Esophagus Cancer Mortality
30 CANCER INCIDENCE AND MORTALITY IN NEW MEXICO, 1970-1996
Innovative Non-Surgical Treatment for Barrett's Esophagus
Detailed Guide: Esophagus Cancer What Are the Key Statistics for Esophagus Cancer?Detailed Guide: Esophagus Cancer How Is Esophagus Cancer Staged?
Using Chemoradiation for Advanced Esophageal Cancer Increases Survival Rates
Some of the available palliative treatments for esophageal cancer are:
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Esophagus Cancer
30 CANCER INCIDENCE AND MORTALITY IN NEW MEXICO, 1970-1996
Major Epidemiologic Features
Cancer of the esophagus is relatively rare in the U.S., accounting for about 1% of all annually diagnosed cancers. Esophageal cancer is a rapidly fatal disease, with mortality rates which basically equal those for incidence. In some circumstances, mortality rates actually exceed incidence rates due to misclassification of cause of death on death certificates. Men are roughly three times more likely than women to be diagnosed with esophageal cancer and blacks are three-times as likely as whites to develop the disease. Esophageal cancer is rare prior to age 40, but thereafter both incidence and mortality increase rapidly with age. Overall age-adjusted incidence among SEER areas during the time period 1991-1995 was 3.9 cases per 100,000 per year. Age-adjusted mortality in the U.S. for the same time period was 3.6 deaths per 100,000.The majority of esophageal cancers occur as squamous cell carcinomas. The incidence of this form of disease has generally been stable over the past several decades, however, the incidence of a less common subtype of disease, adenocarcinoma, appears to be rising among males, particularly White males. Many of the adenocarcinomas arise from Barrett’s esophagus, a medical condition in which the cells lining the lower esophagus change from a normal appearance to a one approaching a pre-cancerous state. Barret’s esophagus commonly arises among patients with longstanding reflux esophagitis and frequently is seen in White males of higher socioeconomic status. The major risk factors for esophageal cancer in the U.S. are tobacco use and heavy alcohol consumption.
These exposures are thought to account for about 80 to 90% of all new cases diagnosed each year. Other suggested risk factors include poor nutrition, obesity, and occupational exposure to certain chemicals. Prevention and Control Measures: The majority of esophageal cancers could be prevented by avoidance of tobacco and heavy alcohol consumption. No screening tests exist for early disease detection.
New Mexico Incidence and Mortality Patterns
A total of 818 cases and 788 deaths from esophageal cancer were reported in New Mexico between 1970 and 1996. Esophageal cancer was rarely diagnosed prior to age 40, but thereafter both incidence and mortality increased rapidly with advancing age. Mortality rates were roughly equal to those for incidence at all ages. For the time period 1970-1996, age-adjusted incidence and mortality was roughly three times higher in males than in females. Among racial/ethnic groups, non-Hispanic Whites had the highest rates, American Indians the lowest, and Hispanics intermediate rates. Between the years 1970 and 1996, esophageal cancer incidence and mortality rates roughly doubled in non-Hispanic White and Hispanic males while remaining about the same in females. (Time trend rates are not shown for American Indians due to the small total number of cases and deaths during 1970-1996.) Fourteen counties in New Mexico had 10 or fewer cases diagnosed over the 27-year time period of observation. A roughly two-fold range in incidence and mortality was observed for those counties with 10 or more cases or deaths.
| 1: Int J Cancer. 2002 Nov 20;102(3):271-4. | Related Articles, Links |
Mortality and incidence trends from esophagus
cancer in selected geographic areas of China circa 1970-90.
For the whole country, esophagus cancer mortality
decreased slightly, 17.4 per 10(5) populations during 1990-92 in contrast to
18.8 per 10(5) populations in 1973-75. In the Linxian area, trends in the
incidence and mortality rates for esophagus+gastric cardia cancer reversed over
time; incidence rates increased significantly during 1959-72 but were decreased
significantly on average -2.26% (95% Confidence Interval [CI]: -1.74, -2.77) and
-1.10% (95% CI = -0.58, -1.62) per year for males and females, respectively,
during 1972-97. In urban Shanghai, incidence trend for esophagus cancer
decreased monotonically and significantly on average by -4.99% (95% CI = -4.28,
-5.70) and -5.18% (95% CI = -4.99, -5.70) per year for males and females,
respectively. In Nanao islet, esophagus+gastric cardia cancer mortality rates
increased during 1970-82 but decreased slowly from 1982-99 (-0.96% per year; 95%
CI = -0.14, -1.78). Our study indicates that incidence and mortality rates for
esophagus or esophagus+gastric cardia cancer are now decreasing in China. The
declines may be due to an unplanned success of prevention, such as changes in
population dietary patterns and food preservation methods. Copyright 2002 Wiley-Liss,
Inc.
