Understanding Esophageal Cancer
- A recent study, done by Mayo Clinic gastroenterologist and researcher Dr. Prasad Iyer, M.D. and his research team, has revealed artificial intelligence (AI) may assist in predicting one’s risk of getting esophageal cancer or a condition known as Barrett’s disease, which—with “minimally invasive tools.”
- Esophageal cancer is a disease that causes cancer cells to form in the tissues of the esophagus, a hollow, muscular tube that food and liquid move through.
- Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer. The disease can be tough to treat because it is often diagnosed late.
- It’s important to be aware of symptoms that may indicate esophageal cancer, such as pain/difficulty swallowing, weight loss, and pain behind the breastbone.
If you're suffering from heartburn and are curious as to whether it may be a symptom of esophageal cancer or a condition known as Barrett's, a change in the cellular structure of the esophagus lining, a recent study has revealed artificial intelligence (AI)may assist in predicting one's risk of disease—and it doesn't include invasive tubes. Mayo Clinic gastroenterologist and researcher
Dr. Prasad Iyer , M.D., who is looking to increase screening rates for Barrett's esophagus, recently told
Mayo Clinic, "We now have access to new, minimally invasive tools for Barrett's esophagus screening.
RELATED: Why Are More Young People Getting Devastating Cancer of The Esophagus? Understanding the Disease and Trends in Diagnoses "However, there is a critical need to develop more accurate Barrett's esophagus and esophageal cancer risk assessment tools that can be easily used with electronic health record data." According to Mayo Clinic, Dr. Iyer and his research team conducted a study to develop and test a tool using AI "to predict the risk of Barrett's esophagus and esophageal cancer based on data from a large database of de-identified electronic health records." The findings were published last year in Clinical and Translational Gastroenterology, in an article titled, "
Development of Electronic Health Record-Based Machine Learning Models to Predict Barrett's Esophagus and Esophageal Adenocarcinoma Risk." As per the study's highlights, which nots that Barrett's esophagus (BE) is a a main risk factor for esophageal adenocarcinoma (EAC), "A machine learning-powered tool to assess the risk of incident BE/EAC was developed using variables available in the deidentified electronic health record of 6 million patients." The study found that the new tool is more accurate whats currently available for patients and it could be "integrated into the electronic health record as a clinical prompt for providers to consider BE screening at clinically appropriate thresholds."
Esophageal Cancer Early Detection and First Steps "Our work has demonstrated that it's possible to create a more accurate risk assessment tool for Barrett's esophagus and esophageal cancer using AI and electronic health record data," Dr. Iyer said in a statement. "This tool could be integrated into the electronic health record and combined with a minimally invasive (nonendoscopic) screening tool and used by healthcare professionals in primary care." However, more research is needed before medical professionals can start recommending this screening, Dr. Iyer explains, adding, "Testing this risk prediction tool in patients and assessing the tool's performance are important next steps." As for the result of the study, the authors explained,"We identified 8,476 BE cases, 1,539 EAC cases, and 252,276 controls. The BE ML transformer model had an overall sensitivity, specificity, and AUROC [area under the receiver-operating curve] of 76%, 76%, and 0.84, respectively. "The EAC ML transformer model had an overall sensitivity, specificity, and AUROC of 84%, 70%, and 0.84, respectively. Predictors of BE and EAC included conventional risk factors and additional novel factors, such as coronary artery disease, serum triglycerides, and electrolytes."
Understanding Esophageal Cancer
Esophageal cancer is a disease that causes cancer cells to form in the tissues of the esophagus, a hollow, muscular tube that food and liquid move through when traveling from the throat to the stomach. The wall of the esophagus is made of up several layers of tissue; cancer begins on the inside lining and spreads to the outer layers of the esophagus as it grows.
Expert Resources On Esophageal Cancer
Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer. Approximately 22,370 new cases of esophageal cancer are diagnosed in the U.S. every year, according to
American Cancer Society estimates, and it is more common among men. “Esophageal cancer, we know is a tough one,"
Dr. Brendon Stiles , a thoracic surgeon at Montefiore Medical Center, previously told SurvivorNet. “It’s one of the cancers with some of the lowest cure rates out there, but like many cancers, if we find it early, we can often treat it effectively, either with surgery, with surgery and chemotherapy, with chemotherapy and radiation." Dr. Stiles recommends that patients report any symptoms that may indicate esophageal cancer to their doctors right away, since there are more treatment options when the cancer is caught early.
Esophageal cancer symptoms
Unfortunately, symptoms can be a bit vague, so those experiencing them may not think cancer right away. Still, it’s important to be aware of signs of this disease, which include:
- Pain/difficulty swallowing
- Weight loss
- Pain behind the breastbone
- Hoarseness/cough
- Indigestion/heartburn
- A lump under the skin
“Try to get diagnosed early,” Dr. Stiles said. “For esophageal cancer, that means getting screened, getting endoscopies if you have any symptoms. The problem with esophageal cancer is it can mimic a lot of other things. You lose a little weight, have a little trouble swallowing, have a little heartburn, those are tough symptoms to pin down sometimes and often leads to patients with esophageal cancer presenting with later disease.”
Dr. Sofya Pintova , who practices hematology and oncology at Mount Sinai Cancer Center, also stressed the importance of getting checked up when these symptoms, which may not immediately indicate cancer, arise. "Symptoms include things like … they’re losing weight, they’re having some burning in their esophagus or their chest, they’re having trouble or pain with swallowing and that will often lead to a medical evaluation,"
Dr. Pintova explained.
