HJNO Jul/Aug 2021

52 JUL / AUG 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY How common is esophageal cancer? Esophageal cancer is the eighth most common cancer and the sixth most com- mon cause of cancer death across the world. There will be approximately 17,000-19,000 cases diagnosed per year in the United States. Esophageal cancer is, unfortunately, a very deadly disease with only a minority of pa- tients presenting with early stage, curable disease. Up to 50-80% of cases are locally advanced and uncurable. In this article, we will review the presentation, work-up and management options for esophageal cancer. The esophagus is the long, muscular or- gan in our digestive system that connects the mouth to the stomach, allowing the passage of food. It is approximately 20-25 centime- ters long in the average adult. There are two main types of esophageal cancer: adeno- carcinoma and squamous cell carcinoma. Adenocarcinoma, the more common form of esophageal cancer, is more common in the lower part of the esophagus. Risk fac- tors for adenocarcinoma of the esophagus include obesity as well as a precancerous irritation of the esophagus known as Bar- rett’s esophagus or increased esophageal acid • Hoarseness. • Decreased hunger. • Nausea. • Weight loss. • Dark stools. • Bloody vomit. It is important to see your primary care provider as soon as possible if you suddenly develop these symptoms. Is there screening for esophageal cancer, and what does the standard workup consist of? If you have multiple risk factors for devel- opment of Barrett’s esophagus, including a history of reflux, male sex, age over 50 and obesity, your doctor may recommend screen- ing for Barrett’s esophagus, which consists of a procedure known as an esophagoduode- noscopy (EGD). During this procedure, you are sedated or put to sleep while a camera is gently inserted down the esophagus to look for abnormal findings and biopsy (the taking of a tissue sample) of any findings is performed as warranted. If you’ve been diagnosed with Barrett’s esophagus, your doctor may recommend a medication to block acid production called a exposure. Barrett’s esophagus is caused by a long history of untreated, severe acid re- flux. Adenocarcinoma is approximately four times more common in the white population than in African Americans. Limited studies have demonstrated protective effect from esophageal cancer with diets high in fiber (more than14.7 grams per day), beta-carotene, vitamin C and folate. Squamous cell carcinoma, on the other hand, is more strongly associated with heavy alcohol use and smoking. Other possible risk factors include prior stomach removal (gas- trectomy) and diets high in N-nitroso com- pounds. It more commonly presents in the middle of the esophagus and is seen more often in African Americans. Are there any signs of esophageal cancer? Esophageal cancer may present with very subtle changes or symptoms that may be more difficult to notice, particularly in the earlier stages of the disease. Potential symp- toms include: • Trouble swallowing liquids or solids. • Choking or gagging on food. • Feeling full more quickly during a meal. What You Should KnowAbout ESOPHAGEAL CANCER