. This is the most solid food she has had in about eight days.

Without a doubt, this has been the toughest week thus far. My wife even had me drive her to radiotherapy one day due to dizziness. I expect next week to be better because she only has four radiation treatments left. Then the long and probably quiet pause before we start gearing-up for surgery. The only new appointment is one with an allergist to document the reaction to whatever was in the IV bags that affected her.

Lastly, the wife is still in great spirits and clinging to the belief that she can return to the classroom in February and complete the school year. However, …

A few hours ago, I was in the midst of explaining to my son what the treatment path was for his mom once the radiotherapy is completed, when she walked into the room. When I mentioned that if the tests prior to surgery showed that the cancer has spread that there would be no surgery then she got very angry and said, “That’s not going to happen.” If nothing else, it showed us that she is not willing to opening discuss the seriousness of her cancer. Flowers and unicorns are all she wants in her world right now. In addition, saying “No” to her about making long term financial obligations has also become a thorny topic but one beyond the scope of the current post.

Week three of chemotherapy was the most difficult yet. My son and I spent the week with colds while trying to care for our cancer patient. We did the home Covid test twice and it was negative—not that we could have done much about it anyway. Junior got to return to school about the time I started suffering from the cold symptoms.

Monday saw us do a two-hour procedure to install a port into my wife’s chest. The entire thing is under her skin and seems to take a path from its endpoint to somewhere near her heart. It is painful and uncomfortable. There is much bruising from this being done to her. Less that 24 hours after installing it, it was being used at the infusion center.

The infusion day was the longest yet. My wife had yet another allergic reaction to a whole different family of drugs. As it turns out, my wife is allergic to a secondary chemical used to keep the medicine suspended in the IV bag. I have heard it also referred to as a preservative. Anyway, this stuff is also a major component of the Covid 19 vaccines. Thus, my wife is medically excused by the CDC from getting the Covid jab.

As an aside, if my wife did get the Covid shot and died—which we now know would happen, the CDC would not classify her death as related to the vaccine because any death within two weeks of getting the shot doesn’t count under their methodology. So next time they claim to be “following the science” you can know yet another reason it’s a lie from the swamp.

Anyway, the infusion time was about 8 to 8 ½ hours for the first chemo drug. We also came home with a portable pump in a fanny pack. My wife is expected to pump this stuff 2.5 ml per hour for 96 hours. The pump uses those rectangular 9-volt batteries; one at a time. We learned this because they sent us home with two spares. We are currently on the second spare, and I had to dig up one of my own in garage just in case it quits at 1 AM like it did last night. Saturday night at 5 PM we can get the pump, hose, and needle assemble removed until the next infusion day. I can’t imagine having the same needle sticking in your chest for over four days while getting dressed and undressed, taking a shower, eating, sleeping, etc.

Meanwhile the radiation is affecting her ability to eat and drink. Even liquids are painful to swallow. The radiological oncologist says that this is expected and said it might get easier in another week. We will see.

Between the chemotherapy and radiation, this week has been the most difficult. My wife even had to ask for help to get to her radiology appointment yesterday. Today was better and she went on her own. Nausea and occasional vomiting and the medication to prevent them have been a big part of this week. Two more weeks to go until this phase of treatment is done.

Chemotherapy week two has been an epic failure. (Is it just me, or do you think of Aaron Park whenever someone uses that term?) Anyway, after five and a half hours at the hospital’s Infusion Center, session two was cancelled by the doctor. Again, my wife had an allergic reaction to the chemo drug even though they gave her three different drugs to prevent any reaction prior to beginning the introduction of the main drug. She was given no more than a fourth of the solution. We were sent home with orders that the doctor would be contacting us the next day.

Some here at the blog wonder if my wife’s reaction is related to the fact that she is a Trump loving Republican that is being given a known poison called “tax all” via an IV. Clearly many Democrats in California are addicted to this stuff. As you might expect, “tax all” was the easy path. One that has now been denied to us as we learned from the doctor the following day.

In reality, my wife ended up speaking with the doctor twice the following day. It looks like the new treatment will be Cisplatin and 5-fluorouracil (5-FU).

If I have this right, Cisplatin will be given weekly at the Infusion Clinic and the fluorouracil will be administered at home over a series of days via a pump connected to a port. Yep, we get to do self-administered chemotherapy for the next three weeks. What could possibly go wrong?

This treatment requires that my wife has a “port” installed.

Your healthcare provider’s decision to recommend a port may depend on several things. Some chemotherapy medications can only be given through a port because they are too caustic to be delivered into a peripheral vein.

Beyond that, using a port is often easier than inserting an IV each time if you will be having several infusions of chemotherapy.

