Esophageal Cancer 101: In 850 Words or Less

 

 

by Terry Ratner, RN, MFA

 
…..in the seventh month, on the tenth of the month, you shall starve your vital energies and do no manner of work…. For on this day it shall bring atonement upon you, to purify you, before God shall you become pure of all your aberrations. (Leviticus) 16: 29-30)

 

A day to remember

 

It was a Thursday, October 9—Yom Kippur, Day of Atonement, the most solemn day on the Hebrew calendar, when my husband, Michael, underwent an endoscopic procedure. He laughed the day before when the doctor said, “Nothing to eat or drink before the test. Can you manage that?” Michael smiled as if he had a secret. “I always fast during the high holidays and this one isn’t going to be any different.”

 

On the Day of Atonement, we went to synagogue for the morning service. Michael’s procedure was scheduled for 12:45 PM. “Perfect timing,” he said stroking his two day whisker growth. “I’m able to immerse myself in prayer and in between undergo a medical test before returning to temple and breaking the fast.”

 

For thirty long minutes, I sat in the outpatient waiting area, looking around at the starkly decorated walls, half listening to the conversation between two receptionists as they talked about restaurants and dating, wondering how everything happened so fast. I noticed his mild symptoms four days ago: some difficulty swallowing, a dry cough when drinking liquids, a slight hoarseness, and an early feeling of fullness while eating a meal. A variety of diagnosis crossed my mind; hiatal hernia, a narrowing of the esophagus, or perhaps a nerve involvement. As a nurse, my imagination went wild.

 

On October 8th, our internist had scheduled Michael for a barium swallow and US (ultrasound) of his abdomen which showed a suspicious area at the bottom of his esophagus. The gastroenterologist urged him to undergo the endoscopy the next day—that was my second hint that something was very wrong. I wondered what all the hurry was about. I tried to stay calm, but my stomach felt skittish, light, like it was being forced up to my neck and then down into my chest cavity.

 

A nurse holding a clip board poked her head out the double doors. “You can come back now, Mrs. Ratner,” she said without looking up at me. “Your husband’s in recovery.” I asked her how it went and suddenly this friendly preop nurse didn’t want to talk. “The doctor will be out shortly to explain his findings,” she said without looking me in the eye.

 

The Diagnosis

 

“Your husband has a tumor at the junction of the stomach and the esophagus. I sent several biopsies to pathology. It looks like cancer.”

 

Being a nurse, it wasn’t necessary for any further explanation to understand the doctor was saying the unspeakable—telling me my husband has cancer, a fast growing cancer in the esophagus. My head started to spin and my legs felt like rubber as I tried to keep them from shifting side to side.

 

“Maybe you need to sit down and discuss this,” I replied as I stared at the doctor’s white coat focusing on his last name embroidered in black thread above the pocket. I glanced at my husband’s face; his eyes were closed and he looked relaxed for the first time since his symptoms began to surface—six days ago. His body lay hidden under a cream-colored blanket and I wondered if he heard the word, “cancer.” I needed to let him rest for a while and not worry about anything, as there would be plenty of time to agonize in the weeks to come.

 

The talk

 

The gastroenterologist had biopsied enough tissue from the tumor site to feel confident about his diagnosis of esophageal cancer. “The pathology report will be her in a couple of days,” he told me, giving me a slim hope that he might be mistaken.

 

“This is not a good time,” came out of my mouth as I began to sob. “There never is a good time for this type of diagnosis,” he told me with compassionate eyes. I must have asked him three times, “What is the size of the tumor?” His response was a number I won’t likely forget—2.5 centimeters.

 

I drove my groggy husband home. He asked me a few questions about the procedure and told him we’d talk later and he needed to rest. The truth was I didn’t want to tell him what I knew, what the doctor had told me. When he woke from a short nap, he refused any food or water even after I assured him God would permit it under the circumstances. But instead he waited until sundown to break the fast, after the evening service with a few slices of Challah, some herring, and a glass of wine.

 

My husband I lived with a secret for the weekend—Michael had esophageal cancer. It was one of those secrets I chose to keep to myself until we had a definitive diagnosis. We played word games Saturday and Sunday, never once uttering the unspeakable word—cancer. Our lips formed the words tumor, swallowing disorder, and hiatus hernia, but we shied away from the ‘C’ word.

 

We continued to pray throughout the weekend, long after the evening service, long after the Sabbath, long after the Kol Nidrei and the Yizkor, in an attempt to elevate our spiritual being and thwart away this vile disease.

 

The pathology report came back on that Monday. When the gastroenterologist phoned me at home, I already knew what he was about to say—our life, as we knew it, was about to change.

