Esophagus Cancer

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.