Chemotherapy has difficult side effects, and radiation causes an irritation that makes it difficult to swallow. “The food won’t go down,” Ms Mordecai said. “You just feel rotten.”
The next stage is major surgery. A doctor pulls out most of the patient’s esophagus, which leads from the mouth to the abdomen, and then grabs the abdomen and pulls it up, attaching it to a stump of the esophagus left behind.
The result is a stomach that is vertical, not horizontal, and lacks the sphincter muscle that normally prevents stomach acid from spreading out. For the rest of their lives, patients can never lie down – if they do, the contents of their stomach, including acids, are put into their throats. They can suffocate, cough and aspirate.
Recovery is difficult, and morbidity and mortality are high. But most patients opt out of their options once during the operation. Refusing treatment means quitting cancer and shutting down the cancer in a situation where some cannot swallow their own saliva, Drs. Said Paul Haleft, a professor of surgery and a politician at Indiana University School of Medicine.
The treatment is so long and annoying that Dr. Halft often uses it to teach medical students and other trainees about informed consent – how patients should be fully informed before beginning any treatment. Esophageal cancer patients in particular should be told that they are likely to recur within the first year.
Ms Mordecai said that her husband had surgery in late September 2008. As of 6 December, he had untreated metastasis in the liver. Now, she said, patients can get a glimpse of hope.
Dr. Ilson, who has spent his career developing treatments to help patients with esophageal cancer, said he did not expect this treatment to be successful: “We all become nihilistic when faced with years of negative studies . “
“This is truly a historical paper,” he said, and medicine “will become a new standard of care.”