Heartburn-Related Cancer Is Curable
Surgical Outcomes Improving, Study Shows
Acid Reflux, Barrett's continued...
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.
Closer surveillance of patients with severe chronic heartburnheartburn and Barrett's would lead to even better survival, Peters says.
But there is much debate about just how intensive this surveillance should be. Barrett's esophagus is considered a pre-malignant condition, but 90% of people with Barrett's esophagus never get esophageal cancer, according to the American College of Gastroenterology.
Even with rigorous surveillance of Barrett's esophagus patients, a large percentage of esophageal cancers will continue to be diagnosed late in the disease when the chances of survival are poor, says Rhonda Souza, MD. She points out that one recent study found that 95% of people with Barrett's esophagus didn't even know they had the condition.
Souza is an associate professor of medicine at University of Texas Southwestern Medical Center at Dallas and the Dallas Veteran's Administration.
"The problem is not that we are missing esophageal cancer in the people we screen, but that the vast majority of high-risk people are not being followed," she says. "Until we have a better way to identify patients with Barrett's esophagus, surveillance will only take us so far."