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Adenocarcinoma is the kind of esophageal cancer Cagle was
diagnosed with, but he hadn't experienced any of the textbook signs or symptoms. Putnam said it was only a matter of time, because patients typically won't notice warning signs until the cancer is very advanced. Esophageal adenocarcinoma is also on the rise in women and African- Americans. "In the past it used to be primarily squamous cell esophageal cancer, but we rarely see that these days," Putnam explained.
Cagle has refused to let his diagnosis slow him down. He's a lawyer, chairs his law firm's educational law practice group, and lobbies the Tennessee General Assembly on behalf of the organization representing school superintendents.
Treatment of cancer of the esophagus requires close interactions between surgeons, medical oncologists and radiation oncologists. For his first step in treatment, Cagle needed to start chemotherapy and radiation immediately. He spent six weeks on the radiation table and two weeks receiving chemo, but missed only one day of work from the fatigue. "I tell everybody this without hesitation, I am a blessed guy. I was not sick one minute," Cagle said. "I worked the whole time. I had some sores in my mouth after the second round of chemo, but only one day was I not able to drive myself home."
The next step was surgery. Putnam, his surgeon, removed his entire esophagus. "We use the stomach and fashion it into a tube and move the stomach up where the esophagus used to be," Putnam said.
After surgery, Cagle was able to eat and swallow normally, but he had to make some big adjustments. "Your lifestyle changes – things like sleeping and eating. I was a pretty big guy. He said I would lose 100 pounds," said Cagle.
He can't sleep flat on his back any more, because he could choke, and he has had to learn to eat several smaller meals. But for Cagle, good food is one of the joys of being alive, and he has continued to cultivate that pleasure. "I'm a cook. I like to grow food, cook food, harvest food and eat food," he said, although he now enjoys those pleasures in a different way. "That's a small price to pay for being here," he said.
Now, Cagle is watched closely by a team of Vanderbilt-Ingram physicians and nurses, who monitor for the cancer's possible return. "The risk of recurrence for patients with esophageal cancer is over 50 percent and the percentage of patients alive at five years after proper treatment is about 30 percent, so we have a lot of progress to make in the treatment of this disease that is unfortunately becoming more common," said Craig Lockhart, M.D., Cagle's medical oncologist. He sees Cagle every three months for blood tests and periodic CT scans. "Mr. Cagle is doing very well and we will continue to see each other regularly over the next five years," said Lockhart.
The tests are nerve-racking, but Cagle said he stays positive. "I still hold my breath a little," Cagle said. "But I'm not going to let this defeat me. I feel good. I am blessed."
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