The 10 deadliest cancers, and why there's no cure
Diagnosis Of Esophageal Cancer - News-Medical.net
Esophageal cancer can be diagnosed with the help of certain imaging studies and other tests.
If a patient presents with the symptoms of esophageal cancer the tests are prescribed.
Diagnosis begins with detailed history of symptoms and inquiry into the known risk factors and exposures (e.G. Smoking, alcohol consumption etc.) This is followed by a thorough physical examination.
Investigations to diagnose esophageal cancerThere are several investigations used for diagnosis, these include barium swallow, endoscopy, biopsy and so forth. (1-5)
Barium swallowThe patient is made to drink a barium solution. This is followed by x-rays of the esophagus and stomach.
Due to the Barium the esophagus and the stomach shows up as white structures in the X ray plates.
This helps diagnosis of abnormalities and the tumor location at times. This test is also called Upper GI series.
EndoscopyA thin tube with a camera on its tip is inserted through the mouth or nose into the esophagus.
The images of within the esophagus are visible via the camera.
The pathway of the entry of the tube is anesthetized using a local anesthetic spray before insertion.
This is also called upper GI endoscopy or esophagoscopy.
Sometimes esophagus, stomach as well as the initial part of the intestine called duodenum may be examined at the same sitting. This is called Esophaghogastroduodenoscopy.
BiopsyThis is the surest test for esophageal cancer. In endoscopy, tissue samples may be gathered from the tumor after it is visualized.
A pathologist then checks the tissue under a microscope.
Other tests for esophageal cancerOther tests for esophageal cancer include:-
Once the cancer is diagnosed it needs to be staged.
Staging helps in determining and planning therapy and also helps predict outcome of therapy.
It assesses how deeply the cancer has invaded the esophagus, whether the cancer has affected nearby tissues and whether the cancer has spread.
Spread to the nearest lymph nodes, bones, or other organs like liver and lungs are assessed. (1-5)
Tests for staging esophageal cancerRecommended staging tests for esophageal cancer include endoscopic ultrasound, chest or thoracic CT scan, Positron Emission Tomography scan and so forth. (1-5)
Endoscopic ultrasoundAn endoscope is passed within the esophagus which has been numbed with anesthetic.
The tip has a probe that sends in ultrasound waves. These bounce off the tissues nearby.
The computer assesses the picture with the help of this. The picture can show how deeply the cancer has invaded the wall of the esophagus.
Chest or thoracic CT scan and Chest MRIThese are sophisticated imaging studies that give detailed picture of the chest and abdomen and show the estent of spread of the cancer.
Positron Emission Tomography (PET) scanA PET (Positron Emission Tomography) scan is also an imaging study.
A small amount of radioactive sugar is injected. The scanner picks up the movement of the sugar within the body.
Cancer cells show up brighter in the picture because of higher and more rapid uptake of the sugar.
This scan shows the extent of spread of the cancer.
Bone ScanA bone scan helps detect extent of spread of the cancer to the bones.
BronchoscopyA bronchoscopy is similar to an upper endoscopy. The doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the lungs.
A bronchoscopy may be performed if a patient's tumor is located in the upper two-thirds of the esophagus to see if the tumor is growing into the person's airway or trachea or bronchi.
LaparoscopyDuring a laparoscopy small incisions are made over the abdomen under general anesthesia in the surgical set up.
The surgeon inserts a thin, lighted tube called the laparoscope into the abdomen. This is used for taking tissue samples and biopsies to look for cancer spread.
Stages of esophageal cancerThe stages of esophageal cancer are:
Why Is Esophageal Cancer On The Rise? - Wfaa.com
Shannon DiMascio was diagnosed with esophageal cancer when she discovered she was anemic while trying to donate blood. She didn't have any other show symptoms.
It's estimated that in 2019, more than 17,000 people will be diagnosed with esophageal cancer. A majority of them are men, and the survival rate is grim.
While women are less commonly diagnosed with esophageal cancer, doctors are seeing an increased number of people diagnosed.
"I was trying to donate blood," said Shannon DiMascio, 43. "When they took my blood sample, they said, you can't donate blood. You're severely anemic and you should probably go see a doctor. No one suspected cancer, but it was cancer."
A competitive sailboat racer, DiMascio is a fighter both on and off the water.
"It's a very primal kind of sport," said the mother of two. "Humans have been sailing for a really long time."
DiMascio's 2017 diagnosis of stage one metastatic esophageal cancer may have slowed down her racing capability — but it hasn't stopped her.
"I've been taking care of her for the past two years," said Dr. Wendy Mahone-Johnson, DiMascio's oncologist at Texas Oncology Plano-Prestonwood.
Mahone-Johnson said she is seeing more cases of cancer in the lower part of the esophagus where it meets the stomach.
"Oftentimes, there may be symptoms with difficulty swallowing food or discomfort swallowing food," she said.
Why the higher instances?
Mahone-Johnson pointed to food choices and acid reflux, which changes cells in the lower esophagus.
Fortunately for DiMascio, her cancer was caught early. Her initial treatment included chemotherapy, radiation and surgery.
"My surgery was Jan. 30, 2018, and June 1, I competed in a major regatta," DiMascio said with a smile on her face.
"I marched into all my doctor's offices and gave them pictures from the regatta," she said.
But her joy came with bad news. Her cancer had returned.
"We had hoped that through chemo, radiation and surgery she would be… cured," Mahone-Johnson said.
DiMascio said she was shocked and scared when she learned her cancer went from stage one to stage four in a year.
"She does understand that her cancer is incurable," Mahone-Johnson said.
The only option now is to manage it, which DiMascio is doing with immunotherapy and additional chemotherapy.
"The odds weren't great at stage one," DiMascio said. "So, when it recurs at stage four, it's a much scarier outlook as well... And it's hard because you feel like you did all the right stuff."
"You went through all the treatment surgery — you recovered from it, returned to life, and it's almost like getting a second chance kind of stolen," she said. "But then you get back to it and you fight it and you keep going. Can't stop," Shannon said through tears."
A fighter in two races, DiMascio is keeping a winning attitude on both fronts.
"These are the moments we live for," DiMascio said about sailboat racing, which she has maintained to the degree that she can. "If you stop doing those things I think, the cancer wins."
DiMascio, who is in clinical remissions, didn't show symptoms of esophageal cancer. If you are experiencing symptoms, call your physician.
Doctors say DiMascio's scans don't show evidence of cancer, but she is still undergoing treatment.
More WFAA reports:
Esophageal CancerBaylor Medicine
A staging laparoscopy procedure allows us to examine the tumor closely. We will make four or five small incisions in your abdomen and fill it with carbon dioxide to push the abdominal wall away from the organs so that the surgeon can see them clearly and examine the tumor.
First, we will determine whether the tumor has spread beyond the tissues that we can remove during an esophagectomy, such as those from the liver, the inner lining of the abdomen (the peritoneum), or the fatty apron of tissue that drapes off the lower edge of your stomach (the omentum). We will also look for cancerous fluid inside the abdomen (malignant ascites). Patients with cancer that has spread to these areas are usually not candidates for an esophagectomy. These cancers are better treated with chemotherapy. During this inspection, we will occasionally find evidence of cancer spreading that was missed with a PET/CT.
Second, we will look for involvement of the tumor with surrounding structures and for large, bulky lymph nodes. Finally, we will look at the surface of the stomach to determine whether or not the stomach can be used to make a new esophagus. This will be necessary if you undergo an esophagectomy. Depending on what we see, we may or may not perform biopsies.
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