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Heartburn-Related Cancer Is Curable

Surgical Outcomes Improving, Study Shows
By
WebMD Health News
Reviewed by Louise Chang, MD

April 17, 2006 -- The clinical picture of esophageal cancercancer is changing, and so is the traditionally bleak prognosis for the disease, new research suggests.

Two decades ago, nearly all patients had a particularly deadly type of esophageal cancer, known as squamous cell carcinoma. Smoking and drinking alcohol are the biggest risk factors for the cancer.

Today, the typical patient has another type of malignancy that has been linked to GERDGERD (gastroesophageal reflux disease), which can cause chronic heartburnheartburn and Barrett's esophagus, a condition that affects the lower part of the esophagus and can lead to cancer. Barrett's esophagus can be caused from acid refluxacid reflux when acid from the stomach backs up into the esophagus.

This is esophageal adenocarcinoma, one of the nation's fastest growing cancers. But the new research shows that with surgical treatment, patients with the malignancy have a much better chance for survival than patients had in the past.

Findings Challenge Trend

Almost half of the 263 surgically treated adenocarcinoma patients in the University of Southern California study survived for five years or more. Researchers reported even better outcomes when lymph nodes were removed along with the cancer.

Study co-author Jeffery H. Peters, MD, FACS, tells WebMD that the findings challenge a trend in oncology to treat patients with chemotherapy and radiation therapy without surgery. Peters leads the department of surgery at the University of Rochester in New York.

Patients are still often told that their risk of death during surgery is high while their chances of long-term survival following surgery are low, Peters says.

"What is worrying is that treatment decisions are being made based on decades-old experiences with a type of esophageal cancer that most patients no longer have, and on fears about problems with a surgery that are no longer a concern."

Acid Reflux, Barrett's

About 14,550 new cases of esophageal cancercancer will be diagnosed in the United States this year, according to figures from the American Cancer Society. The disease is three to four times more prevalent in men than women, and black men have a higher risk of developing adenocarcinomas than white men.

Adenocarcinoma patients tend to be younger than those with squamous cell tumors, and their cancers are often diagnosed earlier in the course of the disease, thanks, in part, to increasing surveillance of people with severe acid reflux disease or a related condition known as Barrett's esophagus.

Barrett's patients have 30 to 40 times the risk of developing this cancer, and 17% of the cancers in the study were detected as a result of increased surveillance of these patients.

The study is published in the April issue of the Journal of the American College of Surgery.

"It is clear that more people are surviving this disease," Peters says. "What is still being debated is why. Is it because of earlier detection with surveillance, better surgery, or because this cancer is biologically a little less aggressive? We don't really know the answers."

Of the patients in the study, about 60% had reported complications including pneumoniapneumonia and abnormal heart rhythm, and there were 12 deaths within 30 days of the surgery. Repeat operation was needed in 13% of the patients.

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