PMID: 12397650 [PubMed - indexed for MEDLINE]
Innovative Non-Surgical Treatment for Barrett's Esophagus
KNOXVILLE, Tenn., July 27 -- An innovative, non-surgical treatment being developed at the Thompson Cancer Survival Center has the potential to reduce the risk of esophageal cancer for people with a condition known as Barrett's esophagus. The results of the Thompson Center's research using this therapy were published in the July, 1995 issue of "Gastrointestinal Endoscopy."
Barrett's esophagus is a condition resulting from long standing acid reflux (heartburn), where the esophageal lining is converted to stomach-type tissue. The lining has the potential to develop dysplasia, a pre-malignant change. In fact, the likelihood of Barrett's patients developing esophageal cancer is 30 to 40 times that of the normal population.
As many as 11,000 people in the United States will be diagnosed with esophageal cancer in the next year. Estimates of the incidence of Barrett's esophagus range between 800,000 and two million cases.
The new treatment is called balloon photodynamic therapy and the Thompson Cancer Survival Center is the only facility in the United States approved to use this type of investigational procedure to treat Barrett's esophagus.
Most patients with severe dysplasia must undergo surgery for the removal of part of the esophagus to eliminate the Barrett's mucosa. This surgical procedure, called esophagectomy, is very difficult on the patient, causing major lifestyle changes and the potential for continuing medical problems.
Esophagectomy also carries a relatively high mortality rate. In contrast, balloon Photodynamic Therapy (PDT) is less invasive and is a more cost-effective treatment. PDT in Barrett's esophagus offers encouraging results in the elimination of Barrett's tissue without lingering side effects.
"Our investigational research indicates that patient outcomes, when defined as lower morbidity, mortality, and costs, are improved by using PDT as the treatment for Barrett's dysplasia and/or superficial carcinoma," said Dr. Bergein Overholt, a gastroenterologist who led the study.
Dr. Overholt, who has worked with the Thompson Center for the past six years in the development of the PDT procedure, feels the balloon PDT program could positively alter the incidence rate of esophageal cancers.
"By treating Barrett's esophagus before it becomes cancerous, we have the potential to decrease the number of Barrett's patients diagnosed with esophageal cancer," said Dr. Overholt.
PDT involves the use of a photosensitizing drug called PHOTOFRIN(R), and a special type of laser called an argon dye laser. The drug is injected into a vein and concentrates in abnormal tissue. When exposed to the special laser light, the drug produces a chemical reaction that kills the abnormal cells.
The balloon is specifically designed to treat Barrett's esophagus because of the way it manipulates the treatment surface and improves the application of light. It was developed by researchers at the Thompson Cancer Survival Center in collaboration with the College of Veterinary Medicine at the University of Tennessee.
"By using our knowledge of photodynamic therapy in the treatment of esophageal cancers, we were able to develop the balloon to target the treatment area more effectively for our Barrett's patients," said Masoud Panjehpour, Ph.D., a Research Scientist in the Laser Center at Thompson.
"PDT is an exciting treatment and has been well tolerated by our patients," said Dr. Overholt. "The Cancer Center's work with Barrett's is indicative of the potential photodynamic therapy has for treating other types of cancerous and pre-cancerous conditions."
CONTACT: Thompson Cancer Survival Center's Laser Center at (865) 541-1433.
American Cancer Society
| Detailed Guide: Esophagus Cancer | |
| What Are the Key Statistics for Esophagus Cancer? | |
 |
|
The American Cancer Society estimates that during 2004 approximately 14,250 new esophageal cancer cases will be diagnosed in the United States. This disease is about 3 times more common among men than among women and almost 3 times more common among African Americans than among whites. Squamous cell carcinoma is the most common type of cancer of the esophagus among African Americans, while adenocarcinoma is more common in whites. Cancer of the esophagus is much more common in some other countries. For example, esophageal cancer rates in Iran, northern China, India, and southern Africa are 10 to 100 times higher than in the United States.
