Diagnosis of esophageal cancer has typically warranted a grim outlook, but prognosis is improving in many respects. Dr. Frank Spitz, associate professor in the division of surgical oncology at the University of Pennsylvania School of Medicine, speaks about advances in diagnosis and treatment of esophageal cancer with host Dr. Lee Freedman. Whom should we screen for the disease? Once diagnosed, what are the likely prospects for a full return to functionality?
Transcript Excerpt
DR. LEE FREEDMAN:
In terms of the diagnosis of Barrett esophagitis that intestinal metaplasia, do we know clearly the role of PPI treatment? Does it seem to alter the course?
DR. FRANCIS SPITZ:
Well, thus far antireflux procedures and symptomatic treatment don't apparently have a significant change in the natural history of the disease once it is identified. So, in other words, once someone has presented with the changes, which are likely secondary to chronic reflux, then treating them with other antireflux surgery procedure or treating them with PPIs is not going to change the risk of developing esophageal cancer. It is likely that whatever genetic hits were in the cells, have been put into motion and then it is a matter of the cells itself and the changes that would continue on.
DR. LEE FREEDMAN:
So, treatment seems to be somewhat relevant at that point.
DR. FRANCIS SPITZ:
Right. Once they have presented with Barrett esophagus, the treatment is symptomatic, but the followup or the endoscopies and biopsies independent on the level of dysplasia or abnormal cells, you can increase screening and increase the biopsies, but once they have a diagnosis, they need to be then followed and that's where we pick up a lot of these early cancers and that's where you can pick up the cancers that are very curable also....read more