UT Southwestern digestive specialists freeze out esophagus cancer with new therapy

July 29, 2008

UT Southwestern Medical Center gastroenterologists are using a new method to freeze damaged cells in the esophagus, preventing them from turning cancerous.

The Food and Drug Administration-approved cryoablation therapy helps Barrett's esophagus patients with dysplasia, a condition in which normal cells are transformed into potentially cancerous ones.

"Due to damage from chronic stomach acid, they are people who have a higher risk of developing esophagus cancer," said Dr. Jayaprakash Sreenarasimhaiah, assistant professor of internal medicine in the division of digestive and liver disease at UT Southwestern. "The goal of this therapy is to literally freeze the damage in its tracks and stop it before it turns to cancer."

Gastroenterologists, using a special catheter, spray liquid nitrogen on the damaged tissue to freeze the superficial lining of the esophagus, the long tube that carries food from the throat to the stomach. The treated tissue eventually falls off, allowing normal cells to grow and replace the damaged cells in about six to eight weeks.

"Repeated treatments can actually help get rid of Barrett's esophagus with dysplasia and prevent the progression to cancer," said Dr. Sreenarasimhaiah, a gastroenterologist who specializes in endoscopic technology.

The minimally invasive cryoablation therapy has recently been approved by the FDA for treating Barrett's, but it requires special training and equipment available in only a handful of centers in Texas and a few dozen nationally.

Barrett's esophagus can result from ongoing heartburn, which allows a constant splashing of acid from the stomach into the esophagus. Untreated, it can become Barrett's with dysplasia, in which cells start to transform.

Typical treatment includes endoscopic mucosal resection (EMR), in which the damaged lining is scraped away, a procedure that takes hours and can have side effects such as bleeding or narrowing of the esophagus. The most aggressive approach includes surgery to remove damaged portions of the tube.

Some patients, however, are too sick or elderly to be candidates for surgery. Others simply want another option.

"This is a disease we see in a lot of older patients with other illnesses, so the decision to send them to surgery requires careful consideration," Dr. Sreenarasimhaiah said. "Cryoablation therapy is particularly attractive for older patients who may have complications or other medical issues - such as accompanying heart or lung diseases - that make traditional surgeries for Barrett's with dysplasia too risky."

Cryoablation therapy takes about 30 to 40 minutes and requires sedation. As with an endoscopy, a tube down the patient's throat is used to insert a tiny camera and instruments. No incisions are required.

Early results from studies show the therapy - similar to that used by dermatologists to freeze off warts - works well inside the esophagus, though further study is needed, Dr. Sreenarasimhaiah said.

"Patients may feel a little pain in the first couple of days, like a heartburn-type pain, but that starts to improve after a few days and after that they usually don't feel anything," he said. "They can eat immediately after they wake. They are not on a special diet, but they do continue their anti-reflux medications."



UT Southwestern Medical Center

---

---

	John Hopkins Patients' Guide to Cancer of the Stomach and Esophagus (Johns Hopkins Patients' Guide) by Mark D. Duncan (Author) Johns Hopkins Patients' Guide to Cancer of the Stomach and Esophagus is a concise, easy-to-follow how to guide that puts you on a path to wellness by explaining stomach and liver cancer treatment from start to finish. It guides you through the overwhelming maze of treatment decisions, simplifies the complicated schedule that lies ahead, and performs the task of putting together your plan of care in everyday terms. Empower yourself with accurate, understandable information that will give you the ability to confidently participate in the decision making about your care and treatment.
	Current State of Endoscopic Therapies in Barrett's Esophagus and Esophageal Cancer (DOI: 10.3810/hp.2011.02.388) (Postgraduate Medicine) by JTE Multimedia Barrett’s esophagus (BE) is a premalignant condition that predisposes patients to esophageal adenocarcinoma. This risk increases with increasing dysplasia, especially in patients with BE and high-grade dysplasia. Radical esophagectomy had long been the only option for these patients; however, it has been associated with significant morbidity and mortality. Endoscopic therapies have been increasingly used as an alternative to radical esophagectomy given the minimally invasive nature and tolerability of the procedure relative to surgery. Currently, the most widely used endoscopic therapies include endoscopic mucosal resection, photodynamic therapy, CryoSpray ablation, and radiofrequency ablation. Retrospective and prospective studies on the use of each of these modalities in patients with...
	100 Questions & Answers About Esophageal Cancer, 2nd Edition by Pamela K. Ginex (Author), Maureen Jingeleski (Author), Bart L. Frazzitta (Author), Manjit S. Bains (Author) The only reference to provide both the patient s and doctor s views, 100 Questions & Answers About Esophageal Cancer, Second Edition aims to provide a much needed primer for patients and their families and aims to address the questions most relevant to patients following a diagnosis of esophageal cancer. This text gives up-to-date, authoritative, practical answers to your questions about treatment options, post-treatment quality of life, sources of support, and much more. Written by two oncology nurses and a gastric surgeon, with extensive commentary from an esophageal cancer survivor, and new information on cancer therapies, this book is an invaluable resource for anyone coping with the physical and emotional