Chemotherapy Ports Benefits and Risks

The port may be placed on your upper chest or occasionally your upper arm. It is then attached to a catheter tube that is threaded into one of the large veins near your neck, such as the subclavian vein or jugular vein, and ends near the top of your heart.

Oh, while all this is happening, the radiation therapy continues, and its effects are starting to manifest.

Lastly, Really Right junior has come home from school with a runny nose, sore throat, and cough. As a precaution, we told him to start the over-the-counter Covid symptom reduction stuff that we bought at the local pharmacy. We bought the stuff just in case something like this happened.

Week three is coming fast and looks to be a bumpy ride.

This week marked the beginning of chemotherapy and radiation treatments for my wife. She still maintains that her treatment will result in being cured and that come sometime in February, she will be able to resume her life.

Let me break this down in a little more detail.

First, chemotherapy is being used because leeches are like so Middle Ages. Chemotherapy is the purposeful injection of poison into your body that works much like the theory of the game “chicken”. You hope the “bad” cells are killed before the “good” ones. Depending on the dosage and frequency of treatment this may or may not work. However, it turns out, your body and immune system take a beating. Oh, to get your body to tolerate the chemo drugs, they give you other stuff before and after.

Radiation is more of the same. It is trying to concentrate a lethal dose of this unseen killer at a particular point or points in the body. As mentioned in a previous installment, the radiated tissue must be removed in a window five to ten weeks after “treatment” ends. Also, they forget to remind you that all the tissue which the radiation passes thru to get to the cancer takes a beating as well. The military would call this collateral damage but guys in white lab coats call it medicine.

Oh, my wife’s new basis for claiming that she will be cured is that the doctor filled out her initial disability application and said that the soonest that she could return to work would be February 2022. In her mind this means that she will be cured by February. Is this an example of childlike faith or utter delusion? I think the latter. In my opinion, my wife’s optimism is that of a five-year-old aspiring to be the next Disney Princess. This may be cute when looking at five-year-old children but in adults its disturbing.

As to the actual treatment. We were at the hospital for just over seven hours for the first round of chemo instead of the expected two and a half to three hours. My wife had a reaction to the drug, and it took much longer than advertised. After a few hours at home, she had a horrible headache and was not allowed to take any medication for the pain. (The following day she was told Tylenol would be ok to take.) In addition, while she has no fever, it looks like she spent 14 hours in the sun yesterday as her skin is a very bright shade of red; especially her face.

Two days later, my wife is lethargic and had some nausea. There is a prescription for that if she remembers to take it. She also spent a few hours in bed but was unable to nap so she opted to read a book.

The treatment train has left the station. I plan to post another update in about a week as we travel thru this journey.

Treatment is finally scheduled. I should be happy about that but…

We finally have a start date for chemo and radiation in mid-September. The radiation is the heavy lifter in this treatment plan and the chemo is supposed to make the radiation more successful. This is penciled -in for five weeks. This will be followed by four to six weeks of waiting and then will be followed by surgery. Said surgery is just in time for the beginning of the holidays. And then everything is all better, or so my wife claims.  (She keeps using variations of the word, “cured”.)

Folks, if having esophageal cancer was really this easy, then why are half of all patients diagnosed with this cancer, dead within 13 to 18 months of diagnosis? I guess in polite company we don’t ask, and they won’t volunteer it.

For those willing to listen, the talk with the radiologist was measured and cautious. No, “you probably won’t get burns on your skin” and “your hair probably won’t fall out”. Then the comment about “if you’re healthy enough, you can have surgery.”

Of course, the treatment is to shrink to tumor and then allow for surgery. “Yes, radiation shrinks the tumor, but you may develop sores in your esophagus that prevent you from eating what you want.”

The chemo/radiation treatments will decimate my wife’s immune system and necessitates locking down all household members in a manner that sounds suspiciously like the two weeks to flatten the curve nonsense inflicted on us during the spring of 2020. However, unlike then, wipes and toilet paper are easily obtainable. During this time, our son gets to go to school and back, while I’m the designated grocery shopper. My wife is expected to lose 20 to 25 pounds during this period of time and that’s without the doctor knowing that I will be the designated cook for much of this time.

As for the surgery, my wife has it in her head that it will be laparoscopic in nature and over in a short period of time. Color me skeptical. We will know in a few days when we meet with the surgeon.

Update after meeting with the surgeon.

The surgeon says the procedure must be performed between five to ten weeks after the end of the radiation treatments. Five weeks is to allow the presence and effects of chemo to dissipate and probably allow the immune system to recover slightly. The ten-week limit is due to the fact that irradiated tissue will become scare tissue making the success of the surgical procedure unlikely.

Now for the procedure itself. Here are some quotes related to what is scheduled to happen.

