Mass Near The Esophagus -- Cancer? Benign?
Read the
very personal story about Jean Ross
Acid Reflux -- Esophageal Spasms
Gastroesophageal Reflux Disease (GERD, Acid Reflux)
Acid-Alkaline Balance by Karl Loren
Dr. Weston Price -- On Acid -- Alkaline Balance
Mass Near The Esophagus -- Cancer? Benign?
Advice From Friends -- Esophagus Cancer
Treatments and Protocols BEYOND The Traditional
On this page:
Jean Ross: Close and Very Personal
Barrett's esophagus is associated with increased risk of developing an invasive cancer
Fibrovascular polyp of the esophagus: diagnostic dilemma
Barrett's Esophagus -- Cleveland Clinic
Benign lesions mimicking malignant tumors of the esophagus.
BENIGN FIBROVASCULAR POLYP/INFLAMMATORY FIBROID POLYP/INFLAMMATORY PSEUDOTUMOUR
Metastatic thyroid carcinoma presenting as an expansile intraluminal esophageal mass.
Close And Very Personal
This is very personal, but real and possibly of value to you.
About in
mid-2003 Jean Ross, my wife, started having
trouble swallowing. The symptom was a sudden vomiting of food she had just
tried to swallow. The first time this happened it was sudden and very
disconcerting.
It didn't happen again, for some weeks, but by the early part of 2004 it was becoming unpleasantly frequent. Finally this was happening almost every meal. She lost weight because of not being able to get the food down. She could eat some things, strangely that included popcorn, and when she started trying it, she could drink a protein drink, with a raw egg mixed in.
We learned that an "endoscopic examination" was the usual thing -- she learned of the details and really didn't want to do that.
The first thing she was willing to do was called an "upper
GI." She swallowed "barium" and
had several X-Rays taken, in the area of the esophagus. They only saw a
"narrowing" of the opening of the esophagus, but specifically missed the "mass"
that was there. Later a doctor explained this saying the barium had either
already passed this part, or hadn't gotten there when they did the X-Ray in that
area. I don't think they were very competent. But it is hard to be
critical when you don't know what is happening.
But,
when the swallowing got more difficult she decided it was the necessary thing to do.
I was remiss in not doing the research into this problem until about then, but
that is when I started researching and publishing the several pages in this
section -- starting with "endoscopy" and then concentrating on the "esophagus."
Without looking carefully at all the facts we both thought this might be one of those well-publicized "acid reflux" problems, and I initially concentrated my research on that subject.
But, she soon realized that when she vomited there was never any sour or bitter taste -- there was no stomach acid or bile. The only thing that came up was what she had just tried to swallow. Later a doctor told us that acid reflux could exist without any of the stomach acids or bile getting high enough up to taste it -- that the damage to the esophagus could be caused by acid-reflux even so. The time of the endoscopy was fast approaching -- scheduled for February 13, 2004.
By the day before the endoscopy I had published most of the material you now find here -- I knew that a "mass" could be the problem causing closure of the esophagus, and thus preventing swallowing, but that seemed somehow remote, so I did not particularly research into that possible problem initially.
The endoscopy was done, and the immediate report was that there was a "mass" at the bottom of the esophagus, and that the doctor dilated the opening at the end of the esophagus -- he said that might give some immediate but temporary relief for swallowing. It did not!
I knew that an endoscopy exam would normally include a "biopsy" of any mass found during the exam. We asked the doctor if he could agree to do the endoscopy without doing any biopsy -- if we requested that. He said he could, but seemed puzzled as to why we might want that. I mentioned the dangers of metastasis if a biopsy is done of a mass that turns out to be cancer. He didn't think that was any danger.
We then went
to another doctor -- one we have used for 20
years and trust more than any other we knew. He said that the type of
biopsy done during an endoscopy was a "scraping" of the surface and that he
thought this was quite safe. He also suggested Jean start drinking Aloe
Vera Gel every day and I suggested Jean start using our
Germanium every day.
She was afraid she couldn't swallow the
Taheebo Capsules, and didn't like the
idea of pulling the capsules apart and trying to drink some water with the
contents of the capsule in them. Later I arranged to get the concentrate
part of our capsules and package them into tiny tablets that could be chewed, or
held in the mouth, more like many homeopathic remedies. The report on
those is later on this page.
So, we accepted that the endoscopy doctor would do his normal procedure.
Since he found a mass he did go ahead and do his "biopsy."
He told me, afterwards, that he did two types of biopsy -- one was "scraping"
and the other was like "picking" with a "pinch." He assured me that there
was no "needle biopsy" ever contemplated.
There is a very important point to realize here, now.
I strongly believe that any person has an absolute right to make decisions about
their body without any control by another. I might venture my opinion,
even strong opinion, but my relationship with my wife is that I will support
whatever decision she makes in the area of being responsibility for her own
body. Both of the photos along side were taken after we learned that there
was a mass!
Since it was "Jean's swallowing" not mine, that was the problem, I knew that she would have a different viewpoint than I did. She was much more willing to have the endoscopy than I liked, but then, it was her throat and not mine.
So, she went into the endoscopy with me doing all the research I could, telling her what I found, and accepting, without reservation, HER decision to move ahead.
The report of "mass" found was very upsetting to both of us. I knew, immediately, that a "mass" was either cancer, or it was not. Jean knew that also.
Jean immediately increased her dosage of Germanium -- taking about three full teaspoons per day -- about 5,000 mg. That is a very large dosage, but from all the research I've done on Germanium I thought it would be the very best thing she could do, outside of surgery and standard chemo or radiation, to reduce that mass. Germanium, in the loose powder form we have, is very easy to take. It doesn't have any bad taste. Jean would hold the Germanium in her mouth -- allow it to dissolve with a bit of water, be absorbed, and swallow some (mixed with saliva) so that it would trickle down the throat -- down the esophagus. When you can apply Germanium very directly to an unwanted mass it is likely to be quite effective.
She continued with her Aloe Vera Gel, and took as many of our vitamins as she could swallow.
I immediately did much more research on cancer in the esophagus, or benign tumor in that area -- that is all published on this page, actually. I knew that a biopsy result could be "estimated" by the doctor who did the procedure, in five minutes, "if he wanted to." But, you would hardly ever get a doctor willing to report on HIS findings, rather the standard of care is that he prepares the biopsy sample and sends it to the specialized lab that does these tests. I knew, also, that even though they COULD do the official test in a couple hours, they normally took several days.
This expected waiting time is one of the hardest parts of getting a biopsy. You know that the doctor has taken the tissue sample. You might even suspect that he or others know the results. But, you also know that the doctors usually prefer to give you these results personally, not over a phone call, and that you then have to fit into his regular appointment openings.
We understood that Jean would see her doctor the following Monday -- reasonably fast. But, by Saturday we realized that the next Monday was President's Day, no office hours -- his next available time was the following Thursday, February 19th. That was scheduled. The doctor had also told us that he wanted Jean to get a CAT Scan, and we knew that the appointment for that was being "worked on."
The doctor's office called to say that the CAT Scan was now scheduled for the same Thursday we expected to see the doctor and get the results of the biopsy. I might have protested more, but Jean was into getting the CAT scan done as soon as possible. So, she asked if the doctor's nurse if he would please give her the results over the phone. His nurse said he would call, he did, on Thursday morning.
This was now the sixth day after the procedure -- the sixth day after we had been told there was a "mass." At the time of the endoscopy the doctor held up his fingers to estimate what he thought the size of the mass was -- about the size of a small golf ball! The CAT Scan would give not only exact dimensions but exact position -- in anticipation of surgery to remove it.
You can imagine that the expected phone call was a time of gathering attention and concern.
The doctor called, and gave his report.
He said, "Whether or not there is cancer is inconclusive." "There was," he said, "inflammation at the bottom of the esophagus, and that inflammation may have been the cause of what he saw as some irregularity in the cells." Jean asked him if another biopsy was needed? He said, "no, the CAT scan will tell us more."
So, we were certainly relived that there was no diagnosis of cancer, but worried about this "inconclusive" remark.
As I write these very words, Jean has had the CAT Scan, and it is now Friday, February 20, 2004. We have an appointment to see the doctor on the next Monday. He will, by then, have looked at the CAT scan results.
You notice the "we" throughout. Over the past few years neither one of us has gone for a medical consultation without the other. The doctor would not allow me actually inside a room where a medical procedure was taking place, but we both always saw the doctor, for either her situation, or mine, together.
In the meantime the "dilation" does not seem to have helped much -- Jean is still unable to swallow much -- vomits up the just-eaten food too often for comfort. She can do OK with a protein drink, so she is getting basic nutrition.
I have been giving Jean "spiritual assists" according to the methods of our religion. My religion suggests that you are an immortal spiritual being. You are not an animal but you do inhabit an animal body that limits your awareness, your intelligence, etc. Does that indicate to you? More information.
Just yesterday, February 19th, Jean had a sudden realization -- from something I had learned and from her looking and reviewing events. Just several days earlier I was talking with an IV chelation MD I know and he mentioned that the first (only?) time he had a patient die, under his care, was when she started bleeding internally and he couldn't stop it -- it was from taking and using Naproxen (Aleve).
Jean has been taking Naproxen -- a prescription drug for pain relief from arthritis. This is another of those actions I might have felt differently about, but she had lots of pain that led up to her knee surgery, and so did I leading up to my hip replacement. We were both taking this Naproxen. She had a prescription from her knee surgeon -- I was using the over-the-counter version.
She realized, yesterday, that the surgeon had warned her about Naproxen, emphatically, NOT to take it on an empty stomach. Well, she did take it, usually, on an empty stomach.
She would take it in the morning "before" breakfast. Breakfast usually followed by less than 30 minutes, but she certainly did violate the doctor's instructions. Apparently the prescription papers from the drug store also warn the patient to take Naproxen only with food in the stomach.
We realized, too late, that these Naproxen tablets could well be getting stuck in her esophagus when she took them -- not enough stuff to cause vomiting, but leaving them to dissolve in an area where I had learned the tissues (of the esophagus) are much more delicate that the tissues in the stomach. Thus, if she swallowed a Naproxen before breakfast, and if it never got into the stomach, but stuck at the end of the esophagus, these tablets could be causing considerable damage to the inner lining of the esophagus. The tablet could dissolve, cause damage, and then be vomited up with food from breakfast, or perhaps some swallowed. In any event she has not seen these tablets in the material that has been vomited up. She also takes regular vitamins AT the breakfast table, with food, and these have often been among the material vomited up. The Naproxen was always taken "upstairs" before breakfast -- not WITH breakfast.
We now think that is what happened. This damage could include causing the inflammation which the endoscopy found -- I think that this Naproxen may even have caused or contributed to the growth of that "mass." If this is true, we have an immediate treatment: "Stop using Naproxen!" Jean has not yet done this. She is now very careful to take this drug ONLY when there is food in the stomach. That wouldn't mean "instant healing" but it should mean "instant elimination of the irritation of the tissues."
This is good news, of course, because it gives an explanation other than cancer for some of what the doctor found in the endoscopy. The doctor may have known that Jean was taking Naproxen, but he certainly did NOT know that she was taking it on an empty stomach -- or he might have considered that the inflammation was caused by that, and even suggested some treatment for that problem rather than an "unexplained inflammation."