The American Cancer Society estimates during 2004, 13,300 deaths from esophageal cancer will occur. Because esophageal cancer is usually diagnosed at a late stage, most people with esophageal cancer eventually die of this disease. However, survival rates have been improving. During the early 1960s, only 4% of all white patients and 1% of all African-American patients survived at least 5 years after diagnosis. Now, 13% of all white patients and 9% of all African-American patients survive at least 5 years after diagnosis.
The 5-year survival rate refers to the percent of patients who live at least 5 years after their cancer is diagnosed. Many of these patients live much longer than 5 years after diagnosis; however, 5-year rates are used to produce a standard way to discuss prognosis (outlook for survival). Five-year relative survival rates exclude patients who die of other diseases from the calculations, and they are a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. Of course, today’s 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. Improvements in treatment often result in a better outlook for recently diagnosed patients.
Detailed Guide: Esophagus Cancer How Is Esophagus Cancer Staged?
Staging is the process of finding out whether the cancer has spread and if so, how far. The treatment and prognosis (the outlook for chances of survival) for people with esophageal cancer depend, to a great extent, on the cancer's stage.
Eophageal cancer can be staged in several ways but symptoms such as dysphagia most commonly lead to a barium swallow and/or endoscopy procedure. The size of the tumor can then be estimated. Then a CT scan is usually done, especially if the tumor is smaller than 5 centimeters (2 inches). The CT scan can show if the cancer has spread to nearby lymph nodes and/or the lungs, if the tumor extends through the esophagus into the trachea (windpipe), and if the cancer has spread to distant organs like the liver.
In some medical centers, endoscopic ultrasound can be performed to give very detailed pictures of just how deeply the cancer has invaded the esophageal tissue. The depth of penetration of the cancer is very important in determining the chances for at least a 5-year survival as well as whether surgery is likely to help the patient.
The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes 3 key pieces of information. T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs. N refers to cancer spread to nearby lymph nodes. M indicates whether the cancer has metastasized (spread to distant organs).
T Stages
TX: primary tumor cannot be assessed
T0: no evidence of primary tumor
Tis: carcinoma in situ (the tumor has not invaded beyond the epithelium, the first or innermost layer of the esophagus)
T1: tumor invades the lamina propria (second layer) or submucosa (third layer)
T2: tumor invades the muscularis propria (fourth layer)
T3: tumor invades the adventitia (fifth and outermost layer)
T4: tumor invades nearby structures
N Stages
NX: nearby lymph nodes cannot be assessed
N0: no spread to nearby lymph nodes
N1: spread to nearby lymph nodes
M Stages
MX: spread to other organs cannot be assessed
M0: no spread to distant organs
M1: spread to distant organs
Information about the tumor, lymph nodes, and metastasis is then combined to assign a stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV:
|
Stage 0 |
Tis |
N0 |
M0 |
|
Stage I |
T1 |
N0 |
M0 |
|
Stage IIA |
T2 or T3 |
N0 |
M0 |
|
Stage IIB |
T1 or T2 |
N1 |
M0 |
|
Stage III |
T3 |
N1 |
M0 |
|
T4 |
Any N |
M0 |
|
|
Stage IV |
Any T |
Any N |
M1 |
Stage 0: This is the earliest stage of esophageal cancer. This stage is also called carcinoma in situ, meaning that cancer cells are limited to the epithelium (the part of the mucosa forming the inner lining of the esophagus). The cancer does not invade the connective tissue beneath the epithelium. The cancer has not spread to lymph nodes or other organs.
Stage I: Stage I means that the esophageal cancer has invaded from the epithelium into some of the other layers of the esophagus. Cancer may be present in the lamina propria, the connective tissue part of the mucosa, or the submucosa, the connective tissue underneath the mucosa. The cancer has not spread to the muscularis propria, the thick muscle layer of the esophagus that pushes food from the throat into the stomach. In this stage, the cancer has not spread to lymph nodes or to any other organs.
Stage II: There are 2 substages IIA and IIB.
Stage IIA: In this stage, the cancer has invaded the muscularis propria and may extend through that layer into the adventitia, the connective tissue covering the outside of the esophagus. The cancer has not spread to lymph nodes or to any other organs.
Stage IIB: The cancer may invade the lamina propria, submucosa, and the muscularis propria, but not the adventitia. However, it has spread to lymph nodes near the esophagus. Other organs are not involved.
