Esophageal adenocarcinoma is one of the fastest growing cancers in the United States. However, it has been able to be treated surgically to achieve higher survival rates and a better prognosis.
Researchers at the University of Southern California convened 263 patients with surgically treated adenocarcinoma, about half of whom survived for more than 5 years (i.e., a 5-year survival rate of 50% or more). Patients who had potentially metastatic lymph nodes removed in conjunction with surgical treatment had better outcomes. A related paper was published in the Journal of the American College of Surgeons.
Jeffery H. Peters, MD, PhD, a fellow of the American College of Surgeons (FACS) and one of the authors of the study, noted that treating esophageal adenocarcinoma with chemotherapy and radiation alone is not necessarily better than surgery. In the past, however, patients were often told that they were at high risk of dying during surgery and had less chance of surviving long-term afterwards. These treatment decisions were based on the experience of treating squamous esophageal cancer decades ago, but most people now have adenocarcinoma that does not apply to past experience.
However, surgery is not without its drawbacks. About 60% of patients in this study had complications such as pneumonia and arrhythmias; and, within 30 days of surgery, there were 12 deaths; in addition, 13% of patients required reoperation.
In response, this paper also explores how early detection of patients with esophageal adenocarcinoma can improve the success rate of early surgery.
Peters noted that gastroesophageal reflux disease (GERD), and its resulting Barrett’s esophagus (BE), is strongly associated with esophageal cancer, with patients most often presenting with heartburn. Closer monitoring and regular screening gastroscopy for people who frequently experience heartburn, as well as for patients with Barrett’s esophagus, which can detect early cancer, may increase the survival time of patients with adenocarcinoma.
Patients with adenocarcinoma are usually younger than those with squamous carcinoma and can be diagnosed with Barrett’s esophagus early in their disease. However, 95% of patients are unaware that they have the disease. Studies have shown that increased screening and surveillance in this population can lead to early detection of 17% of adenocarcinomas.
While adenocarcinoma is relatively uncommon in China, the incidence of GERD and Barrett’s esophagus is increasing every year. If you have these conditions, it is recommended that you watch for symptoms of discomfort such as heartburn and acid reflux and consult your doctor.