Radiation Answers by Dr. Pankaj Vashi
Dr. Pankaj Vashi offers insight into diagnosing and treating esophageal cancer, as well addressing quality of life.
How can people with gastroesophageal reflux disease (GERD) reduce their risk of esophageal cancer?
There are two kinds of esophageal cancer, adenocarcinoma and squamous cell carcinoma. In the United States, adenocarcinoma is most common. GERD, obesity and tobacco use are the main risk factors for adenocarcinoma, which typically develops in the lower part of the esophagus near the stomach. You should see your doctor if you have chronic GERD that does not respond to two weeks of treatment with over-the-counter medications such as Prilosec®, Nexium® and Prevacid®, especially if you are a smoker or obese. Difficulty swallowing solid food may suggest narrowing of the esophagus, which can be another symptom of esophageal cancer. Learn more about GERD and get tips to reduce your risk of esophageal cancer.
How is esophageal cancer diagnosed?
An upper endoscopy can diagnose precancerous lesions called Barrett’s esophagus, which develops when chronic acid reflux erodes the lining of the esophagus. For the procedure, your doctor will insert an endoscope, a thin tube with an attached camera, through your mouth to examine the esophagus, stomach and the beginning of the small intestine. If you are diagnosed with Barrett’s esophagus, you would not undergo treatment unless the condition is advanced. But you would have an upper endoscopy every three to five years to monitor the condition.
How does genomic tumor assessment help diagnose and treat esophageal cancer patients?
If you have advanced esophageal cancer that does not respond to standard of care treatments—radiation therapy, chemotherapy and surgery—you may be a candidate for genomic tumor assessment. For this testing, a biopsy is performed to obtain fresh tissue sample for testing. The sample is analyzed to identify potential genetic mutations that are driving the growth of your cancer. Understanding what’s happening at the genetic level may help identify specific targeted therapies that may be effective in treating your individual cancer.
What are recent advances in treatment for esophageal cancer?
We now have more sophisticated radiation therapy and chemotherapy agents that may help improve quality of life and may result in better outcomes. Intra-esophageal brachytherapy may be used on patients who’ve already undergoneexternal beam radiation therapy (EBRT) for a primary esophageal lesion but still have a tumor causing obstruction or bleeding.
Intra-esophageal brachytherapy is an innovative way of treating a tumor that is partially blocking the esophagus. For the treatment, your doctor would place a wire through the tumor with the help of an endoscope. Radiation beams are sent through the wire and directly to the tumor. The treatment also may help with tumors that are bleeding. The goal of treatment is to make it easier to swallow and eat.
What can be done for patients who have difficulty swallowing or eating as a result of their cancer?
Maintaining good nutrition is critical during and after your treatment. Our dietitians work with you one-on-one to address how the cancer is affecting you and your nutritional needs. During treatment, we can put in a feeding tube in the stomach or small intestine to make sure you don’t lose weight and you can keep up your strength for radiation therapy and chemotherapy. Intra-esophageal brachytherapy, radiofrequency ablation, cryotherapy and esophageal stenting are additional treatments that may help improve swallowing and eating.