Barrett’s esophagus is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. A premalignant condition, Barrett's esophagus may lead to the development of cancer of the esophagus in a small number of patients. This type of cancer is called esophageal adenocarcinoma. Esophageal cancer develops through a sequence of changes in the cells of the esophagus known as dysplasia, which can only be detected by endoscopic biopsies. Patients with Barrett's esophagus should have regular surveillance exams to detect cancer at an early and potentially curable stage.
At Cleveland Clinic Florida, Barrett’s esophagus with dysplasia or cancer is treated using photodynamic therapy, radiofrequency ablation, cryotherapy, endoscopic mucosal resection or surgical removal of almost all the esophagus.
The esophagus is the muscular tube that connects the mouth and throat with the stomach. There are two major kinds of cancer of the esophagus. The first, squamous cell carcinoma, is associated with tobacco and alcohol abuse, some nutritional deficiencies, ongoing esophageal injury, and certain dietary irritants.
The second kind of esophageal cancer is adenocarcinoma. It has now overtaken squamous cell carcinoma as the most common form of this disease in North America. Its incidence is increasing at a rate faster than any other malignancy in the United States. It is much less commonly associated with tobacco or alcohol abuse, and tends to develop most frequently in middle aged and older Caucasian males.
In patients with early stage disease, the optimal cancer treatment approach is surgery. Although an esophagectomy (removal of the esophagus) is a major operation and may not be an appropriate cancer treatment in elderly or debilitated patients, it is associated with an excellent cure rate in patients with early stage diseas
Unfortunately, most patients with esophageal cancer present with either locally or regionally advanced disease. In this situation, surgery as a single form of cancer treatment is not effective. Multi-modality approaches to cancer treatment using surgery, radiation and chemotherapy have been recommended instead and can result in cure in a percentage of patients. Radiation therapy by itself has been relatively unsuccessful, but when combined with chemotherapy, it has been curative. Whether the use of surgery in conjunction with radiation and chemotherapy can further improve the results is still being investigated. Other patients, unexpectedly found to have more advanced disease at the time of their surgery, will benefit from post-operative, or adjuvant, chemotherapy and radiation.
In patients with widespread, incurable cancer, single-modality chemotherapy and/or radiation therapy can provide significant symptomatic relief. There are also a number of endoscopic techniques available for cancer treatment that can successfully address the swallowing problems for those with locally advanced cancer. Endoscopic stent placement, photodynamic therapy, laser photoablation and esophageal dilatation have all been used in this situation.
Cancer of the stomach, also called gastric cancer, is a disease in which malignant cells arise from the lining of the stomach. Stomach cancers can develop in any part of the stomach and then may spread throughout the stomach and to other organs.
Types of stomach cancer include: adenocarcinoma, which is the most common type, starts in the glandular tissue of the stomach and accounts for 95 percent of all stomach cancers; lymphomas involve the lymphatic system; and sarcomas affect the connective tissue, such as muscle, fat or blood vessels.
Stomach cancer can often be cured if it is found and treated at an early stage. At Cleveland Clinic Florida, stomach cancer may be treated with the following, in combination or alone:
- Surgery, called gastrectomy, to remove all or part of the stomach, as well as some of the tissue surrounding the stomach
- Radiation therapy
- Biological therapy (may need to explain. I have not heard of this treatment modality)
During a gastrectomy, lymph nodes near the stomach are also removed and biopsied to check for cancer cells. Lymphoma of the stomach is more frequently treated by gastrectomy than adenocarcinoma of the stomach. Only about one-third of stomach cancer cases can be treated and cured surgically.
Gatrointestinal Stromal Tumors (GISTs)
Gastrointestinal stromal tumors (GISTs) are uncommon tumors of the GI tract. These tumors start in very early forms of special cells found in the wall of the GI tract, called the interstitial cells of Cajal (ICCs). Sometimes called the “pacemakers” of the GI tract, ICCs signal the muscles in the digestive system to contract to move food and liquid through the GI tract.
More than half of GISTs start in the stomach. Yet, others may start in the small intestine (duodenum), or anywhere along the GI tract. A small number of GISTs start outside the GI tract in nearby areas such as the omentum (an apron-like layer of fatty tissue that hangs over the organs in the abdomen) or the peritoneum (the layer of tissue that lines the organs and walls of the abdomen).
The main treatment for a gastrointestinal stromal tumor (GIST) that has not spread is usually surgery, with the goal of removing all of the cancer. If the tumor is small, it often can be removed along with a small area of normal tissue around it through an incision in the skin (open procedure). Unlike many other cancers, GISTs almost never spread to the lymph nodes, usually eliminating the need to remove nearby lymph nodes.
Laparoscopic surgery may be an option for some small GISTs. The laparoscopic approach involves making several small incisions and inserting long, thin surgical tools through these incisions (along with a tiny video camera) to remove the tumor. Because the incisions are small, patients usually recover more quickly from this type of surgery than from traditional surgery. If the tumor is large or growing into other organs, the surgeon could still try to remove it entirely. To do this, portions of organs (such as sections of the intestines) may have to be removed. The surgeon might also remove GISTs that have spread elsewhere in the abdomen, such as the liver.