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Oncology (General Cancer)/esophageal and salivary gland cancers

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Hello Dr. Higby,
My husband began having difficulty swallowing and lost 40 pounds before he would agree to see a doctor about the problem.  He had an esophageal dilation with a biopsy that was benign.  He needed to have these dilations about every three weeks for two months and then the doctor repeated the biopsy. The last biopsy taken from the distal esophagus showed adenocarcinoma.  
My husband developed a firm lump below his jaw during the weeks he was having the dilations.  His oncologist said we should put this lump on the back-burner since it was painless and deal with it after treatment for the esophageal cancer was completed.
My husband had chemo/radiation therapies and then had a transhiatial esophagectomy with partial gastrectomy. The surgeon removed and biopsied thirty lymph nodes and only one lymph node showed malignant cells.  
After he healed from this surgery, he saw an ENT physician because the lump below his jaw was bigger and uncomfortable.  A pre-op needle biopsy did not show any malignancy but when the surgeon removed the submandibular salivary gland and mass, the biopsies taken during surgery showed "the same kind of cancer that was in your esophagus".
I do not know if this cancer was only in the gland/mass or also in lymph nodes. I believe the surgeon said he removed two lymph nodes along with the salivary gland.
My husband was declared cancer-free after the esophagectomy.  We were completely dismayed and frightened to find out that he had cancer in the salivary gland, also.
Now I am worried about all the nausea and abdominal pain my husband has been having for the past three weeks.  The doctors attribute these symptoms to either unexplained vasovagal episodes or dumping syndrome but I am worried that he may also have stomach cancer.  I have checked his finger-stick blood sugar during the nausea/pain episodes and it is always normal so I have doubts that he is having dumping syndrome. Also, the nausea and abdominal pain is not always associated with eating. Sometimes it lasts all day. He is losing weight again after having gained 15 pounds post-surgery.
We have an appointment to see his oncologist in a week.  My husband does not think he will agree to any more radiology or chemo because he was so very sick from the last chemo/radiation therapy.
From what I've been able to tell you, what do you think his prognosis might be?  Is submandibular salivary gland adenocarcinoma easy to cure?  
Also, we are wondering how the cancer spread from the distal esophagus to the salivary gland. Could you tell us how?
Thank you for your time and for your help.
Deborah

Answer
If the salivary gland mass is made up of the same kind of cancer cells from the esophageal cancer, then he was stage IV at the time the esophageal cancer was discovered.  We would normally do a PET scan before embarking on radical treatment for esophageal cancer, and had that been done the salivary mass might have been discovered before the treatment.  "There are many reasons he might be losing weight and having abdominal symptoms, including dumping, scar tissue, recurrent tumor, or even changes in the neural network of the GI tract.  At this point I'd advise a PET/CT scan of the abdomen, looking for recurrence.  If not, he should have some physiologic tests to see what happens when he is given oral contrast material (does his stomach empty abnormally) Finally, if both are not helpful, he should be managed as best as possible medically, and hope that over time things will improve.  Keep me posted.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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