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Gastrointestinal Cancer-3-Esophagus


Welcome to the third part of educational series on GastroIntestinal Cancers. In last issue of GMJ, we learned about risk factors, especially tobacco and alcohol. We also learned about tests for early diagnosis.

Question: Now Dr. Chiragbhai, you had mentioned about discussing each subsite of GI cancer in detail. What should we start with?

Answer: Esophagus. It is very common in Gujarat, in both men and women, as we saw in first part of this series.

There are two main histologies: Squamous Cell Carcinoma AND Adenocarcinoma.

SCC is mainly related to use of tobacco and alcohol.

Adenocarcinoma is mainly related to Barrett’s esophagus and GERD (gastroesophageal reflux disease). GERD known as reflux disease is more commonly seen in obese patients in West, but is an increasing common symptom in India.

However, many patients do not have any of these risk factors.

Que: What is Barrett’s esophagus?

Ans: This is a condition where normal mucosa at gastroesophageal junction is converted from squamous to columnar epithelium. This metaplasia frequently progresses to dysplasia and then cancer.

Que: How do you monitor this risk of cancer in patients with Barrett’s esophagus?

Ans: Patients with Barrett’s esophagus are managed medically e.g. using proton pump inhibitors. Patients with severe symptoms of reflux need upper GI endoscopy. Monitoring frequency is debated. Every 1-3 years, endoscopy is performed. More frequent endoscopy is done for those who develop low grade dysplasia. Esophagectomy is recommended for high grade dysplasia, as over 50% of such patients already have adenocarcinoma.

Que: What is the screening test for other patients?

Ans: There is no good test for other patients. Patients with uncomplicated GERD do not need repeated endoscopy. Most important is to intervene early if there is increase in severity of reflux symptoms, or development of dysphagia, weight loss.

Widespread monitoring with screening endoscopy is done in Japan, but this approach has not been found to be useful in other countries.

Que: What tests are recommended for a patient with suspected cancer?

Ans: Upper GI endoscopy with biopsy from suspected area, CT scan of chest and abdomen are basic tests. Wherever feasible, PET-CT is preferred, as it can detect disease spread early and hence avoid unnecessary local treatment. EUS (endoscopic ultrasound) is also useful in accurate staging, perhaps less important with availability of PET-CT.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496

Diplomate American Board of Oncology and Hematology. Ahmedabad.

Shyam Hem-Onc Clinic. 402 Galaxy, Near Nehrunagar Circle, Ahmedabad.

98243 12144; 98988 31496.