Senior Physicians Speaker Series
by SAM YARED , MD
Dr . Sam Yared introduced Dr . Matthew Black at a Zoom meeting on Tues ., Dec . 5 , 2023 . He is an assistant professor at the University of Louisville in the Department of Cardiothoracic Surgery , specializing in thoracic surgery , and he has a special interest in esophageal surgery . Dr . Black graduated from the UofL School of Medicine and did his fellowship at the University of Pittsburgh , Department of Cardiovascular Surgery .
Esophageal cancer is the 17th most common cancer in the U . S ., and the seventh most common worldwide . It is estimated that there will be around 21,500 people diagnosed this year , up almost 3,000 from just three years ago . Most of these people will ultimately die from their disease . The disease primarily affects males aged 60 to 70 and the five-year survival rate has been increasing up to 21.7 %.
There are two histologic subtypes of cancer , squamous cell carcinoma and adenocarcinoma . The risk factors for the squamous cell subtype are smoking , excessive alcohol , low socioeconomic status and achalasia . The risk factors for adenocarcinoma are obesity , gastroesophageal reflux , Barrett ’ s esophagus and smoking . Squamous cell carcinoma accounts for 90 % of cases worldwide . It affects the upper to middle third of the esophagus . Adenocarcinoma is most common in western society , affecting the middle to lower third of the esophagus .
Typically , a patient will come in with complaints of new dysphagia ( trouble swallowing , with feelings of food getting stuck ), weight loss or vague chest discomfort . The first step in diagnosis is often an EGD via the referring gastroenterologist , or performed by the operating surgeon , to establish histology , delineate extent of the tumor and evaluate for barium enema and access conduit viability . PET scans are also frequently used to identify regional lymph nodes and metastatic disease that may ultimately change the treatment pathway . Endoscopic ultrasound is also used for staging and helps to determine treatment . Staging the TNM ( tumor , nodes and metastases ) is what is most important in determining treatment . It ’ s important to know if the lesion is confined to the mucosa ( T1a ), submucosa ( T1b ), muscle , ( T2 ), esophageal tissue ( T3 ) or other structure ( T4 ). It ’ s also important to know if the lymph nodes are normal and zero , or metastatic lymph node N1 , N2 or N3 .
Endoscopic mucosal resection ( EMR ) can really come into play and be a useful adjunct for a T1 lesion . They are now treat-
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