HJNO Jul/Aug 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2021 53 Ashley Brown, MD Radiation Oncologist Terrebonne General Health System Mary Bird Perkins Cancer Center “proton pump inhibitor” (PPI). This medica- tion has been found in observational studies to reduce the risk of cancer development. Screening for esophageal cancer is recom- mended for those exhibiting Barrett’s esoph- agus by the American Gastroenterological Association and the American College of Gastroenterology based on the severity of the Barrett’s esophagus and may include re- peat EGD every three months to 12 months. Esophageal cancer is similarly diagnosed — with EGD and biopsy. Once the diagnosis is confirmed, your doctor will need to perform other tests to determine the stage and extent of the tumor. Knowing the stage will allow your doctor to select the best treatment for you. The other tests that may be used for staging of esophageal cancer include: • Endoscopic ultrasound: you will be put to sleep while an ultrasound machine inserted gently into the esophageal de- termines how deep the tumor extends into the layers of the esophagus. • PET/CT or CT scans of the chest, abdo- men or pelvis. • Bronchoscopy: this procedure, in which a camera is gently inserted into the windpipe while you are asleep, is done for patients with upper esopha- geal tumors. How is esophageal cancer treated? Early stage esophageal cancer (limited to the inner layers of the esophagus, with no surrounding lymph nodes) is managed definitively with surgery, whichmay include endoscopic mucosal resection or removal of part of most of the esophagus (esophagecto- my). For locally advanced esophageal cancer in which the tumor invades the deeper lay- ers of the esophagus or cancer has spread to nearby lymph nodes, treatment consists of chemotherapy (medications given through veins, “IV” to kill cancer) and/or radiation therapy (high energy X-ray beams aimed at the tumor) prior to surgery or alone. Imag- ing is often performed after chemotherapy and radiation to determine the patient re- sponse to treatment and ability to undergo surgery. In some cases, patients may have findings after surgery for presumed early stage esophageal cancer that warrant the use of chemotherapy or radiation. The abil- ity to undergo surgery will depend on many things, including patient medical conditions and overall health. What are the side effects of treatment for esophageal cancer? Side effects of esophageal cancer will depend on the precise treatment or che- motherapy regimen used, the radiation dosing and the type of surgery. In general, side effects may include nausea, tiredness, sore throat or throat pain, weight loss and decreased blood counts. Due to the poten- tial side effects, it is not uncommon for the providers to recommend placement of a temporary feeding tube to assist in nutri- tional supplementation while the patient is undergoing treatment for esophageal cancer. Symptoms of obstruction from esophageal cancer may also be managed by placement of a tube to allow for passage of food, known as an esophageal stent. The oncology care for a patient with esophageal cancer is multidisciplinary, meaning that there are many doctors and support teams involved in coordinating the care and management of symptoms. The team will often consist of surgical specialists, medical oncologist, radiation oncologist, nutrition expert and other supportive care services. What new treatments are available for esophageal cancer? Immunotherapy represents a newer class of cancer treatments, which includes medi- cations administered via IV that stimulate the patient’s own immune system to assist in fighting the cancer. Many cancer sites are now treated with immunotherapy as the standard of care. A recent trial known as “Checkmate 577”published in 2020 found that patients who received immunotherapy after preoperative chemotherapy and sur- gery went a longer time before experiencing progression or relapse of their tumor. Fur- ther randomized trials are needed to support this promising finding. n Ashley Brown, MD, is a radiation oncologist at Mary Bird Perkins Cancer Center, a partner with Terre- bonne General Health System, inHouma.She earned a medical degree from The Medical College of Wis- consin in Milwaukee, Wisconsin, and internal medi- cine preliminary training at Ochsner Clinic Foundation. She completed a residency at Stephenson Cancer Center at the University of Oklahoma Health Science Center (OUHSC) inOklahoma City,Oklahoma.Brown served as chief resident of the Department of Radia- tionOncology at OUHSC.She is also amember of the American Society for Radiation Oncology,American Society of Clinical Oncology,American College of Ra- diology and the National MedicalAssociation.Brown has researched and has an interest in central nervous system, breast and gynecologic cancers. Risk factors for adenocarcinoma of the esophagus include obesity as well as a precancerous irritation of the esophagus known as Barrett’s esophagus or increased esophageal acid exposure. ” “