What's
New With Esophageal CancerThe following are a few newer publications that
I found useful regarding esophageal cancer. -
The Shanxi province,
a region in north-central China, has some of the highest esophageal cancer rates
in the world. Ref. 4 studied precursor lesions and early cancer lesions and did
genetic studies in collaboration with the National Cancer Institute, Bethesda/
Md (US). The findings showed that four genetic markers were associated
with the initiation of cancer. Loss of "heterogeneity" at these loci
was thought to cause initiation and progression of esophageal cancer. There were
eight other genetic loci that were found to be associated with dysplasia and overt
cancer. Loss of heterogeneity in these loci was thought to be associated with
the later stages of the cancer forming process. These findings likely will lead
to further knowledge about how to diagnose esophageal cancer earlier and how to
prevent it from happening in the first place. -
Infiltrating cytotoxic
T lymphocytes were investigated in Ref. 5. It was found that a subclass of T-lymphocytes,
the CD8(+) T cells, when they infiltrated the esophageal tumor specimen, were
associated with a much better outcome. The authors felt that this finding will
have diagnostic and therapeutic implications in the future. -
Duke's
classification is used for staging in colorectal cancer. Ref. 6 is suggesting
for the first time that this classification would be useful also for classification
of esophageal cancers. Here are the survival data, based on 251 patients between
1981 to 1999, which I arranged as a table for easy comparison with the survival
data above.
| 5-year survival rates
for thoracic squamous cell esophageal cancer |
Stage: (Duke) | Treatment
with esophagectomy: |
| A | 94
% | | B | 75 % |
| C | 43
% | This group of patients had histologically
verified squamous cell esophageal cancer, which excluded
the adenomatous esophageal cancer types, who have a worse outcome. The authors
found that this Dukes' classification, when compared to other classification sytems,
had a good correlation with the tumor size, the clinical course and the outcome
in all the other similar staging procedures. With its simplicity of staging they
felt that this would be a good staging system to use. - Here
is a study that was designed to investigate whether or not the rate
of esophageal cancer was different for surgical or medical control of reflux esophagitis.
The authors of Ref. 7 did this longterm control of gastroesophageal reflux disease(=GERD)
study and recalled 239 patients who either were treated medically or surgically
9 to 10 years earlier. They were examined by gastroscopy and the following findings
were obtained: both the rate of lower esophagitis as well as the rate of esophagus
cancer was identical in both groups. The group that
was in the past treated with fundoplication in the lower esophagus still needed
anti-reflux medication in 62%. The medically controlled group needed anti-reflux
medication in 92%.The annual esophageal adenocancer rate was 0.07% for patients
with only GERD at the outset. With Barrett esophagitis at the outset the annual
cancer rate was higher at 0.4%. These cancer rates were identical for both groups,
with or without surgery. The authors concluded that surgery for GERD
or Barretts esophagitis would not be indicated. The mortality rate
was actually higher in the surgical group because of unrelated cardiac disease.
Anti-acid medication is needed irregardless of the decision to do ant-reflux surgery
or not.
This finding is interesting as it dispels the myth that
has been taught to generations of medical students that anti-reflux surgery at
the lower esophagus would prevent development of espohageal cancer later in life.
What makes a difference is the use of a proton pump inhibitor or the use of Zantac
(see also Barretts esophagus).
Summary
regarding esophageal cancer Esophageal cancer is a difficult
cancer for physicians to diagnose and treat early as it is asymptomatic in the
beginning and due to its high vascularity metastasizes early. It is prudent for
everybody to screen what we eat, as sodium nitrite and sodium nitrates are still
popular curing agents for meat and meat products. These carcinogens make meat
look red for a long time. However, checking food labels for the small print
as mentioned above in the "esophageal cancer prevention " box will pay
handsome dividends for your health on the longterm. Also keep in mind that cigarettes
and hard liquor are not part of a healthy diet. With regard to alcohol it is a
matter of concentration and exposure over the years that decides when the lining
of the esophagus will turn into cancer cells. With regard to carcinogens from
cigarettes it is the effect of swallowed carcinogens that stimulates cancer transformation
of the cells of the lining of the esophagus. Both effects are superadditive and
you may want to give these life style aspects some thought and ,if necessary in
your situation make appropriate changes. This is much easier than facign the shock
of a sudden cancerous disease in the esophagus and the precarious road of treatment
mentioned above. |
