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May 22, 2012 7:53 AM   Subscribe

Stage IV esophageal cancer, metastasized to liver and lungs. What now? Where in Toronto can one find the most aggressive treatment?

Friend just found out he has Stage IV esophageal cancer, which looks like it's metastasized to a shadow in his lung and a spot on his liver. Given his tough-guy personality and the fact that he has a new baby, he wants to fight-fight-fight and take whatever long shots he can to beat the odds.
Sinai is reluctant to do surgery. Where else should he go, and what should he know?
Thanks.
posted by pseudostrabismus to Health & Fitness (10 answers total) 3 users marked this as a favorite
 
Oh dear. Princess Margaret is the big cancer hospital. Your friend should get a second opinion from someone there. Good Luck!
posted by ThatCanadianGirl at 8:03 AM on May 22, 2012 [1 favorite]


Agreed - Princess Margaret is the place to go. Good luck to him.
posted by Dasein at 8:08 AM on May 22, 2012


Princess Margaret is excellent. If travel was an option, across the border the Cleveland Clinic is truly first rate, as is URMC.
posted by French Fry at 8:51 AM on May 22, 2012 [1 favorite]


Toronto General (TG is where most of the oncological surgeries are done). TGH is where he should have gone in the first place, they have the biggest program. Tell him to ask to talk to someone from research and clinical trials (Gail Darling might be the person for TGH). The thoracic program at TGH is divided between Western and TGH, not sure about the clinical side of things (chemo, radiation, etc.) -- that's probably PMH. But first, surgical second opinion.
posted by Felicity Rilke at 9:56 AM on May 22, 2012


Contact me directly if you want help navigating the system and helping your friend advocate for himself. I'm deep in the oncology system at UHN (with experience at Sinai and Sunnybrook, as well) and I know the ins and outs and the strings to pull quite intimately.
posted by Felicity Rilke at 9:59 AM on May 22, 2012 [2 favorites]


Ah, shit. I think Sinai's thoracic program overlaps with the UHN program. This might be slightly more complicated. Memail me and I'll explain the situation as best I can and offer advice once I have more info.
posted by Felicity Rilke at 10:02 AM on May 22, 2012


I hate to ask but is travel an option such as U.S. travel? Perhaps calling the closest, largets U.S. hospital is an option?

Why are they reluctant to do surgery because it's stage IV?

I'm so sorry for your friend, you, and his family. I wish him and everyone all the luck in the world. Know that Stage IV doesn't always mean an immediate, negative sentence. My mom was stage IV breast cancer (name an organ and she had it on there) and she lived over 7 years past diagnosis.
posted by stormpooper at 1:00 PM on May 22, 2012


Princess Margaret has done great things for my uncle in the past few months -- different kind of cancer (skin), though.

All the best to your friend.
posted by pised at 2:35 PM on May 22, 2012


Be sure your friend requests being tested for the genetic marker which makes a patient eligible for a Tarceva trial. Wishing them the best.
posted by at at 4:09 PM on May 22, 2012


When he does get the second opinion, if they again turn him down for surgery, make sure he gets a good explanation that makes sense to him about why surgery is not an option. It's awful feeling like "Maybe if I had just been more insistent" or "They said they can't do X but why can't they try Y?" Most people these days need to know why and really understand the reasoning behind a decision not to treat, rather than just taking a doctor at his/her word like people did 50 years ago.

It might also be worth suggesting that he ask "What is the strategy that will give me the most awake & aware time to spend with my son?" It sounds like that's his real goal, and surgery may actually be a worse option in that case. Obviously I can't speak to this particular case, but sometimes surgery will just add pain and suffering that might completely limit his ability to enjoy his time with his child, even if it does prolong his life somewhat. So yes, fight with everything he's got, but help him be very clear with himself and his doctors exactly what he is fighting for. "Alive" is not the same as "able to spend time with my new baby."
posted by vytae at 7:39 PM on May 22, 2012 [2 favorites]


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