Esophageal Cancer: What You Need to Know

Did you know that a common ailment — gastroesophageal reflux disease (GERD), which affects approximately 20% of Americans — is the leading cause of esophageal cancer?

At St. Elizabeth Healthcare, we are committed to helping raise awareness about this little-known cancer. Each year, around 18,000 patients in the United States receive an esophageal cancer diagnosis. If the disease is caught early, an esophagectomy surgery can be curative.

Burlington, Kentucky resident Jim Miller recently became one of the first St. Elizabeth patients to undergo a robotic assisted minimally invasive esophagectomy (RAMIE), a cutting-edge treatment option offered to esophageal cancer patients. Today, our experts are sharing Mr. Miller’s story in hopes that his experience could save your life or the life of a loved one.

What is esophageal cancer?

Adenocarcinoma of the esophagus is the most common type of esophageal cancer in the United States — and is primarily caused by GERD. GERD affects more than 40 million Americans each year, causing painful symptoms like regurgitation, nausea, chest pain and difficulty swallowing.

Chronic GERD can lead to Barrett’s esophagus, a condition that damages the lining of the esophagus. Not all patients with Barrett’s develop cancer. But Barrett’s patients are 50 times more likely to develop esophageal cancer than the average person. At St. Elizabeth Healthcare, our team of gastroenterologists and thoracic surgeons regularly evaluate chronic GERD.

“It’s so important for patients with persistent or escalating symptoms of GERD to be regularly seen by a doctor,” says Dr. Valerie Williams, Thoracic Surgeon at St. Elizabeth Healthcare. “You don’t want to self-treat GERD with over-the-counter medication and miss something like esophageal cancer.”

The risk of esophageal cancer is much higher in men than in women. According to the American Cancer Society, the lifetime risk for esophageal cancer is 1 in 132 for men and 1 in 455 for women.

Symptoms of esophageal cancer may include:

• Chest pain
• Difficulty swallowing
• Painful swallowing
• Weight loss
• Worsening heartburn or indigestion
• Vomiting

If you or a loved one are experiencing symptoms of GERD or esophageal cancer, it’s important to make an appointment with your physician for an evaluation.

Robotic minimally invasive esophagectomy (RAMIE)

For 58-year-old Burlington resident Jim Miller, his esophageal cancer diagnosis came as a surprise. He experienced only one of the common esophageal cancer symptoms.

“When I was eating, my throat would spasm and close,” says Mr. Miller. “I would have to wait a few seconds, it would return to normal and I’d continue eating. But it was the only symptom I had.”

Two months later, the issue was still bothering him. After speaking with his physician, Mr. Miller underwent diagnostic testing and finally learned the source of his swallowing spasms: adenocarcinoma of the esophagus. Mr. Miller’s cancer was thick enough to require chemotherapy and radiation before surgery, which made him an ideal candidate for the cutting-edge minimally invasive esophagectomy procedure at St. Elizabeth.

“Having a minimally invasive robotic esophagectomy helped Mr. Miller bounce back faster from surgery,” says Dr. Williams. “It allowed him to recover more quickly to get started on the next steps of his cancer treatment.”

This innovative surgical approach requires a team of nurses and surgical assistants who understand both the robot and the details of the multi-step esophagectomy surgery. The St. Elizabeth surgical team received specialized training to assist with RAMIE, including a trip to an out-of-state hospital to observe similar procedures.

RAMIE versus open esophagectomy

During the RAMIE surgery, small incisions are made in the patient’s abdomen and in the right chest area near the ribs. The surgery involves dividing the upper part of the esophagus in the chest as well as the top of the stomach. The cancer segment between the esophagus and the stomach is then removed.

A “new” esophagus is then created to connect the remaining upper part of the esophagus to the rest of the GI tract. The stomach is made into a tube and brought up toward the chest to connect to the remaining part of the esophagus. All of the patient’s draining lymph nodes in the chest and abdomen are also removed during the procedure.

