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According to the American Cancer Society (ACS), more than 16,000 new esophageal cancer cases are diagnosed each year in the United States. The survival rate for the disease, however, is just 10% largely because the cancerous tumors have grown to the point of inoperability by the time these cases are diagnosed. Raising patient awareness about conditions that could progress into esophageal cancer if left untreated will encourage patients to seek appropriate care through their physicians.

Contributing Risk Factors

Many patients are aware that tobacco use increases the risk of esophageal cancer, but there are several other common contributing risk factors, including excessive alcohol consumption, obesity, lye ingestion, and GERD. A recent ACS Gallup poll revealed that 44% of adults in the U.S. have heartburn at least once per month, and about 30% of esophageal cancer cases can be linked to GERD. The condition can be dangerous to the esophageal tissue because it can inflame and damage the lining of the esophagus. If GERD becomes chronic, it can develop into Barrett’s esophagus, a significant precursor to esophageal cancer. Although only a small percentage of people with GERD develop Barrett’s esophagus, patients need to be encouraged to see their physicians regularly once it’s diagnosed to avoid the development of esophageal cancer.

According to the ACS, prevention of Barrett’s esophagus can begin with controlling GERD. Lifestyle changes such as losing weight, eating a healthy diet, smoking cessation, and discontinuing alcohol consumption are recommended as initial treatment. However, people with severe GERD and Barrett’s esophagus often require more aggressive treatment and prevention methods. These strategies may include medications, other non-surgical medical procedures (eg, endoscopic therapies), and/or laparoscopic and open surgeries. Oftentimes, swallowing difficulty (dysphagia) and other symptoms can be resolved if they’re identified early.

Treatment Options

Due to the aggressive nature of the disease, most patients who have esophageal cancer aren’t surgical candidates. In these situations, the primary focus becomes palliative care—providing comfort measures to help maintain quality of life. This includes treating dysphagia by opening the stricture within the esophagus. To open the barriers caused by tumor in-growth, physicians may use an esophageal metal stent. Prior to stent placement, patients may require dilation of the stricture to allow room for the stent to be positioned, thereby expanding the lumen of the esophagus. Traditionally, stent placement has been a painful process for patients, but new technologies are making this procedure easier for patients and doctors alike.

New, innovative delivery systems have been designed to enable accurate deployment and recapturability of esophageal stents. The purpose of these systems is to stop the stent from moving or migrating into the stomach. This also reduces the need for repeat procedures to replace or reposition the stent, one of the more common complications in traditional esophageal stenting.

Increase Awareness

Raising awareness about the primary precursors to esophageal cancer—especially GERD and Barrett’s esophagus—will hopefully encourage patients with these conditions to consult their physicians for the screenings and treatments they need. Patients have several therapeutic options to consider, and it’s important for physicians to involve them in the decision-making process. In cases where palliative care becomes the primary option for patients with esophageal cancer, recent advancements in medical device technologies have enabled physicians to more easily implant esophageal stents. In turn, physicians can significantly improve patients’ quality of life.

Ali Fazel, MD, has indicated to Physician’s Weekly that he has worked as a paid speaker for Axcan Pharma, Inc. and has received grants/research aid from Olympus Corp.