Dear Family and Friends,

My dad has esophageal cancer.

His case seems to be a mystery that so far no one can solve. It is presenting in a very unusual way. The doctors all agree that he looks healthy and isn't showing the signs and symptoms of someone with advanced esophageal cancer. The doctors can't agree which stage he is in. Some think 4, one doctor thinks 2, and the rest are somewhere in between. They all agree that it is T3 and no one has a guess to what N is, but the part they don't agree on is whether the M is 0 or 1. The cancer is present. They think it has spread to nearby lymph nodes and tissues. They don't know yet if the cancer has spread to distant parts of the body.

Stages of esophageal cancer are assigned based on The American Joint Committee on Cancer’s (AJCC) TNM system, a commonly accepted method based on 3 key components:

1. Tumor (T) describes the size of the original tumor.

2. Node (N) indicates whether the cancer is present in the lymph nodes.

3. Metastasis (M) refers to whether cancer has spread to other parts of the body.

A number (0-4) or the letter X is assigned to each factor. In esophageal cancer staging, as in all cancer staging, a higher number indicates increasing severity.

Anatomic categories include T descriptors (tumor invasion), N descriptors (regional lymph node invasion), and M descriptors (distant site). Non anatomic categories include grade differentiation (G descriptors) and tumor location (L descriptors). Category descriptors are currently assessed by endoscopy with biopsy, by endoscopy ultrasound fine-needle aspiration (EUS-FNA), by thoracic-abdominal-pelvic computed tomography (CT), and whole body flurodeoxyglucose positron emission tomography (FDG-PET) fused with CT.

More tests are being done and we will keep you updated. For the full story read on 2 sections below under background information.