The RAMIE surgery is the newer alternative to an open esophagectomy, a surgery that is much more invasive. For patients undergoing an open esophagectomy, the thoracic surgeon must make a large vertical incision down the abdomen and a large incision in the chest to spread the ribs to get access to the cancerous segment in the esophagus. The recovery is significant, and the patient’s return to normal activities can be slower.

Specialized esophageal cancer care

The RAMIE approach allows for significantly less pain and easier movement following surgery as well as a lower risk for complications like a clot or pneumonia.

“I was surprised by the recovery,” says Mr. Miller. “I was sitting up in a chair within eight hours after the surgery finished, and I was up and walking the next day.”

His first post-surgery meal request was so unique that Dr. Williams and her team say they’ll always remember it: Cincinnati chili. Today, Mr. Miller is finishing his chemo treatment and looking forward to returning to traveling, spending time with his family and serving at his church.

“I’m so grateful to Dr. Williams and her team,” says Mr. Miller. “They’ve all been amazing. This surgery saved my life.”

If you or a loved one are diagnosed with esophageal cancer, St. Elizabeth offers patients a multidisciplinary approach to treatment and many specialized surgical options. For more information or to schedule a consultation, please call (859) 301-2465.

Know Your Risk

While Ginny’s lung cancer has no known cause, tobacco smoke remains the largest risk factor for developing lung cancer. The disease is a serious health concern across our state. Kentucky leads the nation in smoking and has more deaths from lung cancer than the next eight cancers combined, including breast, prostate and colon cancer.

Lung cancer can be a serious, deadly disease. However, the implementation of lung cancer screening is changing the outcomes for many people that are found to have lung cancer by detecting it early, when it is very curable.

“The most exciting advancement in lung cancer is screening,” Dr. Calhoun says. “We can target people who are at most risk for lung cancer and offer them a low-dose CT scan. It’s a safe, effective way to detect and diagnose lung cancer in its early stages, which ultimately leads to better treatment and outcomes. We are moving lung cancer screening to match the screening that occurs with mammography for breast cancer.”

The low-dose CT scan can detect lung cancer early. According to the NCCN Guidelines for Patients Lung Cancer Screening Version 1.2017, individuals may be a good candidate for a low-dose CT scan if they are:

• Between 55 and 77 years old
• A current smoker or have quit within the past 15 years
• Have a 30-pack year history. Pack years are calculated by multiplying the number of years smoked. For example, if you smoked one pack a day for 30 years (1×30), that would equal a 30-pack year history. Smoking two packs a day for 15 years (2×15) would also equal a 30-pack year history.

A Team Approach to Care

Since coming to St. Elizabeth, Dr. Calhoun has been working to help advance the care and treatment available to individuals with lung cancer. At the heart of that is a multi-disciplinary approach where radiologists, pathologists, pulmonologists, thoracic surgeons and medical and radiation oncologists work together to discuss the patient’s case, review the films, pathology and identify the best treatment plan for each individual, including clinical trials.

“Detecting, diagnosing and treating lung cancer is evolutionary,” he says. “When we work across disciplines, we get different perspectives, experience and knowledge that are all relevant to the same problem. We’re positioned to do what’s best for the patient at any stage of their treatment.”

Expert Care, Right Here

Ginny is thankful for not only the care she received but that the guidance, support and expertise she needed was so close to home. Dr. Calhoun’s approach is one that resonated with her, and with many of his other patients.

“It’s clear that Dr. Calhoun cares about his patients,” Ginny says. “He took the time to sit down and talk with me – to understand what I wanted from treatment, my history and interests. He used all that information, along with his own experience and knowledge, to make a recommendation that would be best for me.”

“I try to see everyone as an individual,” Dr. Calhoun says. “I recognize that what they are going through is scary. But, I’m also an expert in what I do with a lot of experience, so I’m well positioned to help them figure out their lung cancer situation and get the treatment that’s best for them.”