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Esophageal Cancer

Esophageal cancer is on the rise in this country. In fact, the incidence of esophageal cancer is rising faster than any other cancer. This probably is because of the rising incidence of GERD in Americans, as well. Currently, adenocarcinoma is the most common type of esophageal cancer found. Adenocarcinoma is the type that arises in Barrett’s esophagus, which is caused by GERD. Squamous cell carcinoma used to be the more common type. It is related to risk factors such as alcohol and tobacco abuse, but not GERD. Adenocarcinoma occurs in the lower esophagus, whereas squamous cell carcinoma usually occurs higher in the esophagus.

Barrett’s esophagus is known to increase the risk of esophageal cancer many times compared to normal. Estimates are that the risk increase is 40-120 times normal, and 0.5% of Barrett’s patients will develop cancer each year. This is why effective treatment of Barrett’s is so important—it is much easier to treat at that stage than to wait for cancer to develop.

Esophageal cancer may be discovered on routine endoscopic examination of a patient with GERD, but it usually is found when the patient develops difficulty swallowing due to partial blockage of the esophagus by tumor, or has bleeding from the tumor surface. Biopsies taken at endoscopy will usually make the diagnosis clearly.

Treatment of esophageal cancer depends on the “stage” of tumor at the time of diagnosis. Stage refers to the size and extent of tumor, as well as lymph node involvement or metastatic spread. National Comprehensive Cancer Network (NCCN) guidelines recommend surgical treatment of esophageal cancer whenever possible, but certain stages of tumor will not be suitable for surgery.  Others may benefit from treatment with chemotherapy or radiation before having surgery. These determinations are made by your surgeon after completion of a thorough staging evaluation. Tests such as CT scanning, PET scanning and endoscopic ultrasound help the surgeon determine stage and the appropriate treatment, and will be arranged after thorough consultation.

Esophageal cancer surgery is recommended when the tumor appears resectable, and the patient is healthy enough to tolerate surgery. Such patients are termed operable. Some patients will have resectable tumors, but will not withstand surgery. Others are healthy enough for surgery, but the tumor stage makes it unresectable.

Esophageal cancer surgery usually removes most of the esophagus with the tumor, as well as surrounding lymph nodes and a portion of the stomach. Advanced laparoscopic techniques are utilized, and the esophagus is usually replaced with the remaining stomach tissue. Although it is a complex surgery, patients can expect to return to nearly normal eating patterns and lifestyle. Dr. Graybeal has been performing esophageal cancer surgery for over 20 years.

Helpful Links

Good care of GERD will reduce the risk of esophageal cancer.  For more information visit ECAN.