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Mr. Smith is 75-year-old gentleman. He noticed he had trouble swallowing solid foods for the past several months. Since it was getting worse, he went to see his physician. Workup showed he had cancer of the esophagus.
The esophagus is a 10-inch-long, hollow, muscular tube that connects the throat to the stomach. Cancer of the esophagus is almost four times more common in men than women.
The most common cause is using any form of tobacco — including cigarettes, cigars, pipes, chewing tobacco and snuff. Heavy alcohol use also increases the risk. So does a diet that is low in fruits and vegetables and certain vitamins and minerals.
There are two types of esophageal cancer. One is squamous cell carcinoma that affects the upper or middle part of the esophagus. Another is adenocarcinoma that affects the lower part of food pipe. Treatment is similar for both of these types of cancer.
There is lots of discussion among cancer researchers about different treatment options in this cancer.
Recently, an excellent article was published in the New England Journal of Medicine. This study answers many of those questions. This study included both kinds of esophageal cancer — adenocarcinoma and squamous cell carcinoma.
The study consisted of 366 patients who were potentially curable. Almost half the patients were treated with only surgery. The remaining patients were treated initially with chemotherapy and radiation therapy, and then they underwent surgery.
Surgery consisted of removal of part of the esophagus which had cancer and reconnecting the remaining part to stomach.
After almost four years of follow-up, the patients in the combined treatment group had a 34 percent lower risk of death. Overall survival was 49.4 months (more than four years) with combined treatment and 24.0 months (two years) with surgery alone. This is more than doubling of survival. Forty-seven percent of the patients in the combined group were alive after five years and were likely cured.
The patients tolerated combined chemotherapy and radiation therapy fairly well. This group also did not experience any more complications of surgery or death from surgery either. Complete resection was more possible in the combined group.
Actually, 29 percent of the patients had no cancer found at the time of surgery after chemotherapy and radiation therapy. An unanswered question remains whether this group of patients even needs surgery.
This study clearly suggests that patients with curable esophageal cancer should undergo both combined chemotherapy and radiation therapy followed by surgery. I advised the same to my patient.
He completed the chemotherapy and radiation therapy and is going to have surgery soon. He will require close follow-up after surgery.
Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email firstname.lastname@example.org or call 352-746-0707.