I was fortunate to train with the first group of surgeons to perform Minimally Invasive Esophagectomy (MIE) in Canada. Since the beginning of my practice, the management of esophageal cancer has been a focus of my surgical practice, specifically incorporating advanced endoscopic procedures to treating pre-cancerous Barrett’s disease and early stage cancer and performing advanced laparoscopic/thoracoscopic procedures for locally advanced cancer. Thus, my practice affords my patients comprehensive therapy for all aspects of the esophageal cancer process.
Esophageal cancer is a serious form of cancer that develops in the esophagus, the long tube that connects the back of your mouth with your stomach. The most common types of esophageal cancer are adenocarcinoma, which starts in the glandular cells producing fluids such as mucus, and squamous cell carcinoma, which starts in flat cells of the esophageal lining. Although the causes of esophageal cancer aren’t known, chronic irritation from gastroesophageal reflux disease (GERD), Barrett’s esophagus, smoking, obesity and heavy alcohol use are leading risk factors for the disease.
Barrett’s esophagus is a condition affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth to the stomach. Barrett’s esophagus is caused by injury to the esophagus from the chronic backwash of stomach contents (like acid and enzymes) that occurs with acid reflux. There are no symptoms specific to Barrett’s esophagus, other than the typical symptoms of acid reflux (or GERD).
Barrett’s esophagus has long been established as a pre-cancerous condition of the esophagus. Traditionally, its management has been limited to monitoring the condition with endoscopy with the hope that the disease wound not progress to cancer. More recently, Barrx Radiofrequency Ablation has been shown to cure Barrett’s disease in more than 90% of patients and has become the standard of care for patients with High Grade Dysplasia, those with the fastest growing amount of abnormal cells who have the highest risk of developing cancer.
Early Stage Esophageal Cancer
Cancer occurs when the abnormal cells involved in Barrett’s esophagus have rapid and uncontrolled growth and invade the deeper layers of your esophagus. This is called cancer of the esophagus, or esophageal adenocarcinoma (EAC). The cancer can also spread beyond the esophagus. A majority of patients with esophageal cancer have Barrett’s esophagus, although unfortunately most of them don’t know they have it until cancer develops.
Until recently, all patients diagnosed with esophageal cancer were offered curative esophagectomy, surgery to remove the esophagus, to manage their disease. While this treatment is very effective for early stage cancer, removing the esophagus significantly affects one’s ability to eat and live normally. A newer minimally invasive procedure has been developed to help patients with early stage esophageal cancer. Good evidence has been published to show that patients can benefit from an Endoscopic Mucosal Resection. This procedure is done as an outpatient under sedation. A flexible tube is inserted into the esophagus via the mouth allowing the surgeon to remove a portion of the cancer from the lining of the esophagus. This lower risk procedure allows the patient to eat and live normally Follow up care after treatment is very important and patients should schedule regular checkups regularly to make sure the cancer does not return.
Locally Advanced Esophageal Cancer
For advanced esophageal cancer, an esophagectomy is the recommended course of treatment. During this surgical procedure, part of the esophagus, which is the tube between the mouth and stomach, is removed and then reconstructed using part of another organ usually the stomach. The minimally invasive surgical esophagectomy techniques have evolved since the early days when the entire esophagus was removed and replaced with the stomach. Today, the surgical treatment is based upon the size and location of the tumor. All esophagectomy procedures can be performed using minimally invasive surgical techniques, which result in less pain, shorter hospital stays, and faster recovery than traditional open surgery.