As soon as Jean thought of this, she discontinued taking Naproxen on an empty stomach. She continues taking the large dose of Germanium, Aloe Vera Gel several times each day, takes as many Taheebo Capsules as she thinks she can swallow, and drinks about two protein drinks (each with a raw egg) per day. Each of those drinks provides about 40 grams of protein -- 80 total. You can survive quite well with about 60 grams of protein per day, so she may lose more weight just now, but she should be well nourished. She takes some vitamins, but feels that they are likely to get caught in the throat.
I have quit taking Naproxen also. I had quit using our herbal MSM for some reason and now have gone back to using that for my hip pain. (I have a second hip replacement planned for sometime in the next few months.)
I end off my writing here, now, on Friday, February 20th. I'll write more after we have seen the doctor, discussed the CAT Scans, and I plan also to write a report TO the doctor, from Jean, about the Naproxen. (I did not -- we told him, only.) I want the doctor to have this possible explanation from us, in writing, so that he can't say we didn't tell him.
It
is hard to show anger or disagreement with a doctor when we may have to put
Jean's life in his hands if he recommends, and she accepts, a proposed surgery
to remove that mass. (I suppose this was the reason I decided, finally, to
NOT give him a written report on the Naproxen -- it shows a lack of trust to
insist that he read something.) It turns out that he is NOT the doctor who does the
surgery -- someone else. But, the concept is still applicable. You
can feel angry about the "medical system" but when you are about to be lying on
a gurney, mostly unconscious, with the doctor holding a knife over your belly,
you may decide to be very polite while talking to him before!
Right now Jean feels that the surgery is probably necessary. I, personally, may have been more willing to allow the Germanium longer to shrink that mass, but it is NOT my body -- I support her decision. I give her data, my opinion only very gently, and accept her decisions.
Oh, Jean called the doctor's office to confirm the time for Monday's appointment. It is often true that the nurses at a doctor's office are very casual about things that are extremely important to a patient. The nurse, "innocently," asked Jean if, "Has the doctor scheduled your visit to the surgeon yet?" (In fact, it turned out that the doctor's office was so sure of what were her next steps that they immediately requested insurance authorization for the next two specialists -- and had even started FAXing data to them -- without an actual appointment being made.)
That was a shock -- you don't expect to get a recommended treatment from the nurse, and we certainly wanted to hear a full story, not this comment that made it look like the matter was already decided.
I figured then, that the doctor really didn't care whether it was cancer or not cancer, he would recommend surgery anyway, and wanted to get us out of his time-slot visit as efficiently as he could -- so, on Monday we expect him to "announce" that Jean must have surgery -- no matter what the biopsy diagnosis is.
The problem with that is that IF there is cancer, then we need some further very vital information:
We just couldn't imagine going ahead with surgery without having these and other questions asked and answered. But, we did NOT get all these questions asked!
Since the doctor we were to visit was NOT the doctor to do a surgery, should we be asking THAT doctor these questions?
I felt that we had fallen into the "medical system" even
though I felt, also, that I know a lot about it. It seems that the entire
medical system is designed to move you along on a conveyor belt into the next
medical procedure, and the next insurance coverage. There doesn't seem to
be much room for personal opinion or decision. These may be very valid
conclusions, but the further you get into the medical system the much more
likely you will become accepting of it -- there seems little alternative.
Many people feel that the "medical system" treats them as an object to be moved along. With my more than 25 years of writing about this, I can tell you that it is very different when it is YOU on that conveyor belt. I felt that I was protected by my knowledge and already-formed opinions on these matters. When you ask a doctor for "help" you naturally feel that you have to accept the conditions in which he gives it. The system has captured the doctor as much as his patients -- the conveyor belt!
If this can happen to US, what will happen to someone who has less knowledge of the medical system?
We have seen the doctor, heard about the CAT scan, and presented him with the data about the Naproxen. The following was published less than three hours after visiting the doctor!
The most significant new information we received was the certainty of the diagnosis of cancer!
It was interesting how this came about.
On the phone this doctor had said that the biopsy was "inconclusive." You have to learn what their "code language" is -- what these words mean to THEM.
Within a short time of arriving the doctor told us about the CAT scan results -- they were actually looking for signs of cancer in other parts of the body, but did come up with an exact size and location for the mass in the esophagus. The mass is about 3.7 x 4.2 cm. That is about 1 1/2 inches by 2 inches -- rather large. The actual CAT Scan report, dry and cold is:
THERE IS A MASS AT THE GE JUNCTION EXTENDING ALONG THE LESSER CURVATURE OF THE STOMACH CONSISTENT WITH A NEOPLASM.
....
There is mass involving the medial wall of the proximal stomach and distal esophagus. At the GE junction the mass measures up to 4.7 cm x 3.8 cm. The medial gastrie wall thickening extends along the lesser curvature. No obvious ulcer is identified. There appear to be small lymph nodes around the celiac axis. These are of unknown significance. A small portaecaval lymph node is also seen. The abdomen is otherwise unremarkable.
Benign esophageal neoplasms are very rare. In a large autopsy study, there were 90 cases out of almost 20,000 autopsies, for a prevalence of 0.5%. Esophageal tumors may be classified as intraluminal, intramural or extramural. Benign tumors of the esophagus are more common in men than in women, and typically present after age 40. (Source)
He made remarks about the CAT scan, then went on to start "explaining" the term "inconclusive" by referencing that the biopsy sample was SO small that it was almost impossible to be absolutely certain about a cancer diagnosis, but he did say that there was virtually NO chance that a mass of this size, in this location, was anything other than cancer.
So, from the first examination, the endoscopy, and the report on the mass and estimate of the size, I feel he was quite certain that it was cancer, but for a variety of "polite and gentle" reasons he did not want to say that on the phone. Apparently there is some tiny chance (probably less than 0.5%) that a mass this size is not cancer. In any event he said that the only treatment that anyone would now suggest would be on the basis that it was cancer -- so he had already gotten the insurance authorization for the visit to the surgeon and the oncologist!
Esophageal cancer is devastating for the patient and family. The prognosis is poor, and dysphagia, regurgitation, and pain can profoundly diminish the patient's quality of life. However, survival rates are improving. About 35 years ago, only 1% of African American patients and 4% of white patients survived 5 years after diagnosis, compared with 9% of African Americans and 13% of whites today (1). Esophageal cancer is almost three times more common among African American men than white men, and it is three times more common among men than women. In 1998, the esophagus was one of the 10 leading sites causing cancer death among men (1). The American Cancer Society estimates that 11,900 patients died of the disease and 12,300 new cases occurred in 1998 (1). In addition to primary disease, the esophagus is occasionally the site of secondary metastasis or direct extension of tumors of the hilum of the lung. (source)
The doctor did NOT give us his opinion as the above quote. Doctors do NOT like to deliver bad news so if you want the truth, you must ask or do alternative research.
You walk into the doctor's office with a great deal of hope, based on a small amount of data and a feeling that, "It can't happen to me!" Then, in one brief comment the doctor dashes your hope with his reality. I still think the "reality" is worth confronting.
However, as the tumor increases in size, patients begin to experience difficulty swallowing. Difficulty swallowing, the most common symptom, worsens as the tumor enlarges and begins to obstruct the normal flow of swallowed food. At first, one notices difficulties with meats, breads and fresh vegetables but as the cancer progresses, even liquids can become difficult to handle. Other problems associated with esophageal cancer are pain behind the breastbone and frequent, painful bouts of coughing or hiccups. In addition, weight loss and breath odor can be signs of an advancing esophageal malignancy. (Source)
That is probably what you should expect if you ever follow this path -- endoscopy -- mass -- swallowing problems.
He told us lots of other stuff, too.
I'll come to that, but the next most valuable advice I can give is this. I suspect that doctors like this are increasingly receiving hostility from patients who have very negative opinions about the slash/burn/poison standard of care for cancer. The hostility, if expressed, will turn his willingness off -- to give data of almost any kind. The motto is probably, "give them the hard reality, but don't give them any data which might raise their hopes!"
So, when we left his office I made a deliberate point of turning to him, smiling, thanking him (sincerely) and shaking his hand. I suspect that is unusual from a patient, or even more unusual from the spouse who may be angry at a doctor for such a diagnosis.
Several minutes later I went back to ask his nurse another question, he was there, and he seemed more friendly and more willing to give me data. The data was not more encouraging, but when you have had this diagnosis you are hungry for as much data as you can get.
During this visit I mentioned "Barrett's Esophagus" and that was MY code word to let him know that I had some somewhat specialized knowledge in this area. You wouldn't want to appear haughty or superior, but using one of these specialized words probably helps establish that the doctor can be "straight" with you.
The normal esophagus (swallowing tube) is lined by a pinkish-white tissue called squamous epithelium. Some people also have red stomach tissue (normal columnar epithelium) present in the bottom part of the esophagus. Barrett's esophagus is a condition in which the normal squamous epithelium of the esophagus has been replaced by an abnormal red columnar epithelium called specialized intestinal metaplasia. Specialized intestinal metaplasia is red, like normal stomach tissue, but does not look like stomach tissue under the microscope. Therefore, a biopsy (a piece of tissue taken from the esophagus) is needed to diagnose Barrett's esophagus1-3. (Source)
When I asked if there were any evidence of "Barrett's Esophagus" it actually caused him to pause. He said that was only detected from a special stain done of the tissue sample, and he didn't know (??) if that had been done. I actually had him looking through the medical file to see if that test had been done. It had NOT been done, but he then said that once there is a mass found it is no longer useful to look for Barrett's Esophagus -- that Barrett's Esophagus undoubtedly was there, much earlier, but by this time the "cancer" had become evident.
Barrett's Esophagus is a condition of the esophagus tissues that predicts cancer, but is not a sign of cancer in existence. It is a sign that damage has been done to the esophagus, but not that cancer is yet present. Since there is usually no pain or other symptom connected with Barrett's Esophagus, detection of it is usually accidental (if early) or too late.
I had learned earlier, I thought, that the dilation done during the endoscopy was not something you would then repeat much. We learned, this day, that there is an expectation that the dilation does NOT result in much of an increase in the opening, or any permanence of that opening, the "first time" and that it was not unusual to schedule several dilations (with an endoscopy each time) to get larger and larger, and more a permanent opening.
So apparently the mass was the primary reason for the closure of the door at the end of the esophagus, not some failure of the sphincter muscle. Pushing the mass outward, to increase the size of the opening, is apparently not all that useful when the mass is fairly large. In any event, there is an option which "someone" could suggest, of a series of more dilations (certainly less invasive and dangerous than either surgery or radiation!).
He also described a "mesh" that can be inserted to hold the esophagus open. This is something like a "stent" in the artery. It actually sounds pretty good to us -- if the mass can be handled as to cancer with the seed-type radiation, and use the mesh to keep the esophagus open enough to eat -- then no surgery would be urgent and slower alternative methods (including Germanium and Aloe Vera Gel) could be used to restore health to the tissues.
He described possible treatments -- saying that it would be up to a surgeon to decide whether or not surgery should be the first option. I have some data in these pages that it is not unusual for a surgeon to say that some radiation treatment should be used "first." We have an appointment with the surgeon for Wednesday, March 3, 2004 -- the same day this page is linked to my newsletter. So, some people may be reading this when we have not yet talked to the surgeon.
We will be making an appointment with the oncologist in a few more hours -- for some unknown date.
Jean told this doctor of her great reluctance to undergo either radiation or chemotherapy.
