Esophageal Cancer Fastest-Growing Cancer Diagnosis

… Dr. Bruce Greenwald talks about causes and prevention …

baltimoresun.com

3:45 PM EDT, April 20, 2011

Esophageal cancer has become the fastest-increasing cancer diagnosis in the country, up more than 400 percent in the past two decades, according to the Esophageal Cancer Awareness Network. The Baltimore-based group pushed for April to be designated Esophageal Cancer Awareness Month in Maryland as a means of bringing attention to a disease that often requires early detection for survival. Dr. Bruce Greenwald, president of the group’s board of directors and a professor at the University of Maryland School of Medicine, answers questions about the disease.

What is esophageal cancer and who typically gets it?

In esophageal cancer, a cancerous mass grows in the esophagus — the muscular tube that connects the mouth to the stomach. The typical patient is a middle-age man, however this cancer can affect men and women of all ages.

What are the main types and their causes?

The most common type of esophageal cancer is called adenocarcinoma. The greatest risk factor for esophageal adenocarcinoma is GERD (gastroesophageal reflux disease), and heartburn is the most common GERD symptom. Other symptoms include regurgitation of food, especially at night; unexplained hoarseness or sore throat; chronic cough and even asthma symptoms. Being overweight is also a risk factor for esophageal adenocarcinoma.

The other form of esophageal cancer is called squamous cell carcinoma. The greatest risk factor for this cancer is tobacco use and excessive alcohol intake.

What is the link between heartburn and esophageal cancer?

Heartburn is a significant risk factor for esophageal cancer, specifically esophageal adenocarcinoma. The link between heartburn and esophageal cancer is a condition called Barrett’s esophagus. In Barrett’s esophagus, the normal lining of the esophagus changes. This new lining may develop cancer.

Are there treatments besides surgery?

The treatment of esophageal cancer depends on the stage of the disease and the condition of the patient. Surgery is the conventional treatment for early-stage cancer. A combination of chemotherapy and radiation therapy is now commonly used for more advanced but potentially curable stages. Surgery may be performed after chemotherapy and radiation therapy. Chemotherapy alone or radiation therapy alone rarely cure esophageal cancer but may shrink the tumor.

New, less-invasive therapies are now available for some Stage I cancers. These therapies are performed through the endoscope (a flexible lighted tube passed through the mouth while the patient is given sedating medicines). In endoscopic mucosal resection, the cancer is lifted away from the wall of the esophagus and cut off. In spray cryotherapy, the cancer is sprayed with liquid nitrogen to freeze and destroy it.

Is esophageal cancer curable if caught early?

Yes! The earlier the cancer stage, the greater the chance of cure. However, even Stage III cancer may be cured with aggressive therapy.

Is the disease preventable?

In some cases, esophageal cancer is preventable. Endoscopy can detect Barrett’s esophagus. When Barrett’s esophagus is found, we perform endoscopy periodically to monitor for more severe precancerous changes, called dysplasia. If dysplasia is found, it can be treated and removed in several ways. Small areas of dysplasia can be removed by endoscopic mucosal resection (described above). The dysplasia and Barrett’s tissue can also be removed by burning or freezing a thin layer of the esophagus containing the Barrett’s tissue. By doing this, the Barrett’s esophagus is removed, preventing it from becoming cancer.

Unfortunately, many people with heartburn do not talk to their doctor about this condition or treat it appropriately. This is unfortunate, as heartburn is a significant risk factor for esophageal cancer. Those patients with heartburn symptoms (burning in the chest or upper abdomen, throat burning, unexplained sore throat) should talk to their medical provider about treatment and whether they should be screened for esophageal cancer.

meredith.cohn@baltsun.com

Copyright © 2011, The Baltimore Sun

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… ATTENTION:  Heavy tobacco and alcohol users! …

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