 

Risk Factors:

 

 

GERD ( gastroesophageal acid reflux)

Alcohol Consumption

Cigarette Smoking

Chewing Tobacco

Barrett Esophagus (patients with chronic reflux should undergo regular endoscopic exams and biopsies).

 

Signs & Symptoms

 

Difficulty swallowing

Substernal pain

Hiccups

Respiratory difficulty,

Heartburn, halitosis,

Significant weight loss (a later sign)

Hoarseness

Halitosis

Coughing

Excessive salivation

Nocturnal aspiration

 

Send your comments to info@terryratner.com

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About TRatner

Terry Ratner is a freelance writer, registered nurse, and writing instructor in Phoenix, Arizona. In June of 2004, she graduated with a Master of Fine Arts degree in creative nonfiction from Antioch University, Los Angeles. Writing has always served a purpose in her life, but it wasn't until her son died in a motorcycle accident in March, 1999, that she began to publish her works. What's unique about Terry is the way she balances the life of a nurse with the life of a writer. "Nursing allows me to give back to the community and then write about those experiences." Ratner teaches creative writing in a variety of settings from community colleges to a school for homeless children (Thomas J. Pappas) to wellness communities throughout the Valley of the Sun. In 2004, Terry launched an Arts and Healing program for children undergoing dialysis at Banner Good Samaritan Medical Center. She has published numerous personal essays, cover stories, interviews, and book reviews for a variety of national and regional publications. Her manuscript, a work in progress, features a series of twelve essays, ten of which are introduced with black and white photos, dealing with issues of family and identity.
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4 Responses to Esophageal Cancer 101: In 850 Words or Less

  1. Joanne Dean says:

    Very sad and I bet it is hard to relive this story.
    Joanne

  2. Terri says:

    Your story and all of your stories are captivating. I wish you would write more.

  3. Sharon says:

    My husband died last month at age 46 from stage 4 rare liver cancer. I was looking for something to give me some relief from the pain, maybe some other women who are in the same situation who i can share my feelings with. Everything i read here so far sounds too familiar. Every detail of the process. I dont know if it will bring me any comfort but i can identify with every word.

  4. Barbara Foster says:

    Terry, Your writing on EC 101 is so similar to my dear husband’s case history. Mike, age 67, 50 year history of smoking 1 pack per day, non-drinker, had undiagnosed GERD for years before I married him in 2000. I had worked with Oncology Dr’s for many years as a Cancer Registrar and attended many Cancer Conferences. I knew the details of most primary cancers.

    So I made him see his Dr. about his night time regurgitations. Endoscopy showed Barrett’s so he was on a 6 mos recheck schedule and omeprazole bid. The EGD schedule was relaxed to yearly. Stable for 15 years! In Oct. 2014 his EGD was still OK. No Barrett’s but now looking back I do see that it said chronic esophagitis.

    In July of 2015 Mike was having some back pain that he couldn’t find a reason to explain it. He also had symptoms of excessive belching after meals. More than just a normal guy thing. He had to belch in order to be comfortable and I looked up symptoms of “sour” burps post-prandial.

    Back to the Drs. and they thought gallbladder…..sent to endoscopy Dr…..who has scoped him for 15 years and he even said all signs pointed to gallbladder with back pain/burps. So he had his gallbladder out in Aug. 2015.

    He still had back pain. Surgeon said could be esophageal spasms and discharged him.
    Went to Chiro for back pain, no help, went to orthopod Dr…..they did lateral spine Xray…..they said arthritis of upper spine and gave him a referral to physical therapy.

    At Thanksgiving he had an episode of not being able to swallow food……but he recovered. That was a one-time occurrence. Then in Dec. he started having extreme night sweats along with more episodes of dysphagia. Time for EGD.

    Endoscopy Dr. came back with a very sad “I’m so sorry, you have a very large tumor in your esophagus.” We delayed his dx for 15 years but still it was a devastating moment. I knew.

    But the surprise was that it did not arise in the area of previous Barrett’s….it arose mid-esophagus and was squamous cell rather than adenoca. Squamous is more associated with smoking.

    But I had some hope……because of the new immunotherapy drugs for NSCLC that were in process for EC. So we hoped to buy him time to get to those trials.

    It was Stage IV at dx. Through the wall, one para-tracheal LN and extension to T5 vertebra.
    ONC was good and told my husband the straight story. He only ever had 1 EC patient in the last 20 years who survived. It was treatable but the recurrence rate was 90%.

    So that was the beginning of my husband’s EC journey.

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