How would you manage dysphagia and odynophagia in an otherwise healthy patient with newly diagnosed metastatic esophageal cancer with a large primary in the mid to distal esophagus?
Depending on patient goals of care, in an otherwise healthy patient starting with chemo to address both the esophageal cancer causing dysphagia as well as the systemic disease is also our preferred plan as well, with analgesics as needed for the odynophagia. Along with dietary modifications perhaps ...
This is a question that comes up frequently and has different answers depending on the context. In general, patients tend to tolerate stents in the distal esophagus poorly. That is because this typically requires the lower esophageal sphincter to be stented open, causing terrible acid reflux. In thi...
Here at our institution, we just completed a 10-patient pilot study of upfront cryotherapy before chemoradiotherapy. The publication is forthcoming. It was a safety study, and 0% had any complications. Almost all patients had significant symptom relief, but for many this was only transient. Nonethel...
We tend to place a J-tube and start the patient on FLOT chemotherapy. Often the tumor regresses adequately to take oral hydration and nutrition after the 2nd cycle. Here is the FLOT regimen from ASCO this year: