“The theory is that, if you get rid of the Barrett’s, you get rid of the cancer. It’s a step-wise process.”
susceptible than men of other races. Although it can develop at any age, it is most likely to show up after age 50. While there are no distinct signs or symptoms associated with Barrett’s, it’s more frequently found in people who suffer from gastroesophageal reflux disease—GERD—or as it’s more com- monly known, heartburn. “I had had GERD for a long time,” Hart acknowledges, “but I also had sleep apnea. I started using a CPAP (continu- ous positive airway pressure) machine to sleep in 1998, and I’ve had no reflux after that. So I thought my GERD had been taken care of by the CPAP machine. I thought everything was OK.” But everything wasn’t OK, as Hart dis- covered when he began seeing gastroen- terologist Keith Hussey, M.D. During one of Hart’s routine endoscopies, Dr. Hussey noticed some spots of Barrett’s that were showing dysplasia, the cellular changes that can signal the beginnings of cancer. “Nothing is going to help Barrett’s once you have it,” Dr. Hussey says. “It hardly ever goes away. But sometimes you see a change in the intestinal metaplastic cells, when the nuclei start to look irregular. Once you get to high-grade changes, there’s a good chance there are cancer cells nearby. “About 10 percent of patients with heartburn will develop Barrett’s,” he
continues. “Of those with Barrett’s, about 10 percent will develop cancer. A significant number of patients with high-grade dysplasia have cancer. Those people are at very high risk. We need to keep an eye on them.” Esophageal cancer is a particularly nasty form of the disease. The National Cancer Institute reports that 17,460 new cases of esophageal cancer were diagnosed in the U.S. in 2012, and 15,070 deaths were attributable to the disease. Accord- ing to the National Institutes of Health, esophageal cancer is usually not curable. If the cancer has not spread beyond the esophagus, surgery to remove the most of the esophagus may improve the chance of survival. If the cancer has spread, the patient is considered terminal and treat- ments focus on palliative care. As with so many cancers, early inter- vention is vital to ensuring a brighter outcome.
The standard response to such a finding would have been to biopsy the spots and, if they were cancerous, refer the patient for endoscopic treatment to destroy or cut out the portion of the esophageal lin- ing that has dysplasia. In severe cases, surgery to remove most of the esophagus may be called for. (In those cases, a por- tion of the stomach is pulled up into the chest and attached to what remains of the esophagus.) But by 2011, another treatment option became available at NCH—HALO radiofrequency ablation (RFA). This pro- cess involves inserting a balloon cathe- ter into the esophagus during endoscopy. The balloon is inflated so that it touches the esophageal lining on all sides. After the balloon is inflated, radio frequency energy is delivered through it, killing the dysplastic cells. “The skin turns white because it’s burned,” Dr. Hussey explains. “Then you scrape it off and push it into the stomach. You wait two months and see how the new skin has grown. You can then tell if you missed any spots. “Normally, it takes about three treat- ments to get it all,” he continues. “The theory is that, if you get rid of the Barrett’s, you get rid of the cancer. It’s definitely a step-wise process.” That theory was borne out in a study released by the American Gastroentero- logical Association in 2011. The study,
THE NEW WAVES OF TREATMENT
Jim Hart was aware of the grim reality of esophageal cancer because his mother had died of the disease in 2004. By that time he was also undergoing annual endoscopies because of his GERD. In 2011, during one of those annual scopes, Dr. Hussey noticed the suspicious- looking spots.
Naples Health | JANUARY-MARCH 2013
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