Stage III: Cancers in this stage have either spread to the adventitia and to lymph nodes near the esophagus or they have spread beyond the adventitia into nearby organs, such as the trachea (windpipe), and may or may not have spread to the lymph nodes. The cancer has not spread to lymph nodes farther away from the esophagus (such as nodes in the neck or nodes in the lower abdomen). It has not spread through the bloodstream to organs farther away from the esophagus (such as the liver, bones, or brain).
Stage IV: This stage indicates that the esophageal cancer has spread to distant organs. Spread through the bloodstream to organs away from the esophagus (such as the liver, bones, or brain) is always considered distant spread. Depending on the exact location of the primary cancer in the esophagus, spread to nonregional (not next to the esophagus) lymph nodes may also be considered distant spread. If the esophageal cancer is in the upper part of the chest, spread to lymph nodes in the abdomen near the stomach is considered distant spread. For cancers of the lower part of the esophagus, spread to lymph nodes near the neck is considered distant spread.
Survival Rates by Stage
Stage 5-year survival rate (surviving at least 5
years)
| 0 | 75% |
| I | 60% |
| IIA | 40% |
| IIB | 20% |
| III | 15% |
| IV | less than 5% |
These survival rates are an average of outcomes of patients with the same stage. They do not take into account differences in treatment or a patient's general state of health. These are provided as estimates only and the outlook for any individual patient may differ from these average figures. . In addition, these rates are based on past cases. Recent treatment advances may offer options for people with esophageal cancer today that past patients did not have.
Revised 1-1-04
The esophagus runs from your throat to your stomach. It is a muscular tube that carried food into the stomach. It is between 10 to 13 inches long and is less than an inch wide at its narrowest point. Cancer of the esophagus starts in the innermost layers and grows out, according to the American Cancer Society (ACS). (Read about "Cancer: What It Is") Close to 13,000 people will find out they have esophagus cancer each year, and about the same number of people die of this disease each year. ACS says this cancer is usually fatal because most esophagus cancers are discovered late, with the disease in an advanced state. The five year survival rate, according to ACS, is 13 percent for whites and 9 percent for African-Americans. While those number are low, they are dramatic improvements from 40 years ago when the rate was 4 percent for whites and 1 percent for African-Americans.
Types of esophagus cancer
Esophagus cancer is divided into two major groups, according to the National Cancer Institute (NCI). ACS says cancers of the esophagus are almost evenly split between the two types. Squamous cell carcinomas tend to start in the upper and middle part of the esophagus but can start elsewhere in the esophagus. The second type is called adenocarcinoma. It starts in the area near the opening to the stomach and is directly related to another condition called Barrett's esophagus. Barrett's esophagus is the result of changes to the cells caused by acid reflux, or the spilling of stomach acid back into the esophagus. (Read about "GERD")
Risk factors
African-Americans are 3 times more likely to have esophagus cancer than whites and men are three times more likely than women. Age is also a factor, with 45 to 70 being the high risk time period, according to ACS. In addition to the already mentioned Barrett's esophagus, other risk factors according to ACS and NCI are:
People who have had head or neck cancers (Read about "Head and Neck Cancers) are
also at greater risk of getting esophagus cancer. Because most esophagus cancers
are discovered late it is important for people to be aware of the risk factors
and work with their doctor on regular screenings. A person diagnosed with
Barrett's esophagus or tylosis should be vigilant.
Symptoms and diagnosis
ACS says there are no regular screening tests for esophagus cancer and in its early stages the cancer usually does not cause symptoms. Trouble swallowing is the most common symptom as the cancer grows. Other symptoms listed by both NCI and ACS include:
These can also be symptoms of other conditions, and should be checked by a doctor.
If cancer is suspected, there are various procedures, such as a barium swallow where a set of x-rays are taken after the patient swallows barium which coats the esophagus. An endoscope can be used to see into the esophagus and a sample can be taken if any abnormalities are found to confirm the presence of cancer.
Once cancer of the esophagus is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for esophageal cancer, according to NCI:
Treatments for esophagus cancer include surgery, radiation, chemotherapy and laser therapy. (Read about "Cancer Treatments) Surgery is the most common treatment, according to NCI. Many treatments are used to relieve symptoms and prolong life and success depends on how far the cancer has progressed, according to ACS.
