(Ivanhoe Newswire) -- Researchers at the Mayo Clinic have found that
early stage cancers of the esophagus can be treated effectively by organ-sparing
endoscopic therapy, thereby avoiding the surgical removal of the esophagus.
Esophageal cancer arising from Barrett's esophagus is increasing faster than any
other cancer in the United States. About 10 percent of patients with chronic
acid reflux develop the tissue changes characteristic of Barrett's esophagus,
which can lead to cancer. The tumor is lethal. Ninety percent of patients die
within five years of diagnosis.
In 20 percent of esophageal cancer cases in the U.S., the cancer is detected in
the early stages," Ganapathy Prasad, M.D., endocrinologist and lead author on
the study was quoted as saying. "Traditionally, esophageal cancer patients
undergo a complicated surgery to remove the esophagus. Our team compared surgery
to the use of endoscopic therapy, where a scope is inserted in the esophagus and
the cancer cells are shaved off. Our results showed the less-invasive therapy
was just as effective as surgery for early-stage cancers."
In
this study of 178 patients with early-stage esophageal adenocarcinoma, 132 were
treated with endoscopic mucosal resection and 46 were treated surgically. The
endoscopic mucosal resection patients underwent a procedure where a liquid is
injected under the lesion and then an endoscope is used to shave off the
lesions. The other patients underwent more traditional removal of the esophagus.
The patients were followed for nine years. Both groups had a comparable overall
mortality rate of approximately 20 percent. Cancer recurred in 12 percent of
patients treated endoscopically, but doctors were able to treat the recurrence
endoscopically.
Dr. Prasad explained that esophagectomy surgery patients are typically in the
hospital for a week, and 30 to 50 percent of them experience complications post
surgery. For example, esophagectomy patients face lifelong dietary restrictions.
Endoscopic treatments, however, are performed in an outpatient setting, and
patients can eat full meals within a couple of days.
"If patients do choose to proceed to surgery, they should be advised to seek a
high-volume surgical center," Kenneth Wang, M.D., gastroenterologist and senior
researcher on the study was quoted as saying. "Research has shown that
high-volume hospitals, such as Mayo Clinic, have better survival rates and
outcomes for patients."
Dr. Wang says that future research in this area will examine genetic markers to
help determine the best course of treatment for esophageal cancer patients. In
addition, the Mayo research team hopes to study the use of endoscopic therapy
for more advanced esophageal cancers.
SOURCE: Gastroenterology, September 2009
