How to manage malignant stenosis of the esophagus following stomach cancer treatment?

Hello doctor,

My mother was diagnosed with stomach cancer last year, and she got surgery to remove 85 % of her stomach, followed by chemotherapy of six cycles which she completed in the first quarter of this year. All subsequent tests and scans showed promising results with no sign of cancer.

A few months later, she started experiencing difficulty swallowing all food and water too. So a few days ago, she did an MRI and PET scan in addition to endoscopy even though the endoscopy equipment could not pass through the esophagus until a children's endoscopy device was used to see the stenosis in her esophagus.

The PET scan indicated some activity at the stenosis, and a sample of the stenosis was also taken for biopsy, showing malignancy. The doctors opted for laparotomy to remove the stenosis. Still, upon opening her up, they discovered that cancer had spread along the esophagus, and they could not remove the diseased part.

They advised us to do chemotherapy together with immunotherapy. Will this help?

Hello doctor,

Thank you for the reply.

Is that a good sign if the radiation oncologist determines that she can receive radiotherapy plus chemotherapy? Does that mean that she has a chance of getting cured? Is a combination of radiology and chemotherapy the same as immunotherapy plus chemotherapy? Which combination will be better, assuming her cancer is not too advanced?

Hello doctor,

Thank you for the reply.

My mother’s surgery report has arrived. I want to share it with you to shed more light on her situation. It is as follows;

Under general anesthesia, the abdomen is entered via a midline incision. Due to the previous surgery, bridectomies were performed, and exploration was achieved. There was no free fluid within the abdomen. Widespread implants were seen on the whole intestinal surface and mesentery as well as on all peritoneal surfaces. Implant excision was performed over the mesentery of the small intestine. The incision was enlarged towards the epigastrium to visualize the esophagojejunostomy area. The anastomosis line was seen to be fixated to the diaphragm, remaining gastric fundus, and peripheral tissues. Another implant excision was performed from the peritoneal surface of the falciform ligament for pathological sampling. The patient was accepted as inoperable and decided to open a feeding jejunostomy. The jejunostomy site was prepared from the distal part of the previous enteroenterostomy site. An 18 Fr silicone catheter was passed through the anterior abdominal wall and fixated to the jejunum. It was then fixated on the skin. Intraabdominal bleeding control was performed. The midline fascia was sutured with loop Pds. The skin was appropriately closed. Then, an IV port catheter was inserted into the subclavian vein from the right infraclavicular area. It was fixated by placing a port chamber under the skin. The port site was checked by scopy. Cutaneous suturing was made. The operation was terminated without complication.

Hello doctor,

Thank you for the reply.

Is radiation an option for us?