Thursday, June 26, 2003
Study Findings Presented by Mayo Clinic Cancer Center Physician at American Society of Clinical Oncology (ASCO) Annual Meeting
SCOTTSDALE, Ariz. – Using Chemoradiation (chemotherapy plus radiation), with or without surgery, has led to a significant increase in the survival rate for esophageal and esophago-gastric cancers over the past ten years according to a presentation given by Leonard L. Gunderson, M.D., radiation oncologist at Mayo Clinic Cancer Center in Scottsdale, at the 39th annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago this month. Gunderson made his presentation along with a thoracic surgeon from M.D. Anderson Cancer Center in Houston and a medical oncologist from Royal Marsden Hospital in London.
Ten years ago it was rare to cure this type of cancer in those for whom surgery was not possible, according to Gunderson. Now, recent statistics show a 42 percent two-year survival rate and a 27 percent five-year survival rate with chemotherapy and radiation, as compared to a 10 percent two-year survival rate and a zero percent five-year survival rate, using radiation alone.
“We’ve made great advances in the past decade,” says Dr. Gunderson. “We used to think that only surgery could cure esophageal cancers, but now we can offer new hope to those with locally advanced esophageal cancer for whom surgery isn’t possible. The realization that chemoradiation could save this many lives has been a landmark and practice-changing event.”
Approximately 13,000 new cases of esophageal cancer are diagnosed each year in the United States. The esophagus is a tube about 10 to 16 inches in length that is part of the digestive tract. The major function of the esophagus is to carry food from the mouth to the stomach. A valve at the connection between the esophagus and the stomach keeps the contents of the stomach, which are acidic, from backing up and damaging the lining of the esophagus. When the valve is unable to perform its function, the patient has the condition known as acid reflux, which may be a risk factor for developing this type of cancer. Thanks to improved imaging such as endoscopy with ultrasound, it is now possible to better assess the extent of cancer in the esophagus and the gastric junction linking it to the stomach.
The disease site team approach at the Mayo Clinic Cancer Center in Scottsdale, which in the case of esophageal cancers includes gastroenterologists, surgeons, radiation oncologists, medical oncologists, diagnostic radiologists and pathologists, enables each case to be individually evaluated as to the recommended course of treatment.
“We have more tools at our disposal,” says Dr. Gunderson. “Our goal now is to make the treatment more tolerable and, when appropriate and safe, more aggressive, so we can increase the odds even more. With improved screening protocols, especially for those who suffer from reflux, I think we will see survival rates rise rather dramatically in the next decade.”
Gunderson is past chair of the gastrointestinal committee of the Radiation Therapy Oncology Group, a national study group that includes physicians from the Mayo Clinic Cancer Center in Scottsdale.
A new anti-reflux stent developed by a Medical College of Wisconsin researcher in Milwaukee has been found to improve the quality of life for patients with terminal esophageal cancer, according to a study published in the November 2002 issue of the journal Radiology.
The stent which incorporates the anti-reflux valve was also
recently cleared for use in the U. S. by the Food and Drug Administration and
has been approved for use in several European countries including the United
Kingdom.
Cancer of the esophagus, the tube that carries food from the mouth to the
stomach, carries a dismal prognosis and unfortunately its incidence at the
junction of the esophagus with the stomach is rising at a rapid rate, especially
in white males.
Most of the 12,000 people who develop this cancer each year
in the U.S. don't have symptoms until it is too late. Difficulty in swallowing,
or dysphagia, is the most common symptom. By then, the cancer is usually in an
advanced stage and cure is not possible.
"Not being able to swallow severely compromises the quality of life in these
patients," says Kulwinder S. Dua, M. D., F.A.C.P, F.R.C.P (Edin), associate
professor of medicine at the Medical College, and inventor of the 'Dua stent'.
Dr. Dua, a gastroenterologist, is the director of the Froedtert and Medical
College GI Diagnostic and Therapeutic Laboratory and chief of gastroenterology
at the VA Medical Center, both major teaching affiliates of the Medical College.
Return to Top
Traditionally, patients who cannot swallow due to incurable advanced cancer have hollow tubes placed through the solid tumor thereby allowing them to eat and drink.
However, with tumors at the junction of the esophagus and the stomach, these tubes have to be placed across the esophagus into the stomach. In this situation, stents not only allow the food to go down but unfortunately also allow the contents of the stomach to return to the esophagus and back into the mouth.
