Chemotherapy has difficult side effects, and the radiation causes a burning sensation that makes it difficult to swallow. “The food will not go down,” Ms. Mordecai said. “You just feel rotten. “
The next step is major surgery. A doctor removes most of the patient’s esophagus, the tract leading from the mouth to the stomach, then grabs the stomach and pulls it upward, attaching it to an esophagus stump left behind.
The result is a stomach that is vertical, not horizontal, and lacks the sphincter muscle that normally prevents stomach acid from spilling out. For the rest of their lives, patients can never lay flat – if they do, their stomach contents, including acid, flow down their throats. They can choke, cough, and suck.
Recovery is difficult and morbidity and mortality are high. But most patients have the operation after weighing their options. Refusing treatment means giving up and letting the cancer close the esophagus to the point that some cannot even swallow their own saliva, said Dr. Paul Helft, professor of surgery and ethicist at Indiana University School of Medicine.
The treatment is so long and painful that Dr Helft often uses it to teach medical students and other trainees about informed consent – how patients should be fully informed before starting a given treatment. Patients with esophageal cancer in particular should be informed that they are at risk of recurrence within the first year.
Ms Mordecai said her husband had surgery at the end of September 2008. On December 6, he had intractable metastases to his liver. Now, she says, patients can have a silver lining.
Dr Ilson, who has spent his career trying to develop therapies to help patients with esophageal cancer, said he didn’t expect this treatment to be successful: “We all become nihilists in the face of years of negative studies.
“This is truly a historic document,” he added, and the drug “will become a new standard of care.”