She was willing to have the surgery -- thinking that this would allow her to swallow, again, and be less harmful than chemo or radiation.
I don't know if this is true, but after indicating this reluctance this doctor described one of the complications that might occur during surgery -- below -- it sure made the surgery sound very unattractive -- and perhaps he had some motive to push her in the direction of accepting the radiation first??
There has been SO much negative publicity on radiation, and so much actual damage caused by it, that I am sure the medical profession has been looking for "safer" radiation procedures. This doctor described what is probably the usual method.
The put a tube down the throat, very similar to an endoscopy, and then insert a "radioactive seed" down the tube and into (?) the mass, apparently for a short time -- then pull it out and up. This small "seed" can be designed for the right size and dosage they think is "right." The hope is that the radiation is most strong in the middle of the mass, and that it doesn't "leak out" much further. I will certainly be doing more research on that.
They might do a dilation at the same time. This type of treatment might, then, be repeated every several weeks, looking for control (death ?) of the cancer mass and more permanent opening of the esophagus. If this "works" then perhaps surgery is not necessary.
This might also be the sequence which the surgeon wants to see -- use some radiation to stop the cancer metastasis, growth, and when it is then relatively safe, start cutting the mass out -- not so much, perhaps, to remove a cancer, but to remove a mass that is pressing on the esophagus.
The "horrible" description of the surgery? Apparently the surgeon cannot tell until he starts cutting what is the condition of the tissues. After he removes the mass, he may have to "repair" the esophagus. If the tissues of the esophagus are not in good enough shape, he can "harvest" some tissues from the stomach lining -- and re-construct them into an esophagus -- I suppose that leaves the stomach smaller.
If there is not enough stomach lining to do this, or if there is damage to the stomach, then he "harvests" pieces of the colon and uses that to re-construct the esophagus. I will be looking for more information on this procedure, but it sure sounds grim. I have no idea, yet, on what shape that leaves you for elimination.
As I said, the doctor may be attempting to scare you by describing such a grim surgical procedure that you are willing to try radiation. I don't must trust doctors, but when you are in their hands you have little choice.
I'll write more as I recall it, or research it, and will be adding quite a bit more to other pages in this section, and to this page.
If you are inclined to contact Jean Ross, my wife, please do NOT send sympathy -- that is never a helpful thought. Advice is OK. In fact I've decided to publish some of the suggestions we receive -- here. Also, she has a treatment planned, primarily using germanium and a few other things, but probably going on through the radiation, first, then surgery if necessary, and does NOT particularly want or need people to argue with her on any of this. It is her decision and I grant her the beingness to make that decision.
Jean's current home treatments rely considerably on germanium -- she takes about 4 teaspoons per day -- or about 8 full grams. Dr. Asai suggests 2 grams for cancer treatment. We will be using this dosage for some time.
Jean cannot swallow capsules, but the Taheebo may be added at some point.
Here is a promising substance not yet used, selenium, probably 1 gram, at least, which is quite a bit more than the RDA:
This remarkable degree of consistency for the inverse associations strengthens the likelihood of a causal relationship between low selenium status and an increased risk of cancer mortality. (Source)
Jean is probably willing to have the "seed radiation" and then esophagus mesh, if that is available. Further dilations, as done in the endoscopy, are probably lease invasive of the options.
Treatment of a malignant stricture of the esophagus is available but can often be disappointing. If the malignancy is determined to be small and localized without any spread beyond the esophagus then a surgical repair is often opted for and may, on rare occasion cure the cancer. If the tumor is not curable, then often, palliative treatments are employed which include chemotherapy, radiation therapy, esophageal dilation, laser treatments, injections, tumor probes or placement of an esophageal stent (wire mesh tube) to keep the esophagus open. In any situation the patient must work closely with his or her physician to decide what is the best approach for that individual since it varies from patient to patient. (Source)
Surgery would be a second choice, if the above is not likely to help.
Surgery for cancer has vastly better success rates in hospitals that do many such procedures:
Esophageal resections were performed in 273 hospitals [in California -- 1990 - 1994]. An average of two or fewer resections were performed annually in 88% of hospitals, which accounted for 50% of all patients treated. The mortality rate in hospitals with more than 30 esophagectomies for the 5-year period was 4.8%, compared with 16% for hospitals with fewer than 30 esophagectomies. This could not be accounted for by other health variables affecting the patients' risk for surgery. There was a striking correlation between a hospital's frequency of esophagectomy and the outcome of this operation. The results support the proposition that high-risk general surgical procedures, such as esophagectomy for malignancy, should be restricted to hospitals that can exceed a yearly minimum experience. (Source)
Alternative and non-standard forms of treatment that I have been researching include the following:
The DETECTION of cancer at an early stage is an important element of effective treatments. One of the reasons that detection techniques have suffered is that the US Drug Industry has controlled this area. An even bigger reason is that these newer techniques often cost much more money than standard techniques and would bust through the top of insurance coverage. Research and use of these techniques is often quite "standard" in countries where insurance does not dominate the standards of medical care.
Even when detection is no longer an issue, there are other measurements of an existing cancer which can be done with modern "markers" and help inform the patient. For instance, when a cancer is fast or slow growing it tells the patient how much time he or she may have to look for alternative forms of treatment. This type of detection is available, but not significantly in the US.
I'll be adding more ABOVE, as we move through a doctor's appointment for March 3rd, one for March 6th, another not yet scheduled, and other standard medical consultations.
But, I am ready, now, to write BELOW what our major conclusion has been -- there has been enough, described above, for us to apply the motto I've written about: "When the Student Is Ready, The Teacher Will Appear!"
I am constantly finding evidence of the lies published by "authoritative sources." I expose them in my writings. If someone is totally within the clutches of the "system," he won't read my stuff. But, as soon as the "student is ready, I will be there -- appear." I have, myself, been a student through these 30 years of writing, and only because of the recent events described on this page have I learned something more basic than I knew about "the student being ready."
When
the student is ready, the teacher will appear.
The teacher could be lost in the wilderness, and not "appear" with any prominence.
Not me! I have 100,000 web pages, and get extremely high rankings for dozens of topics entered into search engines. I am out there where everyone can find me. I have appeared! If the student is ready, he will find me.
As a result of this experience with Jean I have found myself to be a much more "ready" student -- and offer you my new viewpoints. Perhaps you are a student, finding these pages?
As you travel through the many steps that follow some minor difficulty with swallowing to a major concern that there is a cancerous mass you will probably, as did I, cling to false hopes and turn a blind eye to some realities -- until, finally, the messages get through. I had not thought this to be true for me, but I now do: That you need to confront the fact that you are mortal, approaching death and that, along that way, there can be some unpleasant detours.
But, I have found, when you take a very clear look at the road ahead, with all its potholes and rocks, you may well have the incentive to look for the better way.
We are going to continue talking to the traditional doctors, but expect to find any way we can to slow down their instance of rapid surgery and radiation -- now finding new hope in alternatives.
I have increasing confidence, now, that we have found that better way -- I will be writing about that extensively.
That better way starts with appreciation for the importance of ONE WORD -- Oxygen! Let that be enough of a message for now and here -- but there is much more I will be writing.
The normal esophagus (swallowing tube) is lined by a pinkish-white tissue called squamous epithelium. Some people also have red stomach tissue (normal columnar epithelium) present in the bottom part of the esophagus. Barrett's esophagus is a condition in which the normal squamous epithelium of the esophagus has been replaced by an abnormal red columnar epithelium called specialized intestinal metaplasia. Specialized intestinal metaplasia is red, like normal stomach tissue, but does not look like stomach tissue under the microscope. Therefore, a biopsy (a piece of tissue taken from the esophagus) is needed to diagnose Barrett's esophagus1-3.
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Normal Esophagus and Stomach The esophagus passes through a hole in the diaphragm (breathing muscle) where it joins the stomach. The entire stomach is within the abdominal cavity, below the diaphragm. |
Inside the Normal Esophagus and Stomach The entire esophagus is lined by normal squamous (shown here as light pink). The stomach is lined by normal columnar lining (shown here as dark pink). The region where the normal squamous esophageal lining joins the normal columnar stomach lining is called the squamocolumnar junction. |
The Barrett's lining always begins at the bottom of the esophagus where the esophagus joins the stomach and extends upward toward the mouth for varying lengths. Some Barrett's linings are short, less than 3 cm (1.3 inches) in length, and some are long (greater than 3 cm in length).
Hiatal Hernia
Most people with Barrett's esophagus have a hiatal hernia. However, hiatal hernias are very common and most people who have a hiatal hernia do not have Barrett's esophagus4.
There is an opening in the diaphragm (breathing muscle between the chest and the abdomen) through which the esophagus passes from the chest cavity into the abdominal cavity where it connects to the stomach. Normally, the stomach is entirely within the abdominal cavity, below the diaphragm. In some people the top part of the stomach may pass backwards through this opening in the diaphragm and into the chest cavity. This portion of the stomach which has moved into the chest cavity is called a hiatal hernia.
A hiatal hernia may be important as a cause of GERD (backwashing of stomach acid and bile into the esophagus) but its role is uncertain. It is believed that a hiatal hernia weakens the lower esophageal sphincter (the valve at the bottom of the esophagus that keeps stomach contents out of the esophagus). This is because the lower esophageal sphincter (LES) has moved away from the diaphragm that provides part of its surrounding muscular function. Also, acid may become trapped in the hiatal hernia and continue to wash back into the esophagus1-4.
The chance of having a hiatal hernia increases with age, as does GERD5,6. Most people with GERD have a hiatal hernia, but, most people who have a hiatal hernia do not have symptoms of GERD7,8. People who have Barrett's esophagus tend to have larger hiatal hernias than people with less severe GERD or people who don't have GERD at all9.
 |
| Hiatal Hernia The diaphragm (breathing muscle) separates the abdominal cavity from the chest cavity. Normally the entire stomach lies within the abdominal cavity. In this illustration, a small portion of the stomach has moved backwards through the opening in the diaphragm and into the chest cavity. This small portion of stomach above the diaphragm is referred to as a hiatal hernia. |
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 |
 |
| Inside the
Normal Esophagus with Hiatal Hernia The entire esophagus is lined by normal squamous (shown here as light pink). The stomach is lined by normal columnar lining (shown here as dark pink). The region where the normal squamous esophageal lining joins the normal columnar stomach lining is called the squamocolumnar junction. In this case, the squamocolumnar junction has moved up from the diaphragm because of the hiatal hernia. |
Inside a Short
Segment Barrett's Esophagus A short length of Barrett's esophagus is seen between the top of the hiatal hernia and the normal squamous esophagus. In this case, the squamocolumnar junction is made up of normal squamous esophageal lining on one side and Barrett's esophagus (specialized intestinal metaplasia) on the other side. The Barrett's esophagus must be confirmed by biopsy. |
Inside a Long
Segment Barrett's Esophagus A long length of Barrett's esophagus is seen between the top of the hiatal hernia and the normal squamous esophagus. The squamocolumnar junction has moved a great distance away from the diaphragm due to the long segment of Barrett's esophagus (specialized intestinal metaplasia). The Barrett's esophagus must be confirmed by biopsy. |
Esophageal Adenocarcinoma (cancer)
Barrett's esophagus is a pre-malignant (precancerous) condition5-8. This means that the Barrett's lining is more prone to developing cancer than other normal tissues of the body. The type of cancer that develops in Barrett's esophagus is called esophageal adenocarcinoma. Since the 1970's, this cancer has been rapidly increasing in Western Europe and the United States9-18. Esophageal adenocarcinoma now accounts for 60% of all esophageal cancers in the U.S. with an estimated 8,000 new cases diagnosed per year19.
