Some cancers can be scarier than others. While advances in diagnostics and treatment have greatly improved the survival rates of many forms of cancer, others have proved resistant to such advances. One of those is cancer of the esophagus.
The five-year survival rate of those diagnosed with esophageal cancer averages about 20% over all patients, based on 2010-2016 statistics from the American Cancer Society. Those diagnosed with early, localized cancer have a 47% survival rate. This number goes down to 25% if it has spread regionally and to 5% if the cancer has spread to distant parts of the body.
However, the ACS says that there may be good news behind these distressing numbers. Those now being diagnosed with esophageal cancer may have a better outlook, because treatments have improved over the past five years. New diagnostic tools also are coming online, which can help find the disease earlier, when it’s most treatable.
What Is Esophageal Cancer?
The esophagus is the tube that connects and carries food from your mouth to your stomach. Esophageal cancer starts in the cells of the inner lining of the esophagus.
The two main types of esophageal cancer, according to the ACS, are:
— Squamous cell carcinoma. Squamous cells line the inside of the esophagus. This cancer can start anywhere along the esophagus.
— Adenocarcinoma. These cancers start in gland cells and are mainly in the lower part of the esophagus, near the stomach.
“The first type is the most common in many parts of the world, accounting for about 90% of all cases,” says Dr. A. Craig Lockhart, chief of the division of medical oncology at the Sylvester Comprehensive Cancer Center and professor in the department of medicine at the University of Miami Miller School of Medicine. However, in western countries, adenocarcinoma accounts for about 60% of cases. The main reason is most likely a Western lifestyle –particularly diets that lead to obesity and acid reflux.
Adenocarcinoma is caused by chronic inflammation of the esophagus. Risk factors for that include smoking, drinking alcohol and, most often, GERD, or chronic acid reflux. “The esophagus isn’t meant to see the caustic material that’s in the stomach,” says Dr. John C. Lipham, chief of the division of upper GI and general surgery, chair in upper GI cancer and professor of surgery at the Keck Medical Center of the University of Southern California. The acid damages the tissue, ultimately causing a condition called Barrett’s esophagus, a precancerous change in the tissues that most patients get before developing cancer, he says.
Symptoms and Diagnosis
In its early stages, there are often no symptoms. As the cancer progresses, symptoms can include:
— Trouble swallowing.
— Chest pain.
— Weight loss.
— Hoarse voice.
— Constant cough.
These symptoms can of course result from many other disorders, so your doctor may recommend one or more of the following tests to make a diagnosis:
— Upper endoscopy. A flexible, thin tube with a light and camera is sent from your mouth down your esophagus and to your stomach. If there are suspicious lesions, the doctor can remove a small piece of tissue to biopsy.
— Barium swallow. You swallow a thick, chalky liquid that includes barium, which coats the esophagus and outlines any suspicious growths, which can be detected by X-rays.
— CT, MRI or PET scan. Your doctor may also order these scans for more detailed images.
If a biopsy reveals cancer, it will be graded and staged, which tells the doctor what type of cancer it is, how fast it is likely to grow and how far it has spread.
Surgery and radiation therapy commonly are used to treat earlier stage cancers. Chemotherapy, targeted therapy and immunotherapy are used to treat cancer that has spread to other parts of the body. Many patients receive a combination of these therapies.
If a patient is diagnosed with precancerous Barrett’s esophagus, surgeons can remove just the affected tissue. But surgery can be much more challenging if the tissue has turned cancerous and has spread. It may require removing all or part of the esophagus and sometimes part of the stomach, in what is called an esophagectomy.
Early-onset Esophageal Adenocarcinoma
There’s a common misconception that esophageal cancer is an older person’s disease. But in recent years, esophageal adenocarcinoma among young patients has doubled. “And it’s tragic,” says Mindy Mintz Mordecai, founder, president and CEO of the Esophageal Cancer Action Network, noting a 32-year-old doctor, a 31-year-old Marine who died a year after giving birth to her only child and a star athlete diagnosed at stage 4 in his senior year of high school. “The worst I’ve seen is a 16-year-old diagnosed at stage 4 who decided he didn’t want treatment anymore when he turned 18. He did not live to become 19,” says Mordecai, who founded ECAN after her husband succumbed to the disease in 2009.
Physicians don’t know why this is happening. It may be that more have acid reflux than is currently known. It could be dietary. It may be linked to obesity, but “not all of (my patients) are overweight. I’ve had triathletes, and there is nothing overweight about them,” Lockhart says.
New Diagnostic Tools
One problem with treating esophageal cancer more successfully has been that there are few diagnostic tools available, like those used for breast and colon cancer, to find the disease early. However, that may be changing. There are two new tests that involve swallowing a pill-like device that is attached to a string. The pill goes to the stomach, where the outer capsule dissolves, revealing a sponge that is pulled back up the esophagus and out the mouth, taking sample cells or DNA with it for testing.
These have been approved by the Food and Drug Administration, but as of now are only found at a few advanced treatment centers, like at USC. And it’s not as icky as it sounds. “I’ve done it. It’s very easy to do,” Lipham says. As of now, there are no professional society recommendations for their use, but “they always lag. In my opinion they should be considered as a much more cost-effective way to diagnose patients and intervene earlier in the disease,” he says.
Mordecai adds that these new tests don’t require a day off of work, take just a few minutes, are relatively inexpensive and don’t require sedation. “We think that if they are widely used, we can dramatically impact the devastation this disease causes,” she says. “And it will require more public understanding that GERD is not merely an annoyance.”
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