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Medicineworld.org: More Than Half Of Esophageal Cancer Patients Now Survive

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More Than Half Of Esophageal Cancer Patients Now Survive

More Than Half Of Esophageal Cancer Patients Now Survive
In part because the nature of the disease has changed, nearly 50 percent of patients with esophageal cancer that undergo an advanced surgical procedure now survive for five years, not 20 percent as once thought, as per an article reported in the April edition of the Journal of the American College of Surgeons. Scientists at the University of Rochester Medical Center contend that earlier diagnoses, more widespread screening and individualized care have made surgery by far the best way to combat esophageal cancer as it is most often diagnosed today.

Whether surgery, chemotherapy, radiation, or some combination of them should be the standard of care has been debated for years. Until recently, surgery has been considered the gold standard, but its role has been questioned by some medical oncologists based on their assumption that surgery comes with a high risk of complications and small chance of survival. In a number of cases today, oncologists will try chemotherapy and radiation first, completely avoiding surgery. Authors of the current study argue that the information used to make those decisions is dated, and that the surgery is the most effective approach in a number of patients.

"Those who argue against surgery for esophageal cancer cite surgical mortality rates of up to 15 percent and low five-year postoperative survival rates of 20 percent to justify their approach," said Jeffrey H. Peters, M.D., Chair of the Department of Surgery at the University of Rochester Medical Center (URMC) and Surgeon-in-chief of Strong Memorial Hospital. "What's worrying is that therapy decisions are being made based on decades-old experiences with a type of esophageal cancer that most patients no longer have, and on fears about problems with surgery that are no longer a concern. Our study found that the five-year survival of patients after surgical resection for esophageal adenocarcinoma is better than that reported for any other form of treatment," said Peters, co-author of the journal article.

Changing Face of Esophageal Cancer
In the past, the typical esophageal cancer patient had the kind of cancer caused by smoking (squamous cell carcinoma) and was frequently terminal. Patients needed surgery to make swallowing easier in the time they had left. Today, the average patient is younger, diagnosed earlier with a different kind of cancer (adenocarcinoma) and more likely to be cured.

The shift toward earlier diagnosis of esophageal cancer can be explained by the relationship of adenocarcinoma to gastroesophageal reflux disease (GERD). At the point where the esophagus empties into the stomach, a ring of muscle keeps stomach acid used in digestion from flowing back up into the esophagus. For a number of people, the ring malfunctions consistently over time, allowing acid to irritate the cells lining the esophagus, which causes "heartburn" pain and GERD. Acid can also cause long-term changes in the esophageal cells that make them pre-malignant, with the patches of abnormal cells known as Barrett's esophagus.

About 20 million Americans experience severe heartburn. Of those people with frequent heartburn for five years or more, about one in five develop Barrett's esophagus, giving them a 40-fold higher than normal risk of developing GERD-associated adenocarcinoma. While most cancer rates are falling, esophageal cancer has increased dramatically in recent years to become the fastest-growing type in the United States. The trend is likely to worsen as Americans gain more weight.

The increasing prevalence of GERD has resulted in the establishment of Barrett's surveillance programs and the increasing likelihood that a given patient with severe heartburn will undergo endoscopy, an imaging test that can catch cancer early. The combination of the rise in GERD, the drop in smoking, and better diagnostics means that esophageal cancer is often found earlier, and increasingly, while still confined to the esophagus. These patients are the best candidates for surgery to completely remove the tumor and cure it.

A Better Surgery.

Along with younger patients with less advanced cancer, better surgery is contributing to longer survival, as per the new study. Statistical analysis of patient survival found that en bloc esophagectomy, an operation that completely removes the cancer along with nearby lymph nodes, results in 30 percent fewer cancer deaths than a transhiatal resection, a surgery that leaves the lymph nodes in place. Scientists believe en bloc resection is more effective because it has a better chance of completely removing the cancer to control the disease at the tumor site.

While still controversial, the authors argue that their results add to a growing body of evidence that removing the lymph nodes, while not helpful in breast cancer, does indeed improve survival rates in esophageal, gastric and rectal cancer. Refinements in operative technique and postoperative care have made en bloc resection much safer as well, scientists said.

While more effective, en bloc resection is used less often used due to its complexity, and the training involved. Based on the current study, medical center scientists are calling for more widespread use of the technique, especially in those whose tumor is detected early.

The study also found that the number of patients with esophageal cancer now receiving chemotherapy and radiation more than doubled during the ten years during which data was examined, despite a lack of evidence supporting improved survival. One past study found that radiation and chemotherapy are not beneficial in early stage cancer, and may indeed harm patients when side effects are taken into account. Scientists say future work will need to compare survival in patients receiving nonsurgical therapy to survival in patients who have had surgery.



Posted by: Sue    Source




Did you know?
In part because the nature of the disease has changed, nearly 50 percent of patients with esophageal cancer that undergo an advanced surgical procedure now survive for five years, not 20 percent as once thought, as per an article reported in the April edition of the Journal of the American College of Surgeons. Scientists at the University of Rochester Medical Center contend that earlier diagnoses, more widespread screening and individualized care have made surgery by far the best way to combat esophageal cancer as it is most often diagnosed today.

Medicineworld.org: More Than Half Of Esophageal Cancer Patients Now Survive

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