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| Only specialized intestinal metaplasia of the esophagus is classified as Barrett's esophagus. At the present time it is recommended that only patients with this diagnosis undergo periodic cancer surveillance. |
People who have Barrett's esophagus have a 30 to 40 fold increased risk of developing esophageal adenocarcinoma as compared to the general population6-8,20-24. Still, the overall cancer risk in patients who have Barrett's esophagus is low. The results of multiple studies of patients who are being followed by a doctor for their Barrett's esophagus indicate that most patients with Barrett's esophagus (90-95%) DO NOT develop cancer during long-term follow-up3-5,18,20,23-25. In addition, autopsy studies have shown that most patients who have Barrett's esophagus live their lives without ever developing Barrett's associated cancer and die of other causes26.
Definition of Barrett's Esophagus
The definition of Barrett's esophagus has changed since the condition was first
described in 1950 by the British surgeon, Norman Barrett. Dr. Barrett proposed
that the red-colored esophagus seen in some patients was actually part of the
stomach and that these patients were probably born with a short esophagus (due
to the short length of the white esophageal lining)27.
Later, Barrett's
esophagus was defined as any red esophageal lining (columnar epithelium),
including normal stomach lining, of 3 cm or greater in length21,28,29.
We now know that it is only an abnormal columnar lining in the esophagus called specialized intestinal metaplasia that can develop esophageal adenocarcinoma, NOT the columnar stomach lining that can sometimes be present in the esophagus. Both types of these columnar linings look red by upper endoscopy, a procedure performed by a gastrointestinal doctor to examine the esophagus. To confirm that a red lining in the esophagus is indeed specialized intestinal metaplasia, the doctor must take a biopsy (a piece of tissue from the lining) and send it to the pathology lab for histologic analysis (examination of the tissue under a microscope)5,31,32.
According to the American College of Gastroenterology guidelines, Barrett's esophagus should now be defined as "a change in the ESOPHAGEAL epithelium (lining) of ANY LENGTH that can be recognized at upper endoscopy and is confirmed to have intestinal metaplasia by biopsy."5 This definition makes the distinction between normal stomach lining that can be present in the esophagus and the abnormal specialized intestinal metaplasia. The new definition also emphasizes that the intestinal metaplasia must be esophageal in location. Many patients have intestinal metaplasia at the very top of the stomach, just below where the esophagus ends (intestinal metaplasia of the gastric cardia). Intestinal metaplasia in this location is NOT classified as Barrett's esophagus and cancer screening is NOT recommended31. At the present time, it is recommended that only patients who have specialized intestinal metaplasia of the esophagus need to undergo endoscopic biopsy surveillance (cancer screening procedure) to detect esophageal adenocarcinoma, if it develops, at an early and curable stage5,31,32.
Fortunately, the results of multiple studies of patients followed for many years, indicate that about 90-95% of patients who have Barrett's esophagus DO NOT develop cancer1-13. It is not known why some people who have Barrett's esophagus get cancer, while the majority do not.
Chronic Heartburn (GERD)
Chronic heartburn (or
GERD -
gastroesophageal reflux disease) is the most important risk factor for the
development of adenocarcinoma of the esophagus (Barrett's cancer). It has been
shown that the risk of cancer increases in proportion to how often you get
heartburn symptoms and the length of time that you have had a problem with
heartburn14.
In other words, the more frequent
your heartburn symptoms and the greater the number of years you have had
heartburn, the greater your risk of cancer. In one large study of heartburn and
the development of adenocarcinoma of the esophagus, the majority of patients who
had esophageal adenocarcinoma also had Barrett's esophagus14.
Others have shown that the majority
of patients who have chronic GERD and develop esophageal adenocarcinoma also
have Barrett's esophagus. What this probably means is that the more heartburn
you have, the more likely you are to develop Barrett's and it is the Barrett's
esophagus that increases the risk of developing cancer. No one knows whether
Barrett's esophagus patients who continue to have GERD have a higher risk of
developing cancer as compared to Barrett's esophagus patients whose GERD is
controlled with
medication
or
anti-reflux surgery. There is certainly no convincing evidence that
controlling heartburn symptoms with medication or anti-reflux surgery prevents
the development of cancer in Barrett's esophagus.
Family History
It does not appear that having a close relative with esophageal adenocarcinoma significantly increases your risk of developing esophageal adenocarcinoma. There are at least three recent studies looking at relatives of patients who developed esophageal adenocarcinoma and these studies reported that having a close relative with esophageal adenocarcinoma did not increase the risk of developing esophageal adenocarcinoma15,16.
Length of Barrett's Segment
The length of your Barrett's esophagus segment may
be a risk factor in the development of esophageal adenocarcinoma9,17,18.
Longer segments may be at increased risk, however, some studies have not shown
this increase to be significant and short segments can also progress to cancer19,20.
Diet
A diet high in fat and low in fruits and vegetables has been associated with the development of esophageal adenocarcinoma21-25. Alternatively, a diet high in vegetable fiber may be protective21.
Asthma, Smoking and Obesity
There are other factors that may increase the risk
of esophageal adenocarcinoma.
Asthma and
the use of asthma medications may also be associated with an increased risk of
esophageal adenocarcinoma.
Cigarette smoking
has been shown to be a significant risk factor for the development of esophageal
adenocarcinoma.
Obesity also appears to be a strong risk factor for esophageal
adenocarcinoma, especially in non-smokers and in younger patients. One recent
study suggests that it is actually the amount of fat around the abdominal area
(between the hips and chest) and not how fat you are in general, that increases
the risk of developing esophageal adenocarcinoma in Barrett's esophagus. This
study found that in Barrett's esophagus patients, the greater the size of the
abdominal area compared to the size of the hips, the greater the chance of
having
genetic abnormalities and
flow
cytometric abnormalities in the Barrett's cells that are associated with an
increased risk of developing esophageal adenocarcinoma26.
Alcohol Consumption
Alcohol
consumption does not appear to increase the risk of adenocarcinoma of the
esophagus. Consumption of wine,
aspirin (NSAIDs),
and the presence of certain strains of the bacterium
H. pylori,
may be protective and lessen the risk of esophageal adenocarcinoma. Heavy
alcohol use is NOT recommended and increases the risk of developing another type
of esophageal cancer called squamous cell carcinoma of the esophagus.
Whether or not you have any of the above suspected risk or protective factors for esophageal adenocarcinoma, if you have Barrett's esophagus, the ONLY way to know if you are at increased risk of developing cancer is to undergo periodic endoscopic biopsy surveillance.
Current page: If I have Barrett's esophagus, will I get cancer?
Next Page:
What is endoscopic biopsy surveillance?
or:
What are the treatments options for high-grade dysplasia in
Barrett's?
BENIGN ESOPHAGEAL NEOPLASMS
August 26, 1993
Benign esophageal neoplasms are very rare. In a large autopsy study, there were 90 cases out of almost 20,000 autopsies, for a prevalence of 0.5%. Esophageal tumors may be classified as intraluminal, intramural or extramural. Benign tumors of the esophagus are more common in men than in women, and typically present after age 40.
Leiomyoma is the most common benign esophageal neoplasm. In the largest review of leiomyomata of the esophagus, the male to female ratio was 1.9 to 1, and age range was 12 years to 80 years, with a mean of 44 years. Over 50% of patients were asymptomatic; these tumors were discovered in autopsy review, or on routine radiographic examination. In symptomatic patients, dysphagia and vague pain were most common, and symptoms had been present for more than 2 years in 60% of patients. The majority of leiomyomata are found in the lower one-third of the esophagus, and 97% are intramural.
Leiomyomas have a characteristic appearance on barium swallow: a smooth, crescent-shaped defect covered by smooth mucosa. Esophagoscopy should also be performed in all cases. The characteristic endoscopic appearance is a submucosal bulge without actual stenosis, and the lesion is usually movable through the endoscope. Biopsy through the intact mucosa is not recommended if radiographic and endoscopic exams are consistent with leiomyoma because of subsequent ulceration and inflammation, which complicates eventual surgical removal.
The recommended treatment for esophageal leiomyoma is transthoracic enucleation of the tumor. The muscular layer of the esophagus is split, and the tumor enucleated with submucosal dissection. Violation of the mucosa carries the risk of wound contamination with digestive tract flora, as well as possible fistula formation. Esophageal resection with reanastomosis is necessary only in very large tumors, annular tumors, or those densely adherent to larger areas of mucosa.
The second most commonly reported benign tumor of the esophagus is the intraluminal polyp. In contrast to leiomyomas, 80% of these occur in the upper esophagus, and are often closely associated with the cricopharyngeus muscle. Esophageal polyps occur in men 75% of the time, and typically occur in the 6th and 7th decade. There have been several pathologic diagnoses for esophageal polyps, including fibroma, fibrolipoma, pedunculated lipoma, and fibroepithelial polyp, but these are now all considered under the name "fibrovascular polyp" as they have essentially the same histologic findings. There are several reports of polyps more than 15 cm in length, and in some cases, polyps have extended down to the gastroesophageal junction.
The most common symptom at presentation is dysphagia, but regurgitation of the polyp, regurgitation of recently digested food, and sensation of lump in the throat have all be reported. Weight loss and anorexia are also seen, although odynophagia is uncommon. There are several reports of asphyxia and death due to polyp regurgitation and subsequent airway obstruction. The two most common methods of diagnosis are barium swallow and esophagoscopy, and both are usually necessary. Biopsy is not recommended if the characteristic findings are present on esophagoscopy, because these polyps are quite vascular.
Surgical excision of esophageal polyps using an external approach has yielded typically excellent results. Most authors recommend a transcervical approach with a vertical esophagotomy.
Squamous papilloma of the esophagus is also reported. Although it is reported as a rare lesion in the Radiology literature, it is seen more commonly in some GI literature. It is seen more frequently in men (3:1), the mean age is 53.8 years, and the age range is broad (14-79). Most are asymptomatic, although they may cause dysphagia. The most frequent location is the posterior wall of the lower third of the esophagus, and the lesions are usually isolated. Endoscopically, the papilloma is a warty, polypoid mass that is firm to touch. The etiology of esophageal papilloma is unknown. It is unclear whether this represents a true neoplasm, or only reactive change.
Other reported benign neoplasms of the esophagus include a recent report of a recurrent schwannoma of the upper esophagus that mimicked fibrovascular polyp in both symptoms and barium swallow findings. This lesion was treated with cervical esophagotomy and excision. Granular cell tumor is also reported in the esophagus, although it is more commonly seen in the tongue, skin, and subcutaneous tissue. Hemangioma of the esophagus is also reported. Massive blood loss after biopsy is possible, and should be considered before biopsy of any soft, vascular mass.
Finally, extrinsic compression may mimic a benign esophageal neoplasm. Cervical osteophytes, lymphadenopathy, thyromegaly, aortic aneurysms, and left atrial enlargement are among the reported causes of extrinsic esophageal compression.
