Pioneering Technology Treats Esophagus Cancer

Chronic acid reflux and heartburn can be more than a pain. In some rare cases, they can be killers.

Over many years, acid reflux can cause Barrett’s esophagus, a condition Kalispell Regional Medical Center now has pioneering technology to diagnose and treat before it can lead to esophageal adenocarcinoma, a highly lethal form of cancer.

While it’s far from the most common cancer, esophageal cancer cases rose six-fold from 1975 to 2005 ” faster than any other cancer in the United States and Western Europe.

“We’re not entirely sure why that is,” said Dr. Robert F. Yacavone, a gastroenterologist at Kalispell Regional. “But it might have something to do with obesity and the excess-weight epidemic and the result that has on acid reflux.”

About 16,000 people ” the vast majority men older than 50 ” were expected to get esophageal cancer last year. The five-year survival rate for people who develop the cancer is only 17 percent.

Years of acid reflux and caustic stomach acid can cause abnormal tissues to form in the esophagus. That tissue ” known as low-grade or high-grade dysplasia depending on the stage of Barrett’s ” resembles the lining of the stomach.

“In a way it’s an adaptive response, part of the healing process. And in some patients it will correlate with a reduction in heartburn symptoms,” Yacavone said.

That’s one red flag, he added.

“If I see someone who’s 60 [years old] who said he had heartburn for 20 years but in the last few years it hasn’t been such an issue, then I particularly worry about Barrett’s.”

It’s the duration of chronic acid reflux and heartburn, not the frequency or severity, that is most closely correlated to the onset of the pre-cancerous Barrett’s condition.

“That’s been one of the issues,” Yacavone said of diagnosing and treating the condition. “Because someone may come to think that getting heartburn once or twice a week is just kind of normal.”

In the past, people diagnosed with Barrett’s would be monitored with their esophagus tissue sampled every few months to determine if it was turning cancerous. But that approach suffered from sampling errors.

And with lymph nodes extremely close to the surface of the esophagus where abnormal Barrett’s cells grow, any cancer that forms can quickly reach lymphatic channels and spread throughout the body.

“Once it’s sort of out of the bag, if you will, that’s when the prognosis really starts to fall off,” Yacavone said.

Yacavone brought endoscopic ultrasound equipment to Kalispell Regional in 2005, making it the first and only hospital in Montana to have that equipment available to accurately and easily monitor tissue in the esophagus and the surrounding lymph nodes for cancer.

“We’ve done more than 1,000 of those procedures in Kalispell,” he said.

In 2011, Yacavone brought radiofrequency ablation equipment to Kalispell Regional. It can effectively and safely remove ” or ablate ” the abnormal tissue associated with Barrett’s compared to earlier methods fraught with collateral damage, he said.

Kalispell Regional remains the only hospital in Montana to have that equipment, which is now the preferred ablation treatment method of the American Gastroenterological Association.

Radiofrequency waves are administered to larger portions of the esophagus through an inflatable balloon embedded with wires or to smaller portions with a paddle-shaped device.

The energy burns about one millimeter down into the esophagus to destroy the abnormal Barrett’s tissue without burning too deep and causing other problems such as bleeding, scarring or stricture.

“Our ability to ablate that Barrett’s tissue is well in excess of 90 percent. Some studies suggest close to 98 percent. Very good results with low rates of recurrence of that tissue,” Yacavone said of the radiofrequency ablation treatment.

It’s now the preferred ablation treatment for people with advanced Barrett’s esophagus and high-grade dysplasia, and for people with early surface cancers as an alternative to surgery that removes the lower esophagus and brings the stomach up into the chest.

“Studies that have compared the two approaches for advanced dysplasia or early cancer suggest the survival rate three years out is the same whether you ablate it or operate on it,” Yacavone said. “The difference is surgical patients had 30 percent morbidity, or significant deterioration in post-surgical quality of life, as opposed to virtually no morbidity for ablation patients.”

Radiofrequency ablation also is an option for people with earlier stages of Barrett’s esophagus who want to get rid of the tissue rather than have it monitored. And more patients are taking advantage of the technology in Kalispell.

“We’ve done three times more in the first three months of 2013 than we did in all of 2012. We are really expanding it now,” Yacavone said of the treatment.

The bottom line is for longtime sufferers of acid reflux and heartburn to consider asking their doctor if they should be checked for Barrett’s esophagus.

“In their mind it may not be a big deal, but it can be a serious condition,” Yacavone said.

“They should discuss with their [health-care] provider whether they should be checked. And if they have Barrett’s, they should discuss if they might be a candidate to have it ablated as opposed to just watched. Because there are certainly some people that should.”

Reporter Tom Lotshaw may be reached at 758-4483 or by email at tlotshaw@dailyinterlake.com .


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