This year, the American Cancer Society estimates that approximately 22, 370 new cases of esophageal cancer will be diagnosed in the United States, and more than 16,100 deaths attributed to this disease.  April is Esophageal Cancer Awareness Month. To learn more about esophageal cancer, which makes up about 1% of cancers diagnosed in the U.S., we spoke with Virginia Litle, MD, Chief of Thoracic Surgery at St. Elizabeth’s Medical Center.

 

Q. What is esophageal cancer and what makes it so challenging to treat?  
There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. Adenocarcinoma is more common in the United States and risk factors include gastroesophageal reflux disease (GERD), obesity, and Barrett’s esophagus. Adenocarcinoma typically presents in the lower portion of the esophagus near the stomach. Squamous cell carcinoma is still diagnosed but the incidence is lower than for adenocarcinoma. Risk factors for squamous cell include tobacco and alcohol use. Squamous cell presents more commonly in the middle and upper third of the esophagus. Both tumors most often don’t present until they start to cause difficulty swallowing. An upper endoscopy is recommended for evaluation and biopsies and treatment typically involves chemotherapy, radiation and then surgery.

Q. What drew your interest in developing an expertise in treating this disease? 
During General Surgery residency in San Francisco, I spent my academic development time in a cancer research lab, then subsequently I did my cardiothoracic training at the University of Pittsburgh Medical Center, which is a center of excellence with very high volume, for esophageal disease both benign and malignant. Since completing training over 20 years ago, my practice and research has focused significantly on esophageal disease.

Q. How is screening conducted and who should be screened?
Screening for esophageal cancer with routine upper endoscopy has not proven to be cost efficient; however, folks who are at risk for adenocarcinoma should undergo a baseline upper endoscopy. So that would most commonly be men over 50 with frequent (several times/ week) heartburn. Because of the reflux (GERD), the esophagus may become damaged, and the patient may develop Barrett’s esophagus (BE), which is a risk factor for esophageal adenocarcinoma. If a patient has Barrett’s esophagus, they need 4-quadrant biopsies of every centimeter of Barrett’s esophagus to look for precancerous lesions. They also need to take a proton pump inhibitor twice a day and be enrolled in a surveillance program with their endoscopist. The frequency will depend on whether there is dysplastic (pre-cancerous) or nondysplastic Barrett’s esophagus.

Q. Please share more about your research in developing a sponge technique for screening for esophageal cancer. 
When I was Boston Medical Center, we had a research project with one of our residents, investigating the use of an EsophaCap (an encapsulated sponge on a string, that can be swallowed) to screen those at high risk for esophageal squamous cell carcinoma. No anesthesia is involved so it is more cost-effective than endoscopy for everyone. The study was conducted in Gujarat in India, where squamous cell is more common (squamous cell is the predominant type of esophageal globally and per GLOBOCAN data, the incidence of esophageal cancer is anticipated to increase to nearly a million cases by 2040). Our study of 178 subjects showed the sponge was tolerated and screening feasible. Subsequent investigations were impeded by the covid pandemic.

Q. What are some preventive steps people can take to diminish their risk of developing esophageal cancer?
Risks for adenocarcinoma are obesity and GERD, so avoiding the former is one preventive approach. Frequent heartburn in the over 50 male population is an indication for an upper endoscopy to look for inflammation of the esophagus (esophagitis) or Barrett’s esophagus. Avoiding tobacco and excessive alcohol use are steps to reducing squamous cell risk. 

Unexplained weight loss or dysphagia (difficulty swallowing) should be addressed with one’s primary care physician as soon as possible as well.

Dr. Litle is accepting new patients. Her office may be reached at: 617-779-6382.

 

About St. Elizabeth’s Medical Center
Steward St. Elizabeth's Medical Center of Boston, Inc., a Boston University Teaching Hospital, offers patients access to some of Boston's most respected physicians and advanced treatments for a full range of medical specialties, including family medicine, cardiovascular care, women and infants' health, cancer care, neurology care, and orthopedics. The 306-bed tertiary care facility is part of Steward Health Care. For more information, visit www.semc.org.

About Steward Health Care 
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.

As the country’s largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.

Based in Dallas, Steward currently operates more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.

For more information, visit steward.org