Dr. Sofya Pintova explains how esophageal cancer is diagnosed. “It includes an endoscopy, which is when a gastroenterologist puts a camera down the esophagus in the stomach and if they see an area that is suspicious for a mass, or if they see a mass, they may biopsy it. And if the biopsy confirms cancer, the next stage is usually staging,” she added.
Diagnosing esophageal cancer
Several tests may be used when diagnosing a patient with esophageal cancer. These include:
- Physical exam/health history – An exam of the body to check for general signs of health as well as signs that may indicate disease
- Chest X-ray – An X-ray of the organs and bones in the chest
- Upper endoscopy – A test that allows doctors to examine the walls of the esophagus using a small camera that is attached to a thin tube and passed down the patient’s throat
Other tests may be used as well to help get an accurate diagnosis. The upper endoscopy is particularly important because it helps your doctor to clearly see if there are any abnormalities in the wall of your esophagus.
Dr. Whit Burrows, a thoracic surgeon with the University of Maryland Medical System, explains what happens during an endoscopy. Usually if a suspected esophageal cancer is found during an imaging test or an endoscopy, it will be biopsied, which means your doctor will remove a small piece of tissue using a cutting instrument that is passed though the scope. That will then be tested.
RELATED: Finally Some Progress For Esophageal Cancer Patients New Immunotherapy Drugs Are Boosting Survival Staging esophageal cancer
The two most common types of esophageal cancer are:
- Squamous cell carcinoma (which forms in the thin, flat cells lining the inside of the esophagus)
- Adenocarcinoma (cancer begins in the glandular cells, or the cells in the lining of the esophagus that produce and release fluids like mucus)
After you receive an esophageal cancer diagnosis, your doctor will need to determine the type, as well as the stage. Both types of esophageal cancer are broken up into five stages (0, 1, 2, 3, and 4). “Once you do get diagnosed, ask what’s the stage,” Dr. Stiles said. “Patients should never be afraid to push doctors and say, ‘What is my stage? What are the treatment options at my stage? Do I have less invasive treatment options? Do I need multi-modality therapy?’ That means therapy with more than just surgery or more than just radiation with chemotherapy.” Dr. Stiles stressed that patients with esophageal cancer must be advocates for their own disease and speak up about treatment concerns, and what other treatment options or routes may be available in their situation. Getting a diagnosis of metastatic esophageal cancer means that the cancer has spread to distant parts of the body.
Esophageal Cancer Surgery: What to Expect “This is the esophageal cancer that started in the esophagus and spread to other organs,” Dr. Pintova said. “In general, that type of stage is not curable but it is treatable. "The goal of treatment is to help people live longer and better, of course balancing that very carefully with the potential side effects of the treatment,” she added. In this stage, Dr. Pintova explained that a “systemic” treatment is often given which may include chemotherapy, immunotherapy, targeted therapies, or combination approaches. “An oncologist has to analyze the cancer in a lot of detail. It’s no longer enough to know that it’s esophageal cancer. We really get into the nitty gritty in understanding the different proteins the cancer expresses, the genetics in the cancer itself, and then choose the best type of treatment,” she said.
The Importance of a Good Support System Amid Esophageal Cancer
Getting the news that you have cancer, especially a disease that is known for being difficult to treat like esophageal cancer, can be a very traumatic experience. When it comes to treating cancer, making sure the patient feels healthy mentally is part of the process as well and that may look different from patient to patient. Esophageal cancer is more commonly diagnosed in men, who stereotypically have a more difficult time asking for help when they are struggling mentally. “The esophageal cancer population is a unique population,” Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. "Many of the people who develop esophageal cancer are men who are taking care of their families, who are proud, who are strong, who are self-reliant. So when they get faced with this diagnosis and this real vulnerability, they get depressed in a way that can make them crawl up in bed and not want to get out and that’s when the family comes into play."
WATCH: Esophageal Cancer: Getting Emotional Support Dr. Flores stressed the importance of having a good support system in place. Having close friends or family members there to rally for you when you feel the lowest can make a huge difference in how a patient handles treatment. He also stressed the importance of having a solid doctor-patient relationship. Patients should feel comfortable bringing their concerns about their disease and treatment to their doctors, and that includes struggles they may be going through mentally. “There’s a lot more connected with this disease than just your body getting harmed,” there’s your soul, your emotions. There’s a lot that goes with it,” Dr. Flores said. “I think it’s very important to understand that about your patients so you can treat them appropriately. Once they know you see them and where they’re coming from, that’s when you get the, ‘Doc, I’ll do whatever you say, whatever you tell me.’ That’s when you can really get them to the best treatment that they need.” There are also plenty of resources available for people living with cancer who feel like they’re struggling mentally, from traditional therapy to support groups to integrative medicine that may include treatment approaches like acupuncture or meditation. Check out
SurvivorNet’s resources on mental health for cancer survivors.
Questions to Ask Your Doctor
- Will I need surgery for my esophageal cancer?
- Will I need to undergo chemotherapy and/or radiation before surgery?
- What type of side effects can each of these therapies cause?
- What is likely to be the most effective treatment combination for me?
Contributing: SurvivorNet Staff 
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