This usually happens with patients who are sleeping when
the airways are most vulnerable to aspiration. Thus, besides being unpleasant,
this may lead to serious complications like aspiration of stomach contents and
even death.
The 'Dua stent' not only allows patients the pleasure of eating and drinking,
but it also prevents the acidic and other contents of the stomach from returning
into the esophagus. The anti-reflux valve features a three-inch soft tube of
polyurethane that is attached to the lower end of the stent.
Resembling a windsock, it functions as a pressure-sensitive
valve that closes when stomach pressure increases thereby preventing reflux.
However, when the pressure builds beyond a certain point, the valve inverts
allowing for belching or vomiting. By drinking one gulp of water, it reverts to
its anti-reflux position. The complete assembly can be placed into the esophagus
using an endoscope and patients can be discharged the same day.
In the British study, a team of radiologists from the United Kingdom placed
these stents using fluoroscopy, a technique that projects an x-ray image onto a
screen for visual examination.
This procedure allows the radiologist to see the tumor's
precise location in the esophagus and to guide the stent into place. According
to Hans-Ulrich Laasch, MRCP, FRCR, a radiologist at South Manchester University
Hospitals in Manchester, England, and principal author of the study, "With this
new 'Dua stent', we can now control an unpleasant and potentially serious
complication physicians have traditionally asked patients to accept as a trade
off for being able to swallow, eat and drink."
Return to Top
In this prospective study, 50 consecutive patients with inoperable tumors of the lower esophagus received stents across the junction of the esophagus and stomach.
Half the patients received an open traditional stent, and the other half received the 'Dua anti-reflux stent'. Both groups of patients experienced identical improvements in swallowing, and most patients in both groups returned to a normal diet.
However, 24 out of 25 patients with open stents experienced
reflux, while only three of 25 patients with 'Dua anti-reflux stent' had this
symptom. The majority of the patients with the open stent required medication
for reflux. One patient died with aspiration within 24 hours after the open
stent was placed and no such complication occurred with the 'Dua stent'.
The device's effectiveness has important implications for the care of patients
with advanced esophageal cancer, Dr. Laasch said. "Reflux can lead to serious,
potentially life-threatening complications, including pneumonia, if digestive
material enters the lungs."
In addition, the fact that many patients with reflux must
take medication to manage this condition places another mental and physical
burden on individuals who are nearing the end of their lives. "Patients are
reminded of their cancer every time they swallow a pill," Dr. Laasch said.
Dr. Dua, had studied the effectiveness of the stent in clinical trials and
published his findings in the journal of Gastrointestinal Endoscopy in
2001. He has placed several of these stents in patients at Froedtert and VA
hospitals in Milwaukee, and all over the world, and has been giving live
demonstrations on its use at major medical centers. Currently, Wilson-Cook
Medicals, Inc., Winston-Salem, N.C., is manufacturing the stent.
Source
Posted by HFHSM.D.-ab on March 16, 1998 at 14:15:31:
In Reply to: cancer of the esophegus posted by mary c. on March 11, 1998 at 17:19:09:
: I'm looking for advice on cancer of the esophegus. We learned 2/16/98 that
my mom has stage 3 esophegial cancer. From what I've read, this is nasty.
What are we looking at here? and basically, what are treatment options? I'm
afraid her doctor is not treating aggressively as he is only using cisplatin
and 5-FU flouro...(can't recall the rest of the name). No plans to radiate.
I suggested Photodynamic therapy (PDT), surgery, cancer vaccines, and
thalidime as options to check into, he was very unresponsive.
I understand PDT is new, but approved by the FDA for stage 3 esophegus
cancer, but we haven't found where it's available. Any suggestions?
Cancer vaccines. I have read that there are some success with the cancer
vaccines, both cancer-type specific, as well as some that are developed
for the individual's cancer. Do you have any knowledge of this?
Do you know about the thalidime or have knowledge of other drugs keep new
blood vessels from forming? We're searching for help. Any you can offer will
be gratefully appreciated. Thanks, Mary
_________________________________________________
Dear Mary:
We are very sorry about your mother’s recent diagnosis of esophageal cancer.
Each year, approximately 12,000 new cases of esophageal cancer are diagnosed in the United States. Like your mother, most patients have stage III disease at the time of diagnosis.
The two most common types of esophageal cancer are called squamous cell carcinoma and adenocarcinoma.
