San Diego Doctors Use Rare Surgery Treatment For Rare Esophageal Cancer

THERE ARE MANY CAMPAIGNS THAT FOCUS ON RAISING AWARENESS ABOUT VARIOUS DISEASES. THE CAMPAIGN THIS MONTH FOCUSES ON A RARE FORM OF CANCER THAT CAN BE LINKED TO A VERY COMMON SYMPTOM. THAT SYMPTOM IS HARPER. ESOPHAGEAL CANCER IS A PARTICULARLY DIFFICULT CANCER TO BEAT WITH A LESS THAN 20% FIVE YEAR SURVIVAL RATE. DOCTORS ARE INVENTING NEW WAYS TO TREAT THE DISEASE. PEOPLE WITH CHRONIC HEARTBURN ARE BECOMING MORE AWARE ABOUT GETTING TESTED. JOINING ME IS DARKER LIKE A BUFFET, A SURGICAL ONCOLOGIST AT UC SAN DIEGO MOORES CANCER CENTER. WELCOME TO THE PROGRAM. THANKS. FIRST OF ALL CAN YOU DESCRIBE TO US, IN YOUR MIND IS WHERE THE ESOPHAGUS IS AND WHAT IT DOES? SURE. THE ESOPHAGUS IS COMMONLY KNOWN AS THE FOOD PIPE. IT BASICALLY IS THAT FIRST PART OF THE INTESTINE THAT CONNECTS YOUR THROAT TO YOUR . IT LIES DEEP IN THE CHEST BEHIND THE HEART AND BEHIND THE LUNGS SORT OF IN THE CENTER OF THE CHEST HOZIER FOOD PIPE. THAT IS ITS FUNCTIONS. TO CONVEY TO DOWN FROM YOU THROUGH TO YOUR . LOTS OF PEOPLE HAVE HEARTBURN. MOST PEOPLE HAVE EXPERIENCED HEARTBURN AT SOME TIME OR ANOTHER. WHAT DOES HEARTBURN HAVE TO DO WITH DEVELOPING ESOPHAGEAL CANCER? GOOD QUESTION. HEARTBURN IS ALSO KNOWN AS GASTROESOPHAGEAL REFLUX. WHAT THAT IS, IS A CONDITION WHERE SOME OF THE ACID JUICES WILL REFLUX OR GO BACKWARDS UP INTO THE ESOPHAGUS WHERE THEY ARE NOT REALLY SUPPOSED TO BE. IT HAPPENS FOR A VARIETY OF REASONS. SOMETIMES THE SPHINCTER BETWEEN THE ESOPHAGUS AND THE IS A LITTLE WEEK AND IT DOESN'T PREVENT THE ACID FROM KNOWING BACK UP BUT THE LONG AND SHORT OF IT IS IT IF IT HAPPENS OVER TIME THAT ACID CAN DAMAGE THE LINING OF THE ESOPHAGUS AND CREATE WHAT IS KNOWN AS BARRETT'S ESOPHAGUS WHICH IS KIND OF US CHANGE IN THE CELL TYPE OF THE LOWER'S OFFICE -- ESOPHAGUS FROM A SQUAMOUS CELL TO IT COLUMNAR TYPES TELL. SECOND THAT PUTS IT AT RISK OF DEVELOPING A CANCER? THAT IS RIGHT. THAT CONDITION KNOWN AS BARRETT'S ESOPHAGUS IS ASSOCIATED WITH DEVELOPING CANCER IN THE FUTURE. ABOUT MAYBE HALF A PERCENT PER YEAR SO IF SOMEBODY KNOWS THEY HAVE BARRETT'S ESOPHAGUS THEY WOULD WANT TO BE SCREENED ON A REGULAR BASIS TO MAKE SURE THE SOME OF THE CELLS IN THAT LOWER ESOPHAGUS HAVE NOT TURNED INTO CANCER YET. WHAT ARE SOME OF THE OTHER RISK FACTORS FOR ESOPHAGEAL CANCER? I WAS READING OBESITY. WHY WOULD OBESITY BE A RISK FACTOR? WELL, IT TURNS OUT THAT OBESITY IS A RISK FACTOR FOR REFLUX AND ESPECIALLY OBESITY IN MALES, ABDOMINAL OBESITY, IS CAN LEAD TO REFLUX. THAT IN TURN