According to the American Cancer Society, in the United States, an estimated 16,940 cases of esophageal cancer will be diagnosed each year, and 15,690 deaths are expected from the disease. Worldwide, an estimated 455,800 new esophageal cancer cases and 400,200 deaths occurred in 2012.
EA is a silent malignancy and often presents in very advanced stages with symptoms of difficulty swallowing or pain, weight loss, or blood loss. There are two major forms of esophageal cancer – squamous cell and adenocarcinoma. There are important differences between the two and each require different management. In the US and other western countries, adenocarcinoma of the esophagus is most common, and highly associated with chronic heartburn, obesity, and a condition known as Barrett’s esophagus.
It is very important to understand the facts of your case and receive the proper management and care. Cancers may present in many different stages ranging from pre-cancer to very advanced. Therapies may include endoscopic removal, surgical resection, chemotherapy and radiation or some combination of these options.
Staging of an esophageal lesion is the most important part of your evaluation. Staging means we know the exact dimensions of the growth, where it is, and possibly the genetic changes within the growth. Typical tests to determine stage include upper endoscopy with endoscopic ultrasound, CT scan, and possibly PET scan. Samples of the growth are needed to determine the grade and aggressiveness and in some cases, samples are taken for genomic study. Genomic data is being used increasingly to select appropriate chemotherapy agents with greatest likelihood of success.
In addition to staging, patients with esophageal cancer may need help to improve many other issues such as difficulties with swallowing, increasing caloric intake, and controlling pain. It is very important that specialists work as a team as there are many subtle nuances of patient care that need a ‘group thinking” approach. In most cases, a patient with esophageal cancer will need a dietician, medical oncologist, and a radiation oncologist. They may also benefit from counseling and mental health, natural therapies and holistic care.
Patients with esophageal cancer also have family members who may be at risk. We also offer services for screening of relatives and providing strategies to lower risk.
Finally, research is critical to furthering our understanding of this cancer. In our center, patients will be asked to donate samples to allow study of their condition and contribute to scientific research. We have established the ‘Gastrointestinal Research Fund” at Georgia Institute of Technology to develop better tests for detecting cancer at earlier stages and developing more effective treatments.