Ask the Expert: Esophageal and Gastric Cancer
Introduction to Dr. A. Craig Lockhart's Q&A Session at Smart Patients
Dr. A. Craig Lockhart, an expert in gastroesophageal cancers with over 20 years of experience, recently joined the Smart Patients esophageal cancer community for an insightful Q&A session. As the Chief of Hematology/Oncology and Associate Director for Clinical Science at the Medical University of South Carolina/Hollings Cancer Center, Dr. Lockhart's focus on clinical trials and precision therapy enriches our understanding of treatment options.
During this highly engaging session, 194 members from our esophageal and gastric cancer community participated, generating 83 posts that covered the latest research, treatment options, and disease management. Dr. Lockhart provided detailed and nuanced responses, greatly appreciated by patients and caregivers alike, which empowered them with a deeper understanding of their conditions.
Participants expressed a mix of gratitude and anxiety, reflecting on their personal experiences and the complexities of managing esophageal cancer, from handling side effects to contemplating the impacts of treatments on their quality of life.
Several clear trends emerged from the patient questions:
Patients are eager to understand the reasons and latest data behind different treatment options such as CROSS, FLOT, FOLFOX, radiation, and immunotherapy, and why certain regimens are preferred.
Questions about the possibility of avoiding surgery after a complete response to initial chemo/radiation, including the criteria doctors use for this decision, with a preference for non-invasive treatments.
Emphasis on quality of life, managing side effects like neuropathy, reflux, and swallowing issues, balancing efficacy and toxicity of treatments, and criteria for stopping treatment.
Interest in advanced monitoring methods such as Signatera blood tests and interpreting biomarker trends during immunotherapy.
Curiosity regarding differences in treatment approaches across the US, Europe, and Asia.
Concerns about nutrition and maintaining weight and strength during intensive treatments.
Cancer diagnostics
See below where we explore essential questions about cancer diagnostics and the effectiveness of treatments. In this entry, we'll clarify what it means when a PET/CT scan indicates "resolved hypermetabolic metastatic disease," examine how the depth of tumor invasion can influence the likelihood of cancer spreading beyond the esophagus, and discuss the factors that determine whether surgery involves removing the esophagus or the stomach at the gastroesophageal junction.
Treatment planning
Below we address some fundamental questions about the decision-making process in esophageal cancer treatment plans. We explore the typical composition of a multidisciplinary tumor board, the factors influencing the choice of neoadjuvant treatments like CROSS, FLOT, and FOLFOX, and the use of radiation. Additionally, we discuss oncologists' flexibility in choosing treatments "off-script" from standard guidelines, including when immunotherapies or targeted therapies are considered. Finally, we touch on the commonality and implications of stopping treatments due to severe side effects and compare treatment approaches between Asia and Western countries for early-stage esophageal cancer.
Monitoring after treatment
Below we delve into the crucial aspects of monitoring and managing esophageal cancer after initial treatment. We address several key questions about the ongoing benefits of routine follow-up scans even after five years post-treatment, the risks and options for patients who choose monitoring over surgery following a complete response to chemoradiation, and the potential role of advanced blood tests like Signatera, CEA, or CA 19-9 in detecting recurrence. Additionally, we discuss treatment possibilities for limited cancer recurrence, such as solitary liver lesions, and the considerations for using surgery or radiation in such scenarios.
Managing Side Effects
Finally, here we talk about managing specific side effects experienced by esophageal cancer survivors. This post delves into the challenges of night-time reflux, strategies for its management, and preventive measures for oxaliplatin-induced neuropathy. We explore practical tips such as using Gaviscon to coat the esophagus, elevating the upper body during sleep, and dietary modifications to mitigate reflux symptoms. Additionally, we discuss the use of ice mitts and booties during chemotherapy infusions to reduce the risk of neuropathy. This guidance aims to empower patients with knowledge and strategies to manage these side effects effectively, enhancing their comfort and quality of life during and after treatment.
Conclusion
These questions and answers provide valuable information for patients and their families dealing with esophageal and gastric cancers. It is important to remember that each patient's situation is unique, and treatment decisions should be made in consultation with a healthcare provider.
Smart Patients sincerely thanks Dr. A. Craig Lockhart for joining the esophageal cancer community session. His expertise and insights have been invaluable in helping our members better understand the complex landscape of esophageal cancer and its treatment options. Dr. Lockhart’s willingness to share his knowledge and dedication to advancing cancer research and patient care have significantly enriched our community's experience.
We would also like to thank the Esophageal Cancer Action Network for their invaluable contribution and for helping our community members connect the dots between critical esophageal cancer topics and their own health journeys. ECAN’s generosity in sharing resources is greatly appreciated and will surely have a lasting impact.