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Complaining about chest pain and difficulty swallowing. Diagnosed upper tract euretherial carcenoma. Suggest best remedy?

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Oncologist, Radiation
Practicing since : 2007
Answered : 526 Questions
Hi, I live in Calgary Alberta. My dad had a cancer tumour in his kidney. I believe the cancer is referred to as "upper tract euretherial carcenoma". the kidney was removed, however; the cancer has spread to his lymph nodes. Subsequently a year later it has now shown up in his chest. He was just recently hospitalized XXXXXXX 8th complaining about chest pain and difficulty swallowing. Note that a few months ago he lost his voice due to the lymph nodes encroaching on his voice box. On XXXXXXX 12th he had an episode where he had some issues breathing and his oxygen levels were low, but subsequently he ended up doing better now. They put him on antibiotics and steroids and they told us that he got pneumonia due to aspiration. They said that the cancer has caused complications in that he has a possibility of aspirating at anytime and has been put on a thickened food and fluid diet. We are trying to get a certain ENT doctor to check him to see if anything can be done with his throat larynx to help him, but the initial ENT that was there a few days ago was not very helpful. I suspect that all of the doctors are not putting in much of an effort because they feel he is pretty much done and it’s not worth doing anything. I suspect that it may be due to the fact that my father’s goals of cares status was put as an M1 although we initially had him at R1.

During his hospital stay (he is actually still in the hospital but this Wednesday we have a mtg with the staff, unit nurse, some doctors etc regarding the next steps) my dad has had a ct-scan of his chest and it would appear that the lymph nodes are still growing at a rate of about half a cm per every 6 weeks. It is referred to as mediastinal lymph nodes in his chest. I think the lymph nodes are around 3 to 3.5 cm (they have not done a bronchyoscopy due to the high risk factor according to the doctor) I just spoke with my dad's medical oncologist who says that he is definitely not fit enough for chemo and doesnt feel like a crio therapy or crioabration is the solution since it is too deep and is not isolated to a specific node but several in the chest area. Another Dr. that saw my dad was a little more optimistic than the rest. He looked at his charts and couldn't understand why he looked this bad. He said that the lymph nodes in his chest are growing and there is cancer there, however; the rest of his body is ok. He blood tests are ok, the cancer has not spread anywhere else whatsoever.

What I am seeking are some suggestions. Some alternatives, or other procedure that may be feasible. I am seeking something more specific such as including names of Doctors if there is a specific procedure only certain doctors do. So their contact info if possible.

I Find most of the Doctors here in Calgary to be doom and gloom but I am not ready to give up on my father. I do not know if this should go to surgical oncologist or medical. I will select surgical and hopefully that will go to the right person.
Posted Mon, 15 Jul 2013 in Cancer
Answered by Dr. Dipanjan Majumder 7 hours later
Thanks for posting your query at XXXXXXX forum.
I am sorry to listen about your father's condition.

Probably he has been suffering from transitional cell carcinoma of renal pelvis.
The treatment of this disease is not very clear. In early stage radical surgery including kidney and ureter removal is the treatment of choice. Probably that surgery has been already done. Problem is the possibility of relapse. Most of the time local relapse and distant relapse occur very commonly.

Relapsed TCC renal pelvis can also be treated by surgery depending the site and number of metastasis but in case of multiple metastatic deposit surgery may not be an effective alternative.

Chemotherapy is the only option, radiation has not proven benefit. But chemotherapy needs an acceptable general condition of patient.

Mainly the chemotherapy used was M-VAC regime but single agent cisplatin also has shown some results. Phase III trials are going on gemcitabine, cisplatin with bevacizumab. But no clear cut treatment guideline is there.

Consult your medical oncologist for trying some chemotherapy if at all possible.
Hope I have clarified your queries. I will be available for follow up.
Above answer was peer-reviewed by
Follow-up: Complaining about chest pain and difficulty swallowing. Diagnosed upper tract euretherial carcenoma. Suggest best remedy? 6 hours later
is there anything else you would recommend\suggest. An alternative, something that is coming out...trials etc...anything.

I was aware of the above since my oncologist said that it would have to be chemo and offered no other option.
Answered by Dr. Dipanjan Majumder 51 minutes later
Actually I have tried to mention other option like biologics like bevacizumab.

This is not chemotherapy. Mechanism of action is different. Biologics and chemotherapy together in combination is used in recent trials.

Anyway, sorry to say no effective alternative in this setting is available right now. I have mentioned earlier that particular variety of cancer has bad prognosis. So you have limited option.

Hope I could explain you the disease state and prognosis. I will be available for follow up.
Above answer was peer-reviewed by
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