Down to Business - Treatment Programme

We both enjoyed going out last night even though it was only an early one!

I treated myself to a glass of beer, but didn't even drink it.  I must be ill!  I haven't been told not to drink, though I just don't feel like it and am also keen to keep my immune system as "tip top" as it can be.  I've drunk 3 glasses of wine (and, after last night, half a glass of beer since my original visit to the doctor's on 30th December)

Anyway, now it is down to the serious stuff.  My appointment with the Chief Oncologist a week on Monday and the likely commencement of treatment soon after means that I have to consider the issues.

The clinical trial that is available to me is a randomised trial.  If I enter it then there is still a 50% chance that I will receive the standard treatement.  The standard treatment (ECX) is represented by the left hand side of the chart shown below.  The trialled drug approach is represented by the right hand side of the chart (ECX + B)

The key components and the flow of the chart are simple

• 3 cycles of 3 weeks of chemotherapy
• 5-6 week recovery
• Surgery
• 6-10 weeks recovery
• 3 cycles of 3 weeks of chemotherapy
• A further 6 applications of the additional drug at 3 week intervals

Click on the chart to see it in a separate window, as it is too small in this window.  Use your browser back button to return to the main page.




So, the first phase of treatment is chemotherapy.  The chart shows 3 cycles of 3 weeks of chemotherapy but this could be extended up to 6 cycles if it is felt that the size of the tumour requires it.  That decision will be based upon the results of the endoscopic ultrasound that I will be having on 19th March.

Before we take a look at chemotherapy let's be honest; nobody would choose to undergo chemotherapy unless there was another option.  However, given the choice between probable death and chemotherapy it doesn't seem so bad at all.  These things are relative.

The list of potential and severe side effects seems endless but I have spoken to people who have experienced it and for them it has been a tolerable experience.

Chemotherapy is a single word that describes a number of different treatments for a number of different cancers.  It is typically a combination of different drugs.  The ECX referred to in the chart is a combination of 3 different drugs Epirubicin, Cisplatin and Capecitabine (also known as Xeloda).  This is the "Gold Standard" treatment of my condition (adenocarcinoma at the junction of the oesophagus and stomach).

Note that you do have to be careful when gleening information from the internet.  The Wikipedia article seems to suggest that large ardenocarcinoma tumours of the oesophagus are not operable.  It does state that they can become operable after chemotherapy and radiotherapy but the suggestion is that it is palliative care rather that a direct healing path that is the treatment route and I now know tha t to be misleading and the outlook brighter.

The bottom line is that I would benefit enormously from a reduction in tumour size.  The way I see it is simple - the less tumour there is after chemotherapy the less of my oesophagus and stomach has to be removed and the better my chance of a successful operation and of "shaking off" the cancer.  This viewpoint is influential in forming my view of the trial.

If I have the standard treatment then the diagram shows that the span is likely to be 34 weeks whereas the treatment involving the administration of the trial drug takes a full year.