Surgery to remove some or most of the esophagus is called an esophagectomy. If the cancer has not yet spread far beyond the esophagus, removing the esophagus (and nearby lymph nodes) may cure the cancer. Unfortunately, most esophageal cancers are not found early enough for doctors to cure them with surgery.

Often a small part of the stomach is removed as well. The upper part of the esophagus is then connected to the remaining part of the stomach. Part of the stomach is pulled up into the chest or neck to become the new esophagus.

How much of the esophagus is removed depends upon the stage of the tumor and where it’s located:

If the cancer is in the lower part of the esophagus (near the stomach) or at the place where the esophagus and stomach meet (the gastroesophageal or GE junction), the surgeon will remove part of the stomach, the part of the esophagus containing the cancer, and about 3 to 4 inches (about 7.6 to 10 cm) of normal esophagus above this. Then the stomach is connected to what is left of the esophagus either high in the chest or in the neck.

Surgery for Esophageal Cancer

The surgeon described the procedure as a transthoracic esophagectomy. This method is also known as the Ivor Lewis Esophagectomy. The technique was originally developed in 1946.

A transthoracic esophagectomy, also known as an Ivor Lewis esophagectomy, is a procedure in which part of the esophagus is removed. During this surgery, small incisions are made in the chest and another is made on the abdomen. The cancerous portion of the esophagus is removed, along with the surrounding lymph nodes and a small margin of healthy tissue above and below the tumor. The stomach is made into a cylinder, pulled up into the chest and connected to the remaining section of the esophagus.

Transthoracic (Ivor Lewis) Esophagectomy

Illustrations of the procedure can be found at Technique of Open Ivor Lewis Esophagectomy. Please read descriptions of the various drawings to get a better idea of the procedure.

Pre-Surgical Complications

The surgery has a few points of deciding go or no-go on going thru with the procedure.

Is patient physically able to undergo the surgery after the pounding their body endures from the chemo and radiation?

Does the presurgical PET scan show any spread of the cancer since patient has had the chemo and radiation treatment?

Surgical Complications

When surgery begins, following the incision into the chest and stomach area, the doctor does a visual inspection of tissues surrounding the cancerous area. If cancer has spread, then the surgery is aborted before it proceeds further.

The operation begins with an esophagoscopy to confirm the extent of tumor. On opening the abdomen, the right gastroepiploic artery is palpated and its fitness as the blood supply for the gastric conduit is confirmed. Abdominal exploration should confirm absence of liver metastases, extensive nodal disease, omental metastases, etc.

Technique of Open Ivor Lewis Esophagectomy

Post-Surgical Complications

Comparison of complications reported in a recent series is hindered by the lack of uniform definitions of complications, the nonreporting of events, and the mixture of surgical approaches in some of the reports. The incidence of pneumonia has varied from 8% to 26%. Anastomotic leak has been detected in 3% to 8%. Mortality has varied between 1.4% and 10%. It is also known that esophagectomy is a procedure that is affected by hospital and surgeon volumes.

The surgeon said that a hospital stay of 7 or more days was common. Per reading that I have done, some post operative complication is likely. Per the American Cancer Society, here are likely risks:

• Short-term risks include reactions to anesthesia, more bleeding than expected, blood clots in the lungs or elsewhere, and infections. Most people will have at least some pain after the operation, which can usually be helped with pain medicines.
• Lung complications are common. Pneumonia may develop, leading to a longer hospital stay, and sometimes even death.
• Some people might have voice changes after the surgery.
• There may be a leak at the place where the stomach (or intestine) is connected to the esophagus, which might require another operation to fix. This is not as common as it used to be because of improvements in surgical techniques.
• Strictures (narrowing) can form where the esophagus is surgically connected to the stomach, which can cause problems swallowing for some patients. To relieve this symptom, these strictures can be expanded during an upper endoscopy procedure.
• After surgery, the stomach may empty too slowly because the nerves that cause it to contract can be damaged by surgery. This can sometimes lead to frequent nausea and vomiting.
• After surgery, bile and stomach contents can back up into the esophagus because the ring-shaped muscle that normally keeps them inside the stomach (the lower esophageal sphincter) is often removed or changed by the surgery. This can cause symptoms such as heartburn. Sometimes antacids or motility drugs can help these symptoms.

Conclusion … for now.

Now that I have described what lies ahead, I have a few closing comments.

My wife continues to display signs that the cancer is still growing. She has more difficulty swallowing than a few weeks ago and each night she is now afflicted with lots of acid reflux after going to bed. She believes (and based on what I see, I agree) that her stomach is no longer sealing, (sphincter muscle is no longer closing her stomach). She believes that her tumor is preventing this system from working correctly.

I will update you further as we progress thru this treatment. I still remain pessimistic, but as I am but a spectator in the drama, which is about to unfold, my opinion is of limited value.