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Cancer Institute

New Advances in Esophageal Cancer

New Advances in Esophageal Cancer, Barrett’s esophagus

Compared to other forms of cancer, esophageal cancer is relatively rare. Still, there has been a 500 percent increase in the incidence of esophageal cancer since the 1970s. Each year, esophageal cancer claims more than 14,000 lives, making this disease a serious health threat.

Blair Anderson Jobe, MD

“The problem with esophageal cancer is that the majority of patients have an advanced form of this disease at the time of diagnosis,” said Blair A. Jobe, MD, a nationally acclaimed esophageal specialist who heads up the Institute for Treatment of Esophageal Disease at West Penn Allegheny Health System. “Most of these patients are asymptomatic until swallowing becomes difficult and by then the probability of having metastases has increased substantially. When esophageal cancer spreads to distant sites (metastasizes), it is deadly. That’s why it’s extremely important to have esophageal cancer detected early, when it is more treatable. We simply must focus on improving screening efforts and understanding risk.”

Dr. Jobe is bringing together a multidisciplinary team of specialists at West Penn Allegheny Health System to offer patients the latest treatments for esophageal cancer, as well as Barrett’s esophagus (a risk factor for esophageal cancer caused by GERD), esophageal motility disorders, gastroesophageal reflux disease (GERD) and thoracic diseases, such as lung cancer. For patients with Barrett’s esophagus and esophageal cancer, this means that therapies are tailored to address their unique circumstances.

“Up until five years ago, the only option for an esophageal cancer patient was to have their entire esophagus removed,” says Dr. Jobe. “Then we would replace the esophagus with a tubularized portion of the stomach, connecting it to the remaining esophagus in the neck. While this remains the cornerstone of therapy, esophagectomy is a very extensive operation with high risks. But in recent years, there has been a tremendous revolution in the development of new treatment options for patients with early stage esophageal cancer and Barrett’s esophagus. These newer techniques help preserve the natural anatomy of the esophagus, reduce the risk of procedural complications and afford patients a quicker recovery following surgery.”

The Institute for Treatment of Esophageal Disease offers patients a variety of treatment options for esophageal cancer, including radiofrequency ablation (where the surgeon burns pre-cancerous cells from the inner lining of the esophagus), cyroablation (where the surgeon uses a spray gun to freeze the cancerous cells), and endoscopic resection (where the surgeon “scoops” out the cancerous cells). Many of these procedures can be performed on an outpatient basis.

Very promising is a new procedure that involves peeling out the inner lining of the esophagus, then replacing this tissue with extracellular matrix (lining from the bladder of a pig). When the patient’s own stem cells populate the new inner lining, this allows the esophagus to heal with less scarring. To date, Dr. Jobe has performed six of these experimental surgeries. He will soon start a clinical trial to learn how well this procedure prevents cancer from recurring and how well it enables patients to swallow normally over the long term.

While all of these procedures are highly effective in curing esophageal cancer and preserving the esophagus, Dr. Jobe cautions that they only work for patients who are treated with Barrett’s esophagus and early stage cancer where there has been no spread of disease to the regional lymph nodes adjacent to the esophagus. Patients with more advanced cancer have an esophagectomy, preceded by chemotherapy and/or radiation therapy.

The Institute for Treatment of Esophageal Disease is also studying different techniques for esophageal cancer and Barrett’s esophagus screening. For instance, the institute’s clinicians are employing the use of unsedated endoscopy for esophageal disorders. This approach enables patients to have an endoscopy in their doctor’s office without being sedated, thereby lowering the threshold for the decision to edoscopically screen for disease.

“Screening and surveillance are extremely important in saving lives,” said Dr. Jobe. “We recommend that patients who have Barrett’s esophagus be endoscopically surveyed every three to five years. Patients who have been on acid suppression medications for more than five years, or those who have difficulty swallowing, should also be endoscopically screened.

Adds Dr. Jobe: “Esophageal cancer is a very serious condition, but we are making tremendous strides in understanding and treating this disease. That is giving new hope for many patients.”

Dr. Jobe is seeing patients at the Peters Township Outpatient Care Center. To schedule an appointment with Dr. Jobe, call 724.260.7300.

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