In summary, benign neoplasms of the esophagus are rare lesions, but should be considered in the differential diagnosis of dysphagia. The most common lesion is leiomyoma, which is an intramural tumor. It is usually found in the lower third of the esophagus, and presents with dysphagia or as an incidental finding. Diagnosis is made with barium swallow and esophagoscopy, and treatment is surgical excision with enucleation of the tumor. The second most common benign neoplasm reported is fibrovascular polyp. These are usually in the upper third of the esophagus, and present with dysphagia or regurgitation of the polyp. Diagnosis is made by barium swallow and esophagoscopy, and biopsy and snare removal are not recommended. Treatment is surgical excision using the transcervical approach. Squamous papilloma and granular cell tumors are very rare, and are often incidental findings in asymptomatic patients.
Case Presentations
A 67-year old white male presents with a 2-year history of intermittent choking, especially while supine. He reported the sensation of "something stuck in his throat that would block his breathing." He reported that he had actually regurgitated a fleshy mass into his mouth, but had to swallow it because of respiratory distress. He was seen at a medical center in another city, where he underwent a barium swallow, esophagoscopy and laryngoscopy, which were all reported as normal. He was advised to seek psychiatric counseling for "anxiety attacks."
He was referred to a gastroenterologist at The Methodist Hospital for a second opinion. He underwent a barium swallow, which revealed a smooth, polypoid, mobile lesion in the upper esophagus. He then underwent esophagoscopy, with an anesthesiologist on standby for potential airway complications. At esophagoscopy, the patient had a large mucosa-covered polypoid lesion, consistent with fibrovascular polyp, which arose from the hypopharynx. No biopsy or snare removal was attempted, and the patient was referred to the Otolaryngology service for surgical management. He underwent neck exploration, vertical cervical esophagotomy, and excision of a large fleshy polyp. Pathologic examination revealed fibrovascular polyp.
Bibliography
Alberti-Flor JJ, Dunn GD, Karl M, Halter S, Krueger TC. Large hypopharyngeal polyp producing intermittent dysphagia and acute airway obstruction. Am J Gastroenterol 1986;81:721-723.
Allen MS, Talbot WH. Sudden death due to regurgitation of a pedunculated esophageal lipoma. J Thorac Cardiovasc Surg 1967;54:756-758.
Avezzano EA, Fleischer DE, Merida MA, Anderson DL. Giant fibrovascular polyps of the esophagus. Am J Gastroenterol 1990;85:299-302.
Berardi RS, Devaiah KA. Barrett's esophagus. Surg Gynecol Obstet 1983;156:521-538.
Cochet B, Hohl P, Sans M, Cox JN. Asphyxia caused by laryngeal impaction of an esophageal polyp. Arch Otolaryngol 1980;106:176-178.
Cohle SD, McKechnie JC, Truong L, Jurco S. Granular cell tumor of the esophagus. Am J Gastroenterol 1981;75:431-435.
Colina F, Solis JA, Munoz MT. Squamous papilloma of the esophagus. Am J Gastroenterol 1980;74:410-414.
Eberlein TJ, Hannan R, Josa M, Sugarbaker DJ. Benign schwannoma of the esophagus presenting as a giant fibrovascular polyp. Ann Thorac Surg 1992;53:343-345.
Henderson RD. Management of the patient with benign esophageal stricture. Surg Clin North Am 1983;63:885-903.
Herrera JL. Benign and metastatic tumors of the esophagus. Gastroenterol Clin North Am 1991;20:775-789.
Jang GC, Clouse ME, Fleischner FG. Fibrovascular polyp: a benign intraluminal tumor of the esophagus. Radiology 1969;92:1196-1200.
Koehler RE, Moss AA, Margulis AR. Early radiographic manifestations of carcinoma of the esophagus. Radiology 1976;119:1-5.
Lolley D, Razzuk MA, Urschel HC. Giant fibrovascular polyp of the esophagus. Ann Thorac Surg 1976;22:383-385.
Montesi A, Pesaresi A, Graziani L, Salmistraro D, Dini L, Bearzi I. Small benign tumors of the esophagus: radiologic diagnosis with double-contrast examination. Gastrointest Radiol 1983;8:207-212.
Nehme AE, Rabiah F. Ciliated epithelial esophageal cyst: case report and review of the literature. Am Surg 1977;3:114-118.
Nuwayhid NS, Ballard ET, Cotton R. Esophageal papillomatosis case report. Ann Otol Rhinol Laryngol 1977;86:623-625.
Parnell SAC, Peppercorn MA, Antonioli DA, Cohen MA, Joffe N. Squamous cell papilloma of the esophagus. Gastroenterology 1978;74:910-913.
Patel J, Kieffer RW, Martin M, Avant GR. Giant fibrovascular polyp of the esophagus. Gastroenterology 1984;87:953-956.
Petri JJ, Shapshay S. Squamous cell carcinoma in an esophageal polyp. Arch Otolaryngol 1981;107:192-193.
Plachta A. Benign tumors of the esophagus: review of literature and report of 99 cases. Am J Gastroenterol 1962;38:639-652.
Postlethwait RW. Benign tumors and cysts of the esophagus. Surg Clin North Am 1983;63:925-931.
Rosen R. Familial multiple upper gastrointestinal leiomyoma. Am J Gastroenterol 1990;85:303-305.
Seiden AM. Esophageal disorders. In: Paparella MM, Shumrick DA, Gluckman JL, Meyerhoff WL, eds. Otolaryngology, 3rd edition. Philadelphia: W.B. Saunders, 1991;2439-2481.
Seremetis MG, Lyons WS, deGuzman VC, Peabody JW. Leiomyomata of the esophagus: an analysis of 838 cases. Cancer 1976;38:2166-2177.
Shay SS. Benign structural lesions of the esophagus. Gastroenterol Clin North Am 1991;20:673-690.
Shockley WW. Esophageal disorders. In: Bailey BJ, ed. Head and Neck Surgery--Otolaryngology. Philadelphia: J.B. Lippincott, 1993;690-710.
Singer J, Heiken JP. Diagnostic imaging of the esophagus. In: Cummings CW, ed. Otolaryngology--Head and Neck Surgery. St. Louis: Mosby, 1992;2258-2287.
Truong LD, Strohlein JR, McKechnie JC. Gastric heterotopia of the proximal esophagus: a report of four cases detected by endoscopy and review of literature. Am J Gastroenterol 1986;81:1162-1166.
Watson RR, O'Connor TM, Weisel W. Solid benign tumors of the esophagus. Ann Thorac Surg 1967;4:80-91.
| Cancer of the Esophagus | ||||
The
presence of Barrett's esophagus is associated with increased risk of
developing an invasive cancer (adenocarcinoma).
Columnar epithelial dysplasia as seen in
Barrett's
esophagus is a premalignant lesion for adenocarcinoma. Adenocarcinoma
does not develop "out of the blue". Instead, adenocarcinoma in Barrett's
esophagus develops in a sequence of changes, from nondysplastic (metaplastic)
columnar epithelium, through
low-grade and then high-grade dysplasia (preancerous change detected
under the microscope) and finally invasive
cancer. This
makes early detection and early treatment a possibility.
Patients with Barrett's esophagus have a 30- to 125-fold increased risk of the development of esophageal cancer in comparison with the general population. The disease is most common in white males. At Johns Hopkins, patients with esophageal cancer are evaluated and treated by members of the Esophageal Multidisciplinary Group. This group consists of cancer specialists from the Departments of Medicine, Oncology, Radiology, Surgery, and Pathology. This group meets weekly to discuss treatment strategies for each patient. Approximately 30% of the esophageal cancers treated with pre-operative chemoradiation have no residual cancer cells in the excised specimen. These patients have prolonged survival over those treated by surgery alone. There are also several clinical trials currently available for patients with esophageal cancer. Each patient can be offered a trial best tailored to to provide benefits. The treatment of choice for a biopsy-proven early esophageal cancer is surgical resection where the intrathoracic esophagus (the part in the chest) must be removed. Esophageal adenocarcinomas can spread (metastasize) to any of several lymph nodes (lymph "glands") in the chest. As such, diagnosis of metastatic disease in these lymph nodes is best confirmed prior to surgical resection. A surgeon is best qualified to assess whether surgery is a possible option. When adenocarcinoma is detected at an early, usually presymptomatic stage in patients with Barrett's esophagus, the chance of surgical cure is high - 50 to 80%. The current treatment at Johns Hopkins for patients with invasive esophageal cancer is pre-operative chemoradiation followed by surgery. Each patient is staged (evaluated to assess the extent of disease) using various diagnostic tools, including CT scan, MRI, endoscopic ultrasound, and laparascopic examination prior to chemoradiation. What Does Esophageal Cancer Look Like?
This specimen is a segment of an esophagus and a portion of the stomach from a patient with high-grade dysplasia in Barrett's esophagus. The esophagus and stomach have been opened and the esophagus is the narrower area on the right of the frame. The inside lining is whitish on the right but appears reddish and velvety closer to the stomach. The reddish area is Barrett's esophagus. There is no tumor (mass) in this specimen, which showed high-grade dysplasia (severe pre-cancerous change) on microscopic examination.
This specimen depicts a cancer at the area of the junction between the esophagus and stomach. It is a large irregular mass. The objective of endoscopic surveillance in Barrett's esophagus is to detect these processes early on when there is a high probability for cure. |
Interactive Cardiovascular and Thoracic Surgery, Article 282,
(2003) pp. xxx
© 2003 Published by Elsevier B.V. All rights reserved.
PII: S1569-9293(03)00287-1
a
Department of Thoracic Surgery, Dicle University School of Medicine, 21280
Diyarbakir, Turkey
b Department of Gastroenterelogy, Dicle University
School of Medicine, 21280 Diyarbakir, Turkey
c Department of Pathology, Dicle University School of
Medicine, 21280 Diyarbakir, Turkey
Received 8 July 2003; received in revised form 30 September 2003; accepted 11 November 2003
A 51-year-old female patient was admitted to our department. She had symptoms of dysphagia, regurgitation of a fleshy mass into the mouth, and attacks of dyspnea. Every effort was made for diagnosis. At cervical exploration, upper esophageal polyp was discovered accidentally, and removed. We present this case because of rarity and to emphasize the clinical presentation. The physician should be aware of the presence of this rare esophageal tumor.
Keywords: Esophagus; Fibrovascular polyp
*Corresponding author. Tel.: +90-412-2488001; fax: +90-412-2488-520
Benign esophageal tumors are rare. They usually arise close to cricopharyngeus muscle. Symptoms include dysphagia and regurgitation of the fleshy mass into the mouth, which can cause asphyxia [1,2]. We observed a fibrovascular polyp of the esophagus causing diagnostic problems. We present the clinical picture, diagnostic problems, therapeutic intervention and histopathological findings of the tumor.
A 51-year-old female patient was admitted to our clinic with a suspected mass compressing the cervical esophagus from anterior and attacks of dyspnea. She had symptom of regurgitation of a fleshy mass into the mouth. She mentioned that she has had dyspnea attacks and dysphagia for a year and half. She had been operated on for nodular goiter with no relief. She had psychiatric consultation. She had visited another hospital and undergone endoscopy of laryngeal and esophageal inlet. A polypoid mass at postcricoidal area had been seen. At surgery, mass could not be seen and she had been discharged from hospital. She admitted gastroenterology clinic in our hospital. Cervical computed tomography revealed diffuse thickening of right vocal cord and a soft tissue mass measuring 10×6 mm behind left vocal cord (Fig. 1a). An upper gastrointestinal series showed filling defect of upper esophagus (Fig. 1b). Fiberoptic esophageal endoscopy showed compression of upper esophagus from anterior. Cervical ultrasonography confirmed this finding.
