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Medical Edge Newspaper Column from Mayo Clinic

NO MIRACLE DRUG ON HORIZON FOR ESOPHAGEAL CANCER

DEAR MAYO CLINIC: A member of my family was diagnosed with esophageal cancer and given a poor prognosis. Are there any promising new treatments? Where can we find out about research? Do you know why the incidence of this cancer is increasing? — Claypool, Ind.

ANSWER: Researchers aren’t sure exactly why esophageal cancer is increasing, but it’s easy to make some educated guesses. We know there is an association between:

— Gastroesophageal reflux disease (GERD), a common condition, and esophageal cancer.

— Barrett’s esophagus and esophageal cancer. In Barrett’s esophagus, the lining of the esophagus, which carries food and saliva from the mouth to the stomach, changes to a type of tissue usually found in the intestine.

— GERD and Barrett’s esophagus, an uncommon condition.

Because obesity is a risk factor for GERD, the increasing girth of Americans probably contributes to the increased incidence of esophageal cancer. Heavy drinking and tobacco use are also risk factors.

A diagnosis of esophageal cancer is serious. Often no early symptoms appear, so it’s not diagnosed until it’s advanced, when treatment may be more difficult. Symptoms may include difficulty swallowing; unintentional weight loss; hoarseness; chronic cough; and pain in the throat, mid-chest or between the shoulder blades.

The cure rate is low. According to the National Cancer Institute, the incidence and mortality rates are about the same. Esophageal cancer affects about five in every 100,000 Americans.

When diagnosed early, chances of cure are increased and only surgery is recommended. If more advanced but still localized, esophageal cancer is treated by chemotherapy and radiation, followed by surgery.

Research is under way on new chemotherapy agents that show some promise. Other research focuses on new ways to combine radiation and chemotherapy; ways to boost the body’s immune reactions; and the use of targeted therapies to stop cancer growth. There are also new endoscopic techniques being studied for the treatment of early-stage esophageal cancer. So far, there’s no miracle drug or approach on the horizon.

Prevention plays a significant role for patients with Barrett’s esophagus, which is diagnosed by upper gastrointestinal endoscopy and biopsy. Patients with Barrett’s esophagus should be examined periodically for esophageal cancer. Acid-blocking drugs, which help GERD, may improve Barrett’s esophagus. However, it is not clear if these drugs help reduce a patient’s risk of subsequent cancer. Only a few people who have Barrett’s esophagus — less than 1 percent per year — may develop esophageal cancer.

Your relative could consider participating in a clinical trial, where standard treatments are compared to new therapies. By all means ask the oncologist about clinical trials. Or you can find information on clinical trials on esophageal cancer from: the National Cancer Institute (www.cancer.gov, 800-4-Cancer or 800-422-6237); or the American Cancer Society, (clinicaltrials.cancer.org, 800-303-5691).

— Claude Deschamps, M.D., Thoracic Surgery, Mayo Clinic, Rochester, Minn.

Additional Resources:
Esophageal Cancer
Appointment Information
GERD
Barrett's Exophagus
More Information on Esophageal Cancer

READERS: Imagine holding a bowling ball at eye level for 20 minutes. Now imagine holding that bowling ball — the size of your head — all day, every day. It’s no wonder that neck pain is so common. Luckily, it’s a condition you can often control.

Here are some tips to prevent neck pain:

— Adopt good posture. It’s the most important thing you can do. Keep your shoulders back and hold your head high.

— Avoid sitting in the same position for long periods. When you sit, use arm rests.

— At the computer, keep your monitor at eye level and keep your knees slightly lower than your hips.

— Avoid heavy backpacks and purses.

— Don’t carry children on your shoulders.

— Don’t cradle the phone between your ear and shoulder.

— When you sleep, align your neck with the rest of your spine. Avoid pillows that raise your head too high or let it sink too low.

If you have neck pain, self-care measures can help. Rest, but avoid prolonged inactivity. Alternate cold and heat therapies. Try nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others).

Most people don’t need to seek medical attention for neck pain. With self-care measures, pain usually subsides on its own. Seek care if pain lasts more than two weeks, is severe or follows an injury.

Additional Resources:
Neck Pain
Appointment Information
More Information on Neck Pain
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.