WOULD PUT YOU AT HIGHER RISK FOR DEVELOPING ESOPHAGEAL CANCER. AND THERE IS ANOTHER FORM OF IT -- OF ESOPHAGEAL CANCER THAT HAS TO DO WITH ALCOHOL AND SMOKING CONSUMPTION? THAT IS RIGHT. THERE IS REALLY TWO TYPES, MAIN TYPES OF WHICH OF ESOPHAGEAL CANCER PICK THE ONE THAT IS ASSOCIATED WITH SMOKING AND ALCOHOL IS KNOWN AS A SQUAMOUS CELL CANCER THAT IS MUCH MORE COMMON IN DEVELOPING COUNTRIES AND THAT TYPE USUALLY HAPPENS IN THE FIRST OR SECOND PORTION OF THE ESOPHAGUS. WHEREAS THE KIND OF WE GET IN THE WESTERN DEVELOPED COUNTRIES IS AT NO CARCINOMA. THAT USUALLY HAPPENS IN THE LOWER ONE THIRD OF THE ESOPHAGUS AND IS AS MUCH RELATED WITH ALCOHOL THAT THERE IS A LITTLE RELATIONSHIP WITH TOBACCO, BUT MORE OF A RELATIONSHIP WITH OBESITY AND REFLUX. ON SPEAKING WITH DR. MICHAEL BOUVET A SURGICAL ONCOLOGIST AT UC SAN DIEGO MOORES CANCER CENTER. ASIDE FROM HAVING CHRONIC HEARTBURN IF YOU ACTUALLY DEVELOP ESOPHAGEAL CANCER IS IS A FORM OF CANCER WERE PEOPLE WOULD HAVE NOTICEABLE SYMPTOMS? ONCE THE TUMOR GETS LARGE ENOUGH IT CAN CAUSE PROBLEMS WITH SWALLOWING. THE FIRST SYMPTOM SOMEBODY MAY NOTICE WOULD BE BOYCOTT I'M CHEWING SOME MEAT OR HAVING SOME SOLID FOOD AND IT JUST SEEMS TO GET STUCK IN MY LOWER ESOPHAGUS. THAT WOULD BE A WARNING SIGN THAT THE TUMOR HAS GROWN AND HAS CONSTRICTED WERE NARROWED THE LUMEN OF THE ESOPHAGUS IN THAT AREA PREVENTING FOOD FROM GOING DOWN. THEY CAN USUALLY GET LIQUIDS DOWN BUT SOLID FOOD GETTING, IS A WARNING SIGN THAT THERE MIGHT BE A TUMOR THERE. WANT TO MAKE A POINT FOR PEOPLE LISTING, SO AS NOT TO CAUSE A PANIC THERE ARE ONLY A RATHER SMALL NUMBER OF PEOPLE WHO HAVE CHRONIC HEARTBURN AND WHOEVER DEVELOP ESOPHAGEAL CANCER. IS THAT RIGHT? THAT IS RIGHT. YES. IT IS A SMALL PERCENTAGE OF PEOPLE WITH HEARTBURN THAT DEVELOP ESOPHAGEAL CANCER'S. A SMALL PORTION MAKE IT BARRETT'S AND A SMALL PORTION OF BARRETT'S THEY GO ON TO GET ESOPHAGEAL CANCER. I THINK CREATING A LITTLE BIT OF AWARENESS ABOUT IT IS GOOD FOR THE PUBLIC TO BE AWARE OF THE WARNING SIGNS. AND MAYBE TO CHECK WITH YOUR DOCTOR. IF THEY HAVE A HISTORY OF REFLUX TO GET SEEN AND PERHAPS GET AN ENDOSCOPY IF IT HAS BEEN A LONG-STANDING HISTORY. BECAUSE GETTING THAT ENDOSCOPY THAT IS THE CORRECT TITLE FOR THE SCREENING RIGHT? YES. THAT WOULD BE A TUBE THAT IS PLACED DOWN THROUGH YOUR MOUTH INTO THE ESOPHAGUS. USUALLY DONE BY GASTROENTEROLOGIST WHERE HE OR SHE WOULD GO DOWN AND LOOK WITH THE SCOPE AND LOOK AT THE LINING OF THE ESOPHAGUS AND SEE IF THERE IS ANY OF THIS BARRETT'S ESOPHAGUS WE ARE TALKING ABOUT AND PERHAPS DO A BIOPSY