The staging of this cancers is very important. Staging determines treatment options and predicts the prognosis of the patient. The “TNM” staging system is universally applied in the United States. “T” stands for tumor size, “N” for regional lymph node involvement and “M” for distant metastasis. A stage III cancer, implies a tumor that invades the outer lining of the esophagus or adjacent structures, and with regional lymph nodes that are also affected by the cancer. Unfortunately this is an advanced stage of the disease and for patients undergoing the most aggressive treatment options that survive the surgical procedure, the 5-year survival rate reported from major referral centers in the United States is only 15 to 20%.
There are several different treatment options, depending upon the cancer type (squamous cell carcinoma versus adenocarcinoma), the staging and the patient general condition. Combined treatment is frequently used. It uses different combinations of 1) chemotherapy (usually fluorouracil [5-FU] and cisplatin or mitomycin) 2) radiation therapy and 3) surgery. Esophageal tumor resection is a risky surgical procedure and is usually contraindicated if the patient has multiple medical problems and/or if the tumor is not “resectable”.
Because most cases of esophageal cancer are currently detected at an incurable stage, several “palliative” treatments have been described. Palliation means that even though the treatment will not change the prognosis, it will make the patient more comfortable and improve the quality of life. The most common symptom of advanced esophageal cancer is difficulty or inability to swallow due to the tumor obstructing the lumen of the esophagus. The different palliative treatments aim to decrease this obstruction.
Some of the available palliative treatments for esophageal cancer are:
1) Dilatation of the narrowed esophagus with a tube that is passed through the mouth and then pulled out. The disadvantages include the risk of perforation and the short duration of symptom relief.
2) Metallic expandable “stents” (tubes) that are positioned permanently in the esophagus . This procedure has a higher risk of perforation, but the symptom relief is long lasting.
3) A beam of laser can be used to heat and vaporize the tumor and gradually reopen the lumen of the esophagus. This therapy is effective and relatively safe.
4) Photodynamic Therapy (PDT) has also been applied to patients with advanced tumors for the purpose of palliation. It uses a substance that make tissues very sensitive to a special kind of laser light. When the lining of the esophagus is exposed to this light, destruction (necrosis) of the superficial tissue is produced.
5) Other techniques use very low temperature to destroy tissue (cryotherapy) or injection of substances directly to the tumor.
There are still no cancer vaccines or so called “immunotherapy” for esophageal cancer. Thalidomide has been used to promote healing of some kinds of esophageal ulcers, but does not appear to be a treatment for esophageal cancer.
This response is being provided for general informational purposes only and should not be considered medical
advice or consultation. Always check with your personal physician when you have a question pertaining to your
health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and
make an appointment to see Dr. Bravo, one of our experts in Gastroenterology.keywords
Source
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Personal Message: When you send a personal message to Karl Loren, you will receive a personal reply as per his instructions. Karl pledges that every personal message will get a personal answer. When you provide your mail address, we will send you free information including our free catalog and a cassette tape lecture by Karl Loren about heart disease, no charge, by mail, even if outside the US. You can select particular information you would like to receive, along with the free cassette tape and catalog.
You can reach Vibrant Life in many ways, including by mail to Vibrant Life, 2808 N. Naomi St., Burbank, CA 91504. Within the US and Canada, use the toll free number: (800) 523-4521, the local number: (818) 558-1799, the FAX: (818) 558-7299, eMail to kimberly@oralchelation.com or any one of the hundreds of message forms throughout the 50 web sites. Vibrant Life normally ships the same day we get an order. There are message forms on each of the 100,000+ pages on this and other sites where you can communicate with Vibrant Life. Check out our companion site, at: http://www.oralchelation.net where Karl's 2000 page book is published. Karl Loren is the author and webmaster for this BOOK, as well as for another web site about ORAL CHELATION. His personal philosophical articles are at PHILOSOPHY.
Copyright © May 20, 2008 6:23 AM by Karl Loren on behalf of Vibrant Life, ALL RIGHTS RESERVED. Permission is granted for non-commercial downloading, copying, distribution or redistribution on two conditions: One, that some form of copyright notice is included in every copy distributed or copied, showing the copyright belonging to Vibrant Life, Burbank, CA, at www.oralchelation.com . The second condition is that the material is not to be used for any purpose contrary to the purposes and objectives of this site. This permission does not extend to materials on this site which are copyrighted by others.