Fig. 1. (a) Computed tomography of the neck shows a soft tissue mass behind left side of airway, anterior to vertebral body. (b) Barium esophagogram showing a filling defect of upper esophagus.
She has been transferred to our clinic with the aim of cervical exploration. Rigid endoscopy revealed a large lesion narrowing lumen of upper esophagus. It was thought to be an extraesophageal lesion, probably a nodule arising remnant of thyroid gland. Cervical exploration was commenced with a collar incision using old incision line. A mass undistinguished from esophagus was palpated. It was moving with finger dissection. A longitudinal esophagotomy just over the mass was performed and a large, broad pedunculated mass was identified (Fig. 2a). Its base was just below the cricopharingeus muscle. The entire polyp was delivered through the esophagotomy and then the base was ligated and excised, and the mucosa was repaired with absorbable suture. The neck incision was closed and small penrose drain was left for drainage. The tumor was fleshy in consistency, measured 25 mm in length, 15 mm in width. The tumor was covered with a smooth pinkish gray mucosa similar to that of normal esophagus. The mucosa of tumor was torn during finger dissection (Fig. 2b). Microscopically, the specimen was squamous epithelial-lined polypoid structure composed of fibrovascular and adipose tissue, and reported as fibrovascular polyp. Postoperatively she did well and there was no problem on swallowing.
Fig. 2. (a) Intraoperative photograph of a large, pedinculated mass being delivered through the cervical esophagotomy. (b) The photograph of fibrovascular polyp. The tumor was covered with a smooth pinkish gray mucosa similar to that of normal esophagus. The mucosa of tumor was torn during finger dissection.
Although rare, fibrovascular polyps comprise most benign intraluminal tumor-like lesions of the esophagus [3].
Symptoms occur when the polyp reaches a large size. Symptoms included dysphagia, a mass in the throat and regurgitation of the polyp into the mouth with its disappearance on swallowing [4]. Asphyxiation can result from impaction of the polyp in the glottis and is the most feared complication [2].
Unless regurgitated, the presence of a fibrovascular polyp can be difficult to diagnose [5], and up to 30% of patients may die without a correct diagnosis [5]. Accurate diagnosis is best established with endoscopy [6]. But, it may be totally missed at endoscopy because the polyp is covered by normal mucosa and can be easily displaced [7]. The misfortune of our patient was that the history of thyroidectomy clouded the picture and both endoscopy and radiologic examinations such as CT and ultrasonography of the neck and barium swallow were interpreted incorrectly.
Surgical excision is the definitive treatment, done through an esophagotomy where direct control of feeding vessel is easily accomplished. The stalk must be completely excised or recurrence is possible [5,7].
This study was carried out in Dicle University School of Medicine, Diyarbakir, Turkey
[Abstract] [Uncorrected proof] (PDF 161.6 Kb)
© Copyright 2004, Elsevier Science, All rights reserved.
Barrett's Esophagus -- Cleveland Clinic
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Medical Description – Epidemiology
It is estimated that Barrett's esophagus is found in approximately 6% to 12% of patients undergoing endoscopy for symptoms of gastroesophageal reflux disease. Incidences have increased since the 1970's, but this parallels the increased use of diagnostic upper endoscopy. The evolving concept of short segment Barrett's esophagus may play a role in the increasing incidence of this disease, and data suggest that more short segment Barrett’s esophagus is being found. An alternative attractive explanation is that as the population ages, this condition becomes more common and hence the population at risk for esophageal adenocarcinoma increases. Despite its increased incidence, autopsy data from Olmsted County, Minnesota, suggest that the majority of cases of Barrett's esophagus go undetected in the general population; and it is estimated that for every known case, 20 additional cases go unrecognized. Additional support for this concept comes from the fact that 95% of patients with esophageal adenocarcinoma do not have an antecedent diagnosis of Barrett’s esophagus. However, in patient populations undergoing endoscopy for all possible indications, the prevalence of Barrett’s esophagus is much lower than that encountered in patients with symptomatic GERD: typically 1% or less.
This disease predominantly affects
middle-aged white males and is approximately twice as common in men as in
women. When compared to GERD patients without Barrett's esophagus, patients
with the condition develop reflux symptoms at an earlier age, have an
increased duration of symptoms, increased severity of nocturnal reflux
symptoms, and increased complications of GERD such as stricture, ulcer and
bleeding. Thus age of onset, symptom duration and presence of nocturnal
symptoms or complications may be markers of increased risk for developing
Barrett’s esophagus. Interestingly, similar clinical risk factors were
recently identified for esophageal adenocarcinoma. Despite these
observations, most patients have symptoms that are no different than those
en Could there be an inherited risk for development of Barrett’s esophagus? Several case series have reported on families with multiple affected relatives over successive generations. Furthermore, studies from the Mayo Clinic found a clear predisposition to reflux symptoms in parents and siblings of patients with Barrett’s esophagus and esophageal adenocarcinoma. Taken together, these studies suggest the possibility of a genetic predisposition in some settings. The search for a candidate gene is underway in several centers, including the Cleveland Clinic. Implications of Epidemiology on Screening for Barrett’s Esophagus
The principle of screening is to apply a relatively simple and inexpensive investigation to identify individuals harboring cancer or who are at increased risk for developing it. Those found to be positive require further or continued investigation, for example continued endoscopic surveillance, whereas those found to be negative need no additional testing. Endoscopy with biopsy is the only validated technique to diagnose Barrett’s esophagus. However, it has clear limitations as a screening tool including cost, risk and complexity. If applied to the estimated 20% of the population with regular GERD symptoms, the cost implications would be staggering. However, the recent introduction of unsedated small caliber upper endoscopy may change the economics of endoscopic screening. Unsedated small caliber upper endoscopy is feasible, acceptable and accurate when compared to conventional sedated endoscopy. It also has the potential advantages of decreasing sedation-related complications and costs related to nursing and recovery room time, need for a driver and time away from work. However, regardless of cost issues, it is unclear if endoscopy without sedation will meet with patient acceptance given the cultural bias for sedation in the United States. More information on cost implications as well as patient acceptance of unsedated narrow caliber endoscopy is eagerly awaited. Currently, there are no validated alternative techniques to screen for Barrett’s esophagus that overcome the cost and risks associated with endoscopy. Mass screening with balloon cytology is well described in China for the detection of esophageal squamous cell carcinoma and dysplasia in high-risk populations. Similar devices are under development in the United States as well. Much work is underway to determine genetic risk factors for Barrett’s esophagus, but a genetic test is not yet available. It would be welcome as the ultimate noninvasive screening test for this disease. Cost Issues and Screening
Screening strategies will have to consider the following options: limiting screening to only high risk patients; offering mass endoscopic screening to all adults over age 50 years as part of a periodic health appraisal preventive strategy; or, doing nothing until clinical trials provide the evidence to support such a strategy. The pivotal issue to address in the future is the following: does mass screening for Barrett’s esophagus decrease the morbidity and mortality of esophageal adenocarcinoma? |
| 1: Hum Pathol. 1988 Feb;19(2):148-54. | Related Articles, Links |
Benign lesions mimicking malignant tumors of the
esophagus.
Wolf BC, Khettry U, Leonardi HK, Neptune WB, Bhattacharyya AK, Legg MA.
Department of Pathology, New England Deaconess Hospital, Boston, MA 02215.
Three cases of benign lesions which mimicked malignant tumors of the esophagus
are described. In all three cases, two inflammatory pseudotumors and one case of
diffuse leiomyomatosis, the clinical presentations, radiologic features, and
gross pathologic findings led to the mistaken diagnosis of carcinoma at
thoracotomy. The benign nature of the processes was recognizable only on
microscopic examination. Although most benign tumors of the esophagus are
localized solitary lesions that are easily distinguished from carcinoma,
occasionally benign conditions may present as infiltrative, ulcerated mass
lesions. Inflammatory pseudotumor and diffuse leiomyomatosis should be included
in the differential diagnosis of esophageal malignancies.
Publication Types:
PMID: 3343031 [PubMed - indexed for MEDLINE]
GI PATH ONLINE - INDIA
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What is the esophagus? The esophagus is a muscular tube connecting the oral cavity to the stomach. It is made up of muscle tissue of various types, and actively propels food to the stomach when functioning properly. It is about 10 inches (25cm) in length and lies in the chest cavity between the trachea (windpipe) and spinal column. The muscular layers of the esophagus are covered by specialized protective cells known as epithelial cells that are replenished, when necessary, to keep the body and digestive tract healthy.
What is cancer? Although there are many types of cancer, they all share common characteristics that allow doctors to lump them together when discussing general characteristics. Generally, normal cells become abnormal, dividing too often and are unable to regulate their growth the way normal cells can. As these abnormal cells build up, they begin to form a mass known as a tumor. Tumors can be classified as benign or malignant based on their ability to spread and their potential to be life threatening.
What are the causes of esophageal cancer, and can I do anything to prevent it?
Specifically, esophageal cancer, while much more common in some parts
of the world, accounts for only about one percent of all cancers in the
United States. This particular type of cancer tends to be found in patients
over 55 years of age and is twice as likely to be diagnosed in a man than in
a woman. In addition, it is more common in African-Americans than in white
people. While the exact cause of cancer of the esophagus is not yet known,
doctors and researchers have identified several risk factors which can
significantly increase the risk of developing esophageal cancer. In the
United States, smoking tobacco and excessive use of alcohol can put one at
increased risk for developing esophageal cancer. Heavy smokers who drink
alcohol excessively are much more likely than the general population to be
diagnosed with esophageal cancer. Reduction or cessation of these harmful
activities reduces the risk of getting esophageal cancer and can also
decrease your chance of developing other cancers and problems of the
respiratory and digestive systems. Many times, esophageal cancer develops in patients with no clear cut risk factors. When this happens, it is likely a combination of known and unknown factors which contributes to the formation of a malignancy. Avoiding known risk factors, and the maintenance of a well balanced diet and exercise program is the best means of prevention currently available. Patients who consider themselves at risk for the development of cancer of the esophagus should visit their physician for recommendations regarding evaluation and/or therapy.
What are the symptoms of esophageal cancer?
Many symptoms of esophageal cancer may be caused by less serious
health problems and only a physician, after appropriate evaluation, can tell
for sure. Early esophageal tumors which are small in size are not usually
symptomatic. However, as the tumor increases in size, patients begin to
experience difficulty swallowing. Difficulty swallowing, the most common
symptom, worsens as the tumor enlarges and begins to obstruct the normal
flow of swallowed food. At first, one notices difficulties with meats,
breads and fresh vegetables but as the cancer progresses, even liquids can
become difficult to handle. Other problems associated with esophageal cancer
are pain behind the breastbone and frequent, painful bouts of coughing or
hiccups. In addition, weight loss and breath odor can be signs of an
advancing esophageal malignancy. It should be noted that quite often, people are able to compensate for early symptoms of esophageal cancer. For example, avoiding foods that tend to stick may give patients a way to deal with some of the early problems associated with a tumor in the esophagus. In addition, chewing food more completely or drinking more liquids with meals may be ways of compensating for early symptoms of esophageal cancer. Although symptoms may come and go at first, a patient with recurrent symptoms such as those described above should consult with a physician who can suggest appropriate evaluation if warranted.
How is the cancer diagnosed?
