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Treatment and prevention of esophageal cancer
Between you and me
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| | | By Leah Dunaief | | |
December 03, 2008 | 03:23 PM
There have been public service announcements lately about the importance of early detection of esophageal cancer. The spokesperson is particularly poignant because he has the disease, which is pernicious, and he is trying to warn the public not to dismiss out-of-hand chronic heartburn. The message resonates with most of us because sooner or later, especially as we age, we experience heartburn — whether from that last taco or the delicious French fries or the spicy Indian fare we gobbled down.
Now there is an article by Jane Brody in The New York Times Science Section that speaks of less than draconian detection and treatment of this nasty cancer.
Chronic heartburn today is called gastro-esophageal reflux disease or GERD. The splashing upward of acid as the stomach goes about its routine breakdown of food during digestion causes it. That backup, often accompanied by chronic hoarseness and cough, causes ongoing irritation of the esophagus, the part of the digestive tube that runs from the throat to the stomach. Such frequent irritation may be linked to eventual esophageal cancer. It is easy enough to deal with heartburn by taking over-the-counter remedies and so we tend not to take this condition seriously.
There is a benign condition, called Barrett's esophagus, a cellular abnormality of the esophageal lining, that can become pre-cancerous. If persons with Barrett's are left untreated, 10 percent eventually develop esophageal cancer.
Now for some good news preceded by some grim statistics: in the last four decades, the annual rate of new cases has risen 300 to 500 percent; 16,470 new cases will be diagnosed in this country this year alone; more than 14,000 people will die from it. However, diagnosed early, especially before patients develop swallowing problems, esophageal cancer is usually curable. This is particularly true if detected and corrected before or during the advanced pre-cancerous stage.
Without going into details of the miserable assault on the body that diagnosis and treatment usually required in dealing with this disease, I'll talk about simpler and easier procedures available in today's medical arsenal. One new detection method, called TransNasal Esophagoscopy or TNE, can be done safely in a physician's office. A slim tube, with a camera at the end, is lowered through a numbed nostril, bypassing the throat and into the esophagus. This technique avoids the downsides from the previous, more elaborate and invasive procedure, endoscopy: the risk of anesthesia, the loss of work time for patients and the high costs for insurers.
Another, even newer tool, for both diagnosis and treatment uses radiofrequency energy to burn out the pre-cancerous cells. This is done with a device that fits onto the tip of a gastroscope, with a balloon that expands to fill the esophagus and a generator at the other end that sends out radiofrequency waves to burn off the problem lining. Normal cells then create a new lining to replace the discarded one.
Now for the really good news. In a report from the journal "Gastrointestinal Endoscopy," as quoted by Times medical writer Jane Brody, cellular abnormalities were eliminated in 98 percent of 70 patients with Barrett's esophagus. The duration of the study forming the basis of the article was two and one-half years.
There was a second study of 142 patients. The pre-cancerous condition was eliminated in 90 percent of the cases and the Barrett's cells in particular were destroyed in 54 percent of the patients at the one-year mark.
Since there is no way to predict which patients with Barrett's will progress to the cancerous stage, and if it does, the cancer is a major one and fast moving, this new technique can now become a possible procedure for patients who have Barrett's. These new methods of treating and even better, preventing this deadly cancer, signify a major improvement over previous options.
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