Shaving Off Cancer Cells Is as Effective as Esophagectomy

A minimally invasive tumor-removal technique for dealing with early-stage esophageal cancer is just as effective as radical removal of the esophagus and hardly at all disruptive of a patient's quality of life, according to a recent Mayo Clinic investigation.

“In 20 percent of esophageal cancer cases in the United States, the cancer is detected in the early stages,” said Ganapathy Prasad, a gastroenterologist and the study’s lead author. “Traditionally, esophageal cancer patients undergo a complicated surgery to remove the esophagus. Our team compared surgery to the use of endoscopic therapy, where a scope is inserted in the esophagus and the cancer cells are shaved off. Our results showed the less-invasive therapy was just as effective as surgery for early-stage cancers.”

In the study, which appeared in the journal Gastroenterology, the researchers chose 178 patients with early-stage esophageal cancer. Of these, 132 (74 percent) were treated by doctors using an endoscope to find and then scrape off the cancerous mucosa lining the walls of the esophagus. The remaining 46 patients (26 percent) had the cancerous portion of their esophagus surgically removed. In the endoscope patients, the procedure involved injecting a liquid under the lesion and then shaving it off.
   
The doctors followed the participants for nine years and found that both groups had about a 20 percent mortality rate. Cancer came back in 12 percent of the endoscope patients, but it could again be dealt with endoscopically.
   
A patient who has his esophagus surgically removed must be hospitalized for a week. After the surgery, complications arise 30 percent to 50 percent of the time. And patients’ quality of life is greatly affected. They must cope with lifelong dietary limitations. But treatment with an endoscope can be performed on an outpatient basis. Patients can return to normal eating habits in just a few days.

“If patients do choose to proceed to surgery, they should be advised to seek out a high-volume surgical center,” says Kenneth Wang, gastroenterologist and senior researcher on the study. “Research has shown that high-volume hospitals, such as Mayo Clinic, have better survival rates and outcomes for patients.”
   
The cancer increasing the most rapidly in the United States is esophageal cancer, which is quite lethal. Within five years of diagnosis, 90 percent of patients are dead. A big warning sign for this form of cancer is chronic acid reflux, which damages the tissue lining the lower esophagus. About 10 percent of people with chronic acid reflux develop a precancerous esophageal condition that can morph into cancer.
   
The Mayo team, Wang said, will now move on to investigate the use of the endoscope to treat more-advanced forms of esophageal cancer.


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