To help make a diagnosis when symptoms are present, regardless of the
disease, the doctor will take a detailed history and perform a complete
physical exam. In addition to the basic history and physical examination,
the physician will most likely order a battery of blood tests and radiologic
studies, i.e. x-rays. The tests that are most useful to doctors are a barium
swallow (esophagram) and esophagoscopy. To perform a barium swallow,
patients must drink a liquid that shows up well on x-ray examinations. By
looking at these films, doctors can determine if the shape of the esophagus
is suspicious for a mass of some kind. Esophagoscopy is a procedure
performed with the patient under intravenous sedation. A long thin camera is
used to view the lining of the esophagus and take samples (biopsies) of
anything abnormal or suspicious. These biopsies are then studied carefully
by a pathologist who specializes in determining whether small samples of
tissue are normal or abnormal.
How is esophageal cancer treated?
Esophageal cancer is difficult to cure unless it is discovered in the
earlier stages, before it has begun to spread. Unfortunately, early
esophageal cancers are seldom symptomatic and the disease is usually
advanced at the time of diagnosis. Esophageal cancer is treated with
surgery, radiation therapy or chemotherapy. Doctors may choose different
combinations of these treatments based on the specifics of each case.
What can I expect during my recovery? Recovery varies with the overall fitness of the patient and is difficult to predict precisely. However, a minimum of 10-14 days in the hospital should be expected. Patients typically have tubes placed into their small intestine with which tube feedings can be given postoperatively before oral intake is resumed. The anastomosis (hook-up) at the site of tumor resection is protected by inserting a tube that travels through the nose and into the stomach for at least the first week after surgery. In addition, nothing will be permitted by mouth until after an x-ray study is performed to be certain that the anastomosis is intact and water tight. A substantial amount of pain is present in the immediate postoperative period and is controlled with narcotic analgesics in most cases. Early mobilization is critical to an optimal recovery and patients are pushed to ambulate and sit upright as much as possible starting 24-48 hours after surgery. Discharge is anticipated after patients tolerate a soft diet and have demonstrated the strength necessary to function well enough at home. Specific discharge instructions are provided by the department of cardiothoracic surgery.
What is my prognosis? The prognosis is related to how advanced the cancer is at the time of the diagnosis. Early detection is critical, and may improve a patient's chances of a favorable outcome. Do not ignore swallowing difficulties and have any and all swallowing related problems evaluated by a doctor promptly. |
American Heart and Lung Institute's OVERVIEW about
CANCER OF THE ESOPHAGUS
What is the esophagus?
The esophagus, part of the digestive tract, is a tube that
connects the throat with the stomach. It lies between the trachea (windpipe) and
the spine. In an adult, the esophagus is about 10 inches long.
When a person swallows, the muscular walls of the esophagus
contract to push food down into the stomach. Glands in the lining of the
esophagus produce mucus, which keeps the passageway moist and makes swallowing
easier.
The esophagus, like all other organs of the body, is made up
of many types of cells. Normally, cells divide to produce more cells only when
they are needed. This orderly process helps keep the body healthy.
What is cancer?
Cancer is a group of diseases with one thing in common; cells
become abnormal, dividing too often and without any order.
When cells divide without control, they form too much tissue.
The mass of extra tissue, called a tumor, can be benign or malignant.
Benign tumors are not cancer. They do not spread to other
parts of the body and are seldom a threat to life. Benign tumors can usually be
removed by surgery, and they are not likely to return.
Malignant tumors are cancer. They can invade and damage nearby
healthy tissues and organs. Cancer cells can also break away from the tumor and
enter the bloodstream or the lymphatic system. That is how cancer spreads and
forms tumors in other parts of the body. The spread of cancer is called
metastasis.
Cancer of the esophagus is also called esophageal cancer. Each
year, about 11,000 Americans find out they have cancer of the esophagus. Cancer
can develop in any part of the esophagus. If the cancer spreads outside the
esophagus, it usually shows up in nearby lymph nodes (sometimes called lymph
glands). In many cases, the cancer also spreads to the windpipe, the large blood
vessels in the chest, and other nearby organs. Esophageal cancer can also spread
to the lungs, liver, stomach, and other parts of the body.
Cancer that spreads is the same disease and has the same name
as the original (primary) cancer. When cancer of the esophagus spreads, it is
called metastatic esophageal cancer.
What causes cancer of the esophagus?
Cancer of the esophagus is fairly common in some parts of the
world. But in the United States, this disease accounts for only about 1 percent
of all cancers.
The exact causes of cancer of the esophagus are not known.
Researchers are trying to solve this problem. The more they can find out about
what causes this disease, the better the chance of finding ways to prevent it.
Studies in the United States show that esophageal cancer is
found mainly in people over age 55. It affects men about twice as often as
women, and it is more common in black people than in white people. Why one
person gets esophageal cancer and another doesn't cannot be explained.
It is established that no one can "catch" esophageal cancer
from another person. Cancer is not contagious.
Also, it is known that certain risk factors increase a
person's chance of getting esophageal cancer. In the United States, smoking and
excessive use of alcohol are the major risk factors for this disease. Heavy
users of both alcohol and tobacco are much more likely to develop esophageal
cancer than are people who do not drink or smoke.
Cutting down on the use of alcohol reduces the chance of
getting esophageal cancer, as well as cancers of the mouth, throat, and larynx.
By not smoking, people can lower their risk of cancers of the esophagus, lung,
mouth, throat, larynx, bladder, and pancreas. Also, it is very important to know
that people who develop cancer due to smoking are at risk of getting a second
cancer. Most doctors urge esophageal cancer patients to stop smoking to cut down
the risk of a new cancer and to reduce other problems, such as coughing.
The risk of cancer of the esophagus is also increased by
long-term irritation of esophageal tissues. Tissue at the bottom of the
esophagus can become irritated if the contents of the stomach frequently "back
up" into the esophagus, a problem known as reflux. When cells in the irritated
part of the esophagus change and begin to resemble the cells that line the
stomach, doctors call this condition Barrett's esophagus. In some cases,
Barrett's esophagus leads to esophageal cancer.
Other kinds of irritation or damage to the lining of the
esophagus can also increase the risk of cancer. For example, people who have
swallowed lye or other caustic substances have a higher-than-average risk
because these substances damage esophageal tissue.
Poor nutrition is another factor that can increase a person's
risk of esophageal cancer. Scientists are not sure exactly how diet changes the
risk of developing this disease, but they think that it is important to have a
well-balanced diet that includes generous amounts of fruits and vegetables.
Often, patients with esophageal cancer have no clear risk
factors. In most cases, the disease is probably the result of several factors
(known or unknown) acting together.
People who think they might be at increased risk for cancer of
the esophagus should discuss this concern with their doctor. The doctor may be
able to suggest ways to reduce the risk and can suggest an appropriate schedule
of checkups.
What are symptoms of cancer of the esophagus?
Very small tumors in the esophagus usually do not cause
symptoms. As the tumor grows, the most common symptom is difficulty in
swallowing. The person may have a feeling of fullness, pressure, or burning as
food goes down the esophagus. Also, it may feel as if food gets stuck behind the
breastbone. Problems with swallowing may come and go. At first, they may be
noticed mainly when the person eats meat, bread, or coarse foods, such as raw
vegetables. As the tumor grows larger and the pathway to the stomach becomes
narrower, other foods -- even liquids -- can be hard to swallow, and swallowing
may be painful. Cancer of the esophagus can also cause indigestion, heartburn,
vomiting, and frequent choking on food. Because of these problems, weight loss
is common.
Sometimes a tumor in the esophagus causes coughing and
hoarseness. It can also cause pain behind the breastbone or in the throat.
Any of these symptoms may be caused by cancer or by other,
less serious health problems. People with symptoms like these often see a
gastroenterologist, a doctor who specializes in diseases of the digestive tract.
How is cancer of the esophagus
diagnosed?
To find the cause of any of these symptoms, the doctor asks
about the patient's personal and family medical history and does a complete
physical exam. In addition to checking general signs of health, the doctor
usually orders x-rays and other tests.
An esophagram (also called a barium swallow) is a series of
x-rays of the esophagus. To prepare for this test, the patient drinks a barium
solution. The barium, which shows up on x-rays, coats the inside of the
esophagus. The esophagram shows changes in the shape of the esophagus. The
doctor can also use a special x-ray machine called a fluoroscope to watch the
barium move down the esophagus to the stomach as the patient swallows.
Most patients also have a test called esophagoscopy. For this
procedure, the patient's throat is sprayed with a local anesthetic to reduce
discomfort and gagging. The doctor then passes a thin, flexible, lighted
instrument called an endoscope through the mouth and down the throat into the
esophagus. The scope lets the doctor see the lining of the esophagus and the
place where the esophagus joins the stomach. If an abnormal area is found, the
doctor does a biopsy; removal of a small amount of tissue through the endoscopy.
Also, cells can be brushed or washed from the walls of the esophagus through the
scope. A pathologist examines the samples under a microscope to see whether
cancer is present.
If cancer is found, the pathologist can tell what type of
cancer it is. Cancer that occurs in the middle or upper part of the esophagus is
usually squamous cell carcinoma. When cancer develops at the lower end of the
esophagus, near the stomach, it is usually adenocarcinoma. (Carcinoma is another
name for cancer in the lining of tissues.)
If the pathologist finds esophageal cancer, the patient's
doctor needs to know the stage, or extent, of the disease. Staging is a careful
attempt to find out what parts of the body are affected by the cancer.
Treatment decisions depend on these findings. Staging usually
involves a physical exam, with special attention to the neck and chest, blood
tests, additional x-rays, and other tests. The results show whether the cancer
is just in the esophagus or has spread.
The doctor usually order CT (or CAT) scans of the chest and
upper abdomen. During a CT scan, many x-rays are taken and a computer combines
them to create detailed pictures. Some patients also have an MRI scan, which
produces pictures using a huge magnet linked to a computer.
The doctor uses special instruments to check the organs near
the esophagus. For example, the doctor can look through a laryngoscope to see
whether the cancer has spread to the larynx (voice box). A bronchoscope lets the
doctor see into the trachea and bronchi (airways that lead into the lungs).
If lymph nodes near the esophagus are enlarged, the surgeon
may perform a biopsy to find out whether they contain cancer cells. Sometimes,
the surgeon also removes samples of other tissues in the area to see whether the
cancer has spread.
How is cancer of the esophagus
treated?
Treatment for esophageal cancer depends on a number of
factors. Among these are the exact location, size, and extent of the tumor, and
the type of cancer cells. The doctor also considers the person's age and general
health to develop a treatment plan to fit each person's needs.
The patient's doctor may want to discuss the case with other
doctors who treat cancer of the esophagus. Also, the patient may want to talk
with the doctor about taking part in a research study of new treatment methods.
Such studies, called clinical trials, are designed to improve cancer treatment.
Many patients want to learn all they can about their disease
and their treatment choices so they can take an active part in decisions about
their medical care. People with cancer have many questions and concerns about
their health. The doctor is the best one to answer them. Most patients want to
know the extent of their cancer, how it will be treated, how successful the
treatment is likely to be, and how much it will cost.
Many people find it helpful to make a list of questions before
they see the doctor. Taking notes can make it easier to remember what the doctor
says. Some patients also find that it helps to have a family member or friend
with them when they talk to the doctor--either to take part in the discussion or
just to listen.
There is a lot to learn about cancer and its treatment.
