Which specialist to diagnose esophagus?

Throat
My esophageal cancer story started with a trip to the ER while on vacation when I started coughing up flem and could not swallow food properly. The ER doc put me on acid reflux med and directed me to go see my gastro doc (the one who does colonoscopy) when I got home. I did and the first thing he did was an endoscopy with the intent of perhaps stretching the esophagus a little which is a common procedure. But instead he found a large tumor in my lower esophagus which was cancerous. I was then referred to cancer docs and have since had 28 radiation and chemo treatments which have eleminated the cansorous tumor. The docs decided I was not a candidate for surgical removal of the tumor by cutting out a section of my esophagus. My last 2 CT scans with contrast have shown the tumor is gone and the local lymph nodes are back to normal. I never smoked either. Do you have a gastro doc you can check with?

T Y for sharing your inspiring story.
I think I found a new gastro doc and will make an appointment.

While smoking and drinking and other vices ain't the best for our overall health... not usually a factor in esophageal cancer causation.

The best way to know what the hell is going on in there? Get an endoscopy and have a physical look see! If anything looks amiss... biopsy will be done, further scans... and then even a more sophisticated endoscopy will be done (EUS). It is these 3 things that will lead to a true EC diagnosis and staging. But still... pretty rare that you would have EC. But a simple quick and painless procedure... even easier than a colonoscopy. The only way to be sure what's going on in there. And usually a Barrett's dx and/or dysplasia of some sort will be seen before cancer has developed. Problem is... like most cancers, we don't feel these things and get dx'd early enough at stage 1 or 2. Be well.

My husband had an endoscopy about 5 years ago, since he had acid reflux very often and he was taking Prilosec for years…which was (recommended by his primary physician…). I knew something was not right and I insisted that my husband should have an endoscopy, but after the procedure was done, the surgeon said that everything was ok…So my husband kept burping, having acid reflux and have taking Prilosec until now, five years later, when he started to have extreme difficulty to swallow food…So he finally had another endoscopy done from the same doctor. This time he said that he has esophagus cancer, but that fortunately it was just at the beginning. My husband then had MRI, Ct scan/Pet scan and the result is that he has stage 4 esophagus cancer! I am so disappointed about this doctor…He could not see anything 5 years ago…and even now his response was not correct???

My husbands egd in 11/21 was stable Barrett’s as it had been for more than 20 yrs. 13 months later he had another egd because of something seen in a cardiac scan. He was found to have stage 4b esophageal adenocarcinoma. The fact it was HER2+ most likely contributed to the very fast spread. Unfortunately, that happens.

Why would you say that smoking & drinking aren’t a factor in esophageal cancer causation? I’ve read that’s tops on the list, & my doctor said usually the people who get this cancer are men who smoke & drink heavily.

Sorry... while these things (smoking and drinking) aren't good in general, all that I've read and the oncologists I've talked to say universally that GERD, or acid reflux over decades, is what causes a change in the lining of our esophagus, and makes some of us prone to developing EC. Even a hereditary component is heavily discounted. But to me, the hiatal hernia component being a big factor in EC developing... if this runs in families... then maybe. But the ties are strong for certain other cancers (like lung cancer) to smoking. Be well.

I was recently forced to retire from a 35+ year career as clinical medical scientist in academics and the biopharmaceutical and clinical diagnostics industries. Your statement that smoking and drinking are not usually associated with the pathogenesis of cancer is incorrect. There are a large number of peer reviewed experimental, clinical, epidemiologic, and meta-annalytical studies that conclusively establish the increased risk of developing Esophageal carcinoma. The evidence is stronger for squamous cell esophageal carcinoma but they also increase the risk for esophageal adenocarcioma.

Alcohol and nicotine decrease lower esophageal sphincter tone which increases acids reflux, exacerbates GERD and increases the risk of Barrett's esophagus. Also, the primary metabolite of alchohol, acid aldehyde, and the numerous carcinogens in tobacco smoke are cytotoxic to all of the esophageal cellular constituents. They have been shown to cause epigenetic changes in esophageal fibroblasts, smooth muscle, and epithelial cells. These include the production of genetic mutations, changes in methylation pattern cells, upregulation of various oncogenes and their associated signalling pathways, activation of inflammatory pathways and immune suppression.

I agree with you that an upper endoscopy and biopsy of suspicious lesions is the current gold standard for the diagnosis of esophageal cancer. There are newer less invasive techniques utilizing a novel collecting brush that are gaining wider use. Also, it's critical that you have molecular genetic analysis performed on any biopsies or cellular brushing that are obtained. This will provide actionable information to your oncologist and the tumor board as to your tumors oncogene expression, mutational burden/copy number, methylation patterns, and microsatillite instability. This informs the most effective radiotherapy, chemotherapy, immuno-oncology and targeted therapies for treating your tumor. They may also use less invasive liquid biopsies which detect circulating cell free DNA from lysed cancer cells to monitor your response to therapy, and residual disease burden or recurrence.

It is important to understand exactly how our EC progresses, and exactly how it is discovered... and exactly how it is fully diagnosed. Now... so I sit here in judgement? Not really. And the reasons are multiple. First off, we as patients usually can accept our share of the blame. We often ignore our symptoms... for many many months. Then, when we basically can't swallow anymore, we go get things looked at. And then we must understand that esophageal cancer is a pretty rare cancer... while acid reflux and throat issues are not.... most of us have this... most of us pop some Tums or take Maalox or whatever. And then, even when we get referred on to take a better look with specialists... we need them to be able to physically see that something is amiss... and we need to look even deeper!

So, usually the biggest diagnostic piece of the puzzle (by a doctor), will come from the GI doctor. And whether the first level GI doctor can see Barrett's Esophagus... or maybe something worse, like low or high grade dysplasia, or even something much worse - a big ass tumor in our throats... this is how we are often within weeks of a full blown diagnosis. Because even our basic GI docs, the ones who give us our colonoscopies once we hit age 50, can do an endoscopy and grab a biopsy. And then quickly we are usually referred out to a more specialized GI doc who will do an EUS, and grab more biopsies. He'll also take a deep look around to see the invasive depth of our solid esophageal tumors, and look at nearby lymph nodes and other structures. This will be a key piece of our dx. And then scans are quickly ordered to see what spread, if any, is seen. Now an oncologist is assigned and treatments will begin.

But I've seen many things... where initial endoscopy showed little... and then a year later, major swallowing issues and a big ol tumor is seen. And certainly we're all unhappy when normal surveillance protocol, of taking a look every few years, is not enough, once our cancers have begun and rapidly grow! It is why most of us are discovered at stage 3 or stage 4. It takes a freak accident almost to be discovered at stage 1 to 2.

So let's get treatments going and see how he responds. That will be key. All the best.

Gary

Thanks for sharing your expertise with the community