OF THAT AREA IF THERE IS. TO MAKE SURE THAT THERE IS NO CANCER CELLS THERE. IS IT BECAUSE THAT SCREENING DOESN'T HAPPEN WITH A GREAT DEAL OF REGULARITY THAT IS CONTRIBUTING TO THE FACT THAT THE SURVIVAL RATE OF THIS CANCER IS QUITE LOW? I THINK THAT IS A GOOD WAY TO SUMMARIZE IT, THAT IS A TEST THAT REQUIRES A LITTLE SEDATION AND WE DON'T HAVE ANY MASS SCREENING PROTOCOLS IN THE UNITED STATES FOR ESOPHAGEAL CANCER BECAUSE AND THEN YOU WOULD HAVE TO DO THAT ON EVERYBODY AND THAT IS PROBABLY NOT A COST-EFFECTIVE THING AND IT WOULD BE PROBABLY A LOT OF UNNECESSARY PROCEDURES. IF YOU DO HAVE THE RIGHT PERSON WITH THE HISTORY OF OBESITY AND THE REFLUX AND IT HAPPENS MORE COMMONLY IN MEN COMPARED TO WOMEN, BY THE WAY, AND THE AGES DEVELOPMENT WOULD BE ABOUT 65 SO IF YOU FALL INTO THAT CATEGORY THAN THIS WOULD BE THE PEOPLE WOULD PROBABLY WANT TO SCREEN. AS I SAID IN THE BEGINNING, THERE IS A LESS THAN 20% FIVE YEAR SURVIVAL RATE BUT THAT INCREASES IF IT IS CAUGHT EARLY. RIGHT? THAT IS CORRECT. IT ALL DEPENDS ON THE STAGE OF THE TUMOR AND THE STAGE IS DETERMINED BY HOW DEEP THE TUMOR HAS PENETRATED INTO THE ESOPHAGEAL WALL. WE HAVE SOME RELATIVELY NEW TASKS CALLED ENDOSCOPIC ULTRASOUND WHICH GIVES US A GOOD IDEA OF HOW THICK THE TUMOR IS AND THAT IS STRICTLY RELATED TO THE OUTCOME. AT MOORE'S YOU HAVE BEEN DOING A SURGICAL PROCEDURE TO TREAT ESOPHAGEAL CANCER. IT SOUNDS RATHER NONINVASIVE. TELLS ABOUT A. I WOULDN'T SAY IT'S COMPLETELY NONINVASIVE BUT WHAT IS, IS ONE OF MY FELLOW SURGEONS, DR. MORGAN AND I HAVE BEEN DOING, OFFERING PATIENTS A PROCEDURE CALLED ROBOTIC ASSISTED TRANS HIATAL IS OBJECT TO ME. SORT OF A FANCY WORD FOR A MINIMALLY INVASIVE PROCEDURE WHERE WE GO INTO THE ABDOMEN WITH A SMALL PORT AND CLEVER SCOPE AND WE FREE UP THE AND REMOVE THE ESOPHAGUS WITH THE HELP OF THE ROBOT WHICH IS ALSO USED FOR REMOVING A PROSTATE BECAUSE IT IS A HELPFUL AND SMART WHEN YOU ARE WORKING IN A SMALL HOLE AND YOU WANT TO GET GOOD DETAIL ABOUT THE ANATOMY. AND THEN IF SOMEBODY DOESN'T HAVE AN ESOPHAGUS YOU HAVE TO BUILD THEM A NEW ONE. THAT IS WHERE THE COMES INTO PLAY AND WE WANT TO BUILD A NEW ESOPHAGUS BY CREATING A TUBE FROM THE . THAT ACTUALLY GETS PULLED ALL THE WAY INTO THE LEFT NECK AND SEWN INTO THE CERVICAL ESOPHAGUS WITH A PORTION OF THE ESOPHAGUS IN THE NEXT. THAT IS AMAZING.. I REALLY APPRECIATE YOU SPEAKING WITH US TODAY. RAISING AWARENESS ABOUT THIS PARTICULAR CANCER. I HAVE BEEN SPEAKING WITH DR. MICHAEL BOUVET, SURGICAL ONCOLOGIST AT UC SAN DIEGO MOORES CANCER CENTER. THING TO SO MUCH. THANK YOU.