Richard Gaeke, MD, Gastroenterologist Discusses Esophageal Cancer Video Transcript

My name is Dr. Richard Gaeke. I am a gastroenterology specialist which means I take care of digestive disease and liver disease. The focus of my practice is diagnosis of all GI conditions and treatment of inflammatory bowel disease, upper G.I problems, colitis, and cancers.

Symptoms

Symptoms for esophageal cancer are difficulty swallowing solid food that the patient perceives as stopping on the way down. It’s called dysphagia and that’s the cardinal symptom and that’s considered what we call an absolute indication to proceed with diagnostic testing. Weight loss is also an important symptom. In this country, heartburn of a very serious level over a long period of time raises the suspicion of a condition called Barrett’s Esophagus. It turns out that almost all our esophageal cancer in this country is now related to Barrett’s Esophagus. Which means if a surgeon operates on someone with esophageal cancer in this country and you looked at the segment of esophagus he removed, in the background with the cancer is Barrett’s Esophagus. Barrett’s Esophagus is a change in the lining of the esophagus from squamous lining, which if you want to envision it, it’s like your skin to a glandular lining, and that is thought to be due mainly to acid reflux. Conversely there are lots and lots of people with Barrett’s Esophagus and the vast majority of them do not develop cancer although the ones we diagnose we follow much like women are followed with Pap smears or mammograms for early diagnosis. From the physician’s perspective, a patient in their 20s or early 30s with occasional heartburn raises little to no anxiety of esophageal cancer. A patient in their 60s with long-term heartburn on long-term medication to suppress the heart burn and smokes and has lost 15 pounds, it’s almost the first thing you think of.

Risk Factors

Everyone knows the prevalence of smoking in this country has declined a lot over the last 30 years. It’s down now to less than 25 percent of the population and that is thought to correlate with a decrease in the squamous cell esophageal cancer that is so prevalent elsewhere in the world and used to be the main form of the disease here. The other factors . . . acid reflux, obesity, a diet inadequate in fruits and vegetables are also operating. Smoking though cannot be condoned for any reason. Cancer of the lung, head/neck, oral cavity, esophagus and upper GI track all connect with smoking very closely.

Treatment

The treatment of esophageal cancer depends on the stage where it is diagnosed. Most esophageal cancers unfortunately are diagnosed at a fairly advanced stage. The treatments available are, as with so many other cancers, surgical removal or some combination of surgery, chemotherapy and radiation. Other treatments fall into the category of what they call palliative treatment – making the symptoms better but not curing the disease. There have been major advances in the treatment of esophageal cancer over the last 30 years, especially in the area of chemotherapy, where a certain combination of drugs was discovered to tremendously decrease or obliterate all traces of the disease in the esophagus when combined with radiation. It is called chemo-radiation. It is also called neoadjuvant treatment meaning a ‘helping treatment’ because it’s given before surgery to reduce the size of the tumor. But we’re still stuck with the actual cure rate of 19 percent.