James,
Thanks for inviting me to post further on the disease that has unfortunately struck your dear brother. At the outset, I am impressed that he has had state of the art treatment and is a candidate for freedom from disease for a number of years, at the least, and with Gods help, a total cure to frail old age and great, great grandchildren! This is already a stunning achievement to get into this "betting rank" with such a terrible disease for at least 80% of those affected.
This tumor is relatively uncommon, but unfortunately occurs more frequently with reflux esophagitis, (a lot of bubbly soda doing the same thing), exposing the esophagus to acid stomach contents and also more often in smokers and excess alcohol use.
But this could also occur in a skinny non smoker!
Where the cancer is localized to the esophagus itself and immediately adjacent structures, then giving chemotherapy, (often including agents like cis_platinum), and 3D planned radiation therapy with high energy ionizing radiations with 6, 10 or high million electron volt radiation beams from a linear accelerator. The cancer shrinks and hopefully microscopic diseas is mopped up by the chemotherapy and the patient's own immune system.
Follow up CT scans and PET scans show areas of residual mass and areas that are still consuming energy. If this result is optimistic, then the surgery is scheduled. The esophagus and attached tumor has to be dissected free of all the adjacent structures and then pulled out through the neck or abdomen and replaced with a tube made from a free loop of living intestine, "stolen", often large bowel. This can go either in the place that was occupied by the original diseased esophagus or can be placed in from to the heart, behind the sternum, instead. The old esophagus, (if it cannot be removed), can theoretically be left where it was found behind the heart, but now closed off from the oral cavity above and the residual stomach, below!
With good healing, the patient can now eat with no food getting blocked.
In your bother's case, he does appear to be fairly robust and that bodes well for healing. The need for further radiation means that there was, likely as not, at a minimum, microscopic disease at the surgery margins, indicating a real risk for cells to regrow to more tumor. In such cases, with residual microscopic disease left behind, risk of failure is roughly 18% at a minimum. A base line PET CT is essential at about 1-2 months after surgery and then every 6 months for the first year. That would catch regrowth early enough for intervention. CT shows something is there. PET shows where sugar is being consumed at an abnormally high rate, indicating possible tumor activity. Without these tests, the plane has no windshield, compass, altimeter or other instruments to guide the pilot! In a managed care system such as in Canada, these tests might not be normal practice. So one has to ask and make a fuss to get these organized. If need be, the patient simply gets it done and pays the bill out of pocket at $1500-$4,000 a time. Worth it if one can scrape up the cash!
All in all, count this as a major victory, for now, against that shadowy cloaked figure with the long sickle that chases down all of us in the end, no matter what!
Your brother can look forward, all being well, to years of good life. Is it just 2-4 years or will this never return?
If trump can get elected, even once, your brother can be cured for the next 20 -30 years!
I do hope so.
Asher