Cancer of the esophagus can start in any
part of that organ; commonly it occurs at the lower end, near the entrance
to the stomach. The contributing causes are regurgitation of acid from the
stomach, cigarette smoking and alcohol. Repeated indigestion, upper
abdominal pain, regurgitation of recently eaten food can be symptoms of
cancer of the esophagus. Since the survival of this disease needs to be
improved, more thorough investigation of chronic symptoms must be pursued.
The type of cancer that occurs at the
lower end of the esophagus is called Adenocarcinoma; The type of cancer
that occurs in the middle of the esophagus is called Squamous Cell
carcinoma. Both types are treated in the same way; but adenocarcinomas
tend to be more aggressive and more difficult to cure.
Prognosis depends on how advanced the
cancer is at the time of diagnosis. It is difficult to diagnose cancer of
the esophagus early and therefore vigilance of chronic symptoms is
essential.
People with Barrett's esophagus need to
be continuously vigilant.
Treatment:
Careful pre-treatment evaluation is essential. Every effort must be made
to pre-stage the cancer properly for prognosis will depend on the accuracy
of the evaluation. A PET scan is an essential test before any treatment is
initiated. The PET Scan is based on the fact that cancer cells pick up
glucose with ten times the avidity of normal body cells, so radio-active
glucose can be easily seen on spectroscopy. The PET scan will tell more
accurately than any other diagnostic test whether the cancer has left its
primary source.
If the cancer is localized to the
surface of the esophagus, then surgery is all that is needed.
But if the cancer has invaded through
the wall of the esophagus and into the surrounding nodes, then
pre-operative chemotherapy and radiation therapy may be necessary. I am
currently using Taxol, Taxatere and Carboplatinol in the treatment of this
disease. At the present time, concurrent chemotherapy and radiation
therapy seem to be better than sequential chemotherapy and radiation
therapy. Surgery, after this treatment, is very difficult so it is
important that experienced surgeons perform the operation. Complications
are high and need experienced care.
In the future, it is possible that
surgery may not be needed at all. Presently the data is not there to
support this strategy, but I believe that with time, I will prove to be
correct.
If the cancer has already spread to the
upper abdomen or liver, then the prognosis is more grave. Chemotherapy
will keep the cancer controlled for a period of time but it is very
difficult to cure the cancer.
Patients with esophageal cancer need to
be evaluated by surgeons, radiation therapists and medical oncologists
concurrently.