Patients should not feel that they need to understand everything the first time
they hear it. They will have many chances to ask the doctor to explain things
that are not clear.
TREATMENT METHODS
Cancer of the esophagus usually cannot be cured unless it is
found in the earliest stages, before it has begun to spread. Unfortunately,
early esophageal cancer causes few symptoms, and the disease is usually advanced
when the diagnosis is made. However, advanced esophageal cancer can be treated
and symptoms can be relieved.
Esophageal cancer is usually treated with surgery, radiation
therapy (also called radiotherapy), or chemotherapy. The doctor may use just one
treatment method or combine them, depending on the patient's needs.
In some cases, the patient is referred to doctors who
specialize in different kinds of cancer treatment. Often, specialists work
together as a team to plan and carry out the patient's care. The medical team
may include a gastroenterologist, surgeon, oncologist (cancer specialist),
radiation oncologist, nurse, dietitian, and social worker.
Surgery is often part of the treatment plan. Many patients
with esophageal cancer have an operation called esophagectomy. Generally, the
surgeon removes the tumor along with a portion of the esophagus, nearby lymph
nodes, and other tissue in the area. Usually, it is possible to connect the
stomach to the remaining part of the esophagus. In a few cases, the surgeon
forms a new passageway from the throat to the stomach, using tissue from another
part of the digestive tract (such as the colon) to replace the esophagus.
If a tumor blocks the esophagus but cannot be removed, the
surgeon may be able to create a bypass, a new pathway to the stomach. In some
cases, the surgeon can dilate (widen) the esophagus. This procedure may have to
be repeated as the tumor grows. Sometimes, the doctor puts a tube into the
esophagus to keep it open. Recently, some surgeons have used a laser to destroy
cancerous tissue and relieve blockages.
Radiation therapy is the use of high-energy rays to damage
cancer cells and stop them from growing. Like surgery, radiation therapy is
local therapy; it affects cells only in the treated area. Radiation therapy can
be used to shrink a tumor before surgery or to destroy cancer cells that may
remain in the area after surgery. Radiation may also be used instead of surgery,
especially if the size or location of the tumor would make an operation
difficult. In some cases, radiation therapy is recommended for patients who
cannot have surgery for other health reasons. Even if the tumor cannot be
removed by surgery or destroyed entirely by radiation therapy, radiation therapy
can still help relieve pain and make swallowing easier.
In radiation therapy for esophageal cancer, the energy usually
comes from a machine outside the body (external radiation). Some patients also
need treatment with radioactive materials placed in the tumor (implant
radiation). Usually, patients receive external radiation therapy 5 days a week
for several weeks. Most patients can stay at home and go to the hospital or
clinic each day for this treatment. For implant radiation, patients must stay in
the hospital for a short time. More information about radiation therapy can be
found in the National Cancer Institute booklet Radiation Therapy and You.
Chemotherapy is the use of drugs to kill cancer cells. The
doctor may suggest one drug or a combination of drugs. Chemotherapy may be used
alone or combined with radiation therapy to shrink a tumor before surgery or to
destroy cancer cells that remain in the body after surgery. Chemotherapy may
also be used if surgery is not possible and for patients whose cancer returns
after surgery or radiation therapy.
Most anticancer drugs for esophageal cancer are given by
injection into a vein or muscle. Some may be taken by mouth. Chemotherapy is
systemic therapy, meaning that the drugs travel through the bloodstream and can
reach cancer cells all over the body. Often, the drugs are given in cycles: a
treatment period followed by a rest period, then another treatment and rest
period, and so on. Many patients have their chemotherapy as outpatients at the
hospital, in the doctor's office, or at home. Depending on the drugs, the
treatment plan, and the patient's general health, a hospital stay may be needed.
The NCI booklet Chemotherapy and You has helpful information about
this type of treatment.
TREATMENT STUDIES
Because esophageal cancer is so hard to control, many
researchers are looking for more effective treatments. They are also exploring
ways to reduce side effects. When laboratory research shows that a new method
has promise, it is used to treated cancer patients in clinical trials. These
trials are designed to answer scientific questions and to find out whether the
new approach is both safe and effective. Patients who take part in clinical
trials make an important contribution to medical science and may have the first
chance to benefit from improved treatment methods.
Many clinical trials of new treatments for esophageal cancer
are under way. Doctors are studying new ways of combining various types of
treatment. They are also trying new anticancer drugs and drug combinations, as
well as drugs that make cancer cells more sensitive to radiation. Another method
under study is photodynamic therapy; the use of laser light and drugs that make
the cancer cells sensitive to light so the laser can destroy them. Researchers
are also exploring biological therapy; treatment intended to help the body's
immune system fight cancer more effectively.
Patients with esophageal cancer who are interested in taking
part in a trial should talk with their doctor. They may want to read What
Are Clinical Trials All About?, a booklet that explains the possible
benefits and risks of treatment studies.
One way to learn about clinical trials is through PDQ, a
computerized resource of cancer treatment information. Developed by the National
Cancer Institute, PDQ contains an up-to-date list of trials all over the
country. The Cancer Information Service, at 1-800-4-CANCER, can provide PDQ
information to doctors, patients, and the public.
What are the side effects of
treatment for cancer of the esophagus?
The methods used to treat cancer are very powerful. It is hard
to limit the effects of therapy so that only cancer cells are removed or
destroyed. Because healthy cells also may be damaged, treatment often causes
unpleasant side effects.
The side effects of cancer treatment vary. They depend mainly
on the type and extent of the treatment. Also, each person reacts differently.
Attempts are made to plan the therapy to keep side effects to a minimum.
Patients are carefully monitored so that any problems which occur can be
addressed.
Surgery for cancer of the esophagus is a major operation.
Patients who have had trouble eating and drinking may need intravenous (IV)
feedings and fluids for several days before and after the operation. They may
need antibiotics to prevent or treat infections. Patients are taught special
coughing and breathing exercises to keep their lungs clear. Discomfort or pain
after surgery can be controlled with medicine. Patients should feel free to
discuss pain relief with the doctor.
Patients receiving radiation therapy may become tired as
treatment continues. Resting as much as possible is important. It is also common
for the skin in the treated area to become red or dry. The skin should be
exposed to the air but protected from the sun, and the patients should avoid
wearing clothes that rub the area. Good skin care is important at this time. The
doctor may suggest certain kinds of soap, and patients should not use any lotion
or cream on the skin without the doctor's advice. Radiation to the chest and
neck can cause a dry, sore throat or a dry cough. Drinking extra liquids can be
helpful, and doctors sometimes suggest cough medicine. If burning, tightness, or
other pain makes it hard to swallow, the doctor may suggest a local anesthetic
or soothing gargle for use before meals. Some patients find that antacids help
relieve feelings of indigestion. A small number of patients feel short of breath
during radiation therapy. The doctor may prescribe medicine to relieve this
problem.
The side effects of chemotherapy depend on the drugs that are
given. In general, anticancer drugs affect cells that divide rapidly. These
include blood cells, which fight infection, cause the blood to clot, or carry
oxygen to all parts of the body. When blood cells are affected by anticancer
drugs, patients can have a lowered resistance to infection, bruise or bleed
easily, and have less energy. Cells in hair follicles and cells that line the
digestive tract also divide rapidly. Chemotherapy can therefore cause hair loss
and other problems such as poor appetite, mouth sores, nausea, and vomiting.
These side effects usually go away gradually after treatment stops.
The patient's weight is checked regularly because weight loss
can be a serious problem for patients with cancer of the esophagus. Swallowing
food can be difficult, and patients may not feel hungry if they are
uncomfortable or tired. Yet, well-nourished patients generally feel better, have
more energy, and are often better able to withstand the side effects of their
treatment, so good nutrition is important. Patients with esophageal cancer are
usually encouraged to have several small meals and snacks throughout the day,
rather than to try to eat three large meals. It often helps to sit up for a
while after eating, and the doctor may prescribe medicine to control nausea and
vomiting and to relieve discomfort.
When swallowing is difficult, many patients can still manage
soft, bland foods moistened with sauces or gravies. It can be helpful to prepare
other foods in a blender. In addition, puddings, ice cream, and soups are
nourishing and easy to swallow. Doctors, nurses, and dietitians may have other
suggestions to help patients and their families choose foods that supply enough
calories to control weight loss and enough protein to keep up strength and
rebuild normal tissues. For example, they may suggest liquid dietary supplements
or milkshakes made with extra protein powder or dry milk for patients who cannot
swallow solid foods.
The health care team can explain the effects of esophageal
cancer and its treatment, and they can suggest ways to deal with them. In
addition, the NCI booklets Radiation Therapy and You,
Chemotherapy and You, and Eating Hints provide helpful
information about cancer treatment and coping with side effects.
How do patients with cancer of the
esophagus and their families cope?
The diagnosis of esophageal cancer can change the lives of
patients and the people who care about them. These changes can be hard to
handle. It is common for patients and their families and friends to have many
different and sometimes confusing emotions.
At times, patients and their loved ones may feel frightened,
angry, or depressed. These are normal reactions when people face a serious
health problem. Most people handle their problems better when they share their
thoughts and feelings with those close to them. Sharing can help everyone feel
more at ease and can open the way for people to show one another their concern
and offer their support.
Worries about tests, treatments, hospital stays, and medical
bills are common. Doctors, nurses, social workers, and other members of the
health care team can help calm fears and ease confusion. They can also provide
information and suggest resources.
Patients and their families are naturally concerned about what
the future holds. Sometimes, they use statistics to try to figure out whether
the patient will be cured or how long he or she will live. It is important to
remember, however, that statistics are averages based on large numbers of
patients. They can't be used to predict what will happen to a certain patient
because no two cancer patients are alike. The doctor who takes care of the
patient and knows his or her medical history is in the best position to discuss
the person's outlook (prognosis). Patients should feel free to ask the doctor
about their prognosis, but they should keep in mind that not even the doctor
knows for sure what will happen.
Living with a serious disease isn't easy. Cancer patients and
those who care about them face many problems and challenges. Finding the
strength to cope with these difficulties is easier when people have helpful
information and support services.
The doctor can explain the disease and give advice about
treatment, working, or daily activities. If patients want to discuss concerns
about the future, family relationships, and finances, it also may help to talk
with a nurse, social worker, counselor, or a member of the clergy.
Friends and relatives who have had personal experiences with
cancer can be very supportive. Also, it helps many patients to meet and talk
with others who are facing problems like theirs. Cancer patients often get
together in self-help and support groups, where they can share what they have
learned about cancer and its treatment and about coping with the disease. It is
important to keep in mind, however, that each cancer patient is different.
Treatments and ways of dealing with cancer that work for one person may not be
right for another -- even if they both have the same kind of cancer. It is a
good idea to discuss the advice of friends and family members with the doctor.
Often, a social worker at the hospital or clinic can suggest
local and national groups that can help with emotional support, financial aid,
transportation, or home care. The American Cancer Society is one such group.
This nonprofit organization has many services for patients and their families.
Local offices of the American Cancer Society are listed in the white pages of
the telephone book.
Information about other programs and services is available
through the Cancer Information Service. The toll-free number is 1-800-4-CANCER.
The public library is a good place to find books and articles
on living with cancer. Cancer patients and their families and friends also can
find helpful suggestions in the booklet Taking Time.
What resources are available to
patients with cancer of the esophagus?
Information about cancer is available from many sources, including the ones listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.
Source
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