Treatment
Treatment plan development
Based on clinical experience and the guidelines of the National Comprehensive Cancer Network (NCCN) and the European Society of Medical Oncology (ESMO), the physician recommends chemotherapy followed by a decision on further surgical treatment based on the outcome assessment.
Together with the medical records of the two visits, the doctor found that Mr. Sun had a good mental, dietary, and sleep status, normal bowel movements, and no significant changes in weight since the onset of the disease; although he had a history of hypertension for more than 20 years, he had been taking the antihypertensive drug coxsartan potassium, and his blood pressure was controlled at about 120/70 mmHg. history of blood transfusion, etc. This suggests that he is physically able to tolerate chemotherapy and surgery.
However, Mr. Sun is a 40 year-old “old drinker” and “old smoker” who loves to drink liquor, averaging 2 or 2 per day, but has been sober for 3 years, and has been a smoker for 40 years, averaging 20 cigarettes per day, and started quitting 2 weeks ago. The doctor told him that although he had quit drinking for many years and was aware of the need to quit smoking, a history of smoking and drinking still increases the incidence of complications from chemotherapy and surgery. Smoking alone can classify the postoperative lung function risk assessment from low risk directly to high risk or contraindication to surgery. Therefore, smoking cessation and alcohol abstinence should be continued, and a series of pre-treatment tests should be completed, including hematologic tests (e.g., routine blood, biochemistry, coagulation, infection screening, tumor markers, etc.), pulmonary function, electrocardiogram, echocardiogram, and vascular ultrasound.
Treatment history
Mr. Sun underwent 2 weeks of chemotherapy with paclitaxel + cisplatin with only minor side effects. On chest CT evaluation, the mass was reduced to some degree and was ready for the next step of surgery.
After completing a series of preoperative tests, Mr. Sun underwent a lumpectomy with three incisions for esophageal cancer under general anesthesia (known medically as the “right open-chest McKeown procedure”). The surgeon made several “keyhole” sized incisions on the surface of his body, and then performed a lumpectomy to remove the cancer, remove the lymph nodes, create a “tubular stomach”, and anastomose the remaining esophagus. The company’s main goal is to provide the best possible service to its customers.
After surgery, the surgeon immediately sent the excised specimen to the pathology department, and the final result was: hypofractionated squamous carcinoma of the lower thoracic segment of the esophagus, invading the lamina propria of the mucosa, with a pathological stage of ⅢB stage.
This stage is often referred to as “mid to late stage”, and postoperative “adjuvant chemotherapy” is usually needed to “hunt down” any remaining cancer cells in the body and consolidate the therapeutic effect. The treatment effect should be consolidated. The company’s main goal is to provide the best possible service to its customers. This time, Mr. Sun continued to experience only mild side effects and was successfully discharged from the hospital after treatment.
Follow-up exam
For 2 years after surgery, Mr. Sun came to the hospital every 3 months for a follow-up examination. In the third year, follow-up visits were changed to every 6 months. He had hematology, ultrasound, CT, and intermittent PET-CT review at each review. As of now, he is in good health with no recurrence or metastasis.
Summary
From Mr. Sun’s case, we can see that neoadjuvant chemotherapy before surgery is like a “first strike” against the tumor to reduce the size of the lesion, reduce the risk of micro-metastasis, and achieve a reduced tumor stage, thus reducing the risk of distant metastasis after surgery. The first step is to reduce the risk of distant metastases and improve the therapeutic effect of surgery and long-term survival rate.
After surgery, depending on the final pathology report and the patient’s physical condition, postoperative “adjuvant” therapy can be chosen to eliminate as many tumors as possible that have “escaped” to other lymph nodes or invaded the esophageal lining, reducing the risk of recurrence.
Disclaimer:
Tumors are extremely complex and treatment options are highly individualized, and this case does not represent a treatment decision for a “similar patient. Please seek professional advice from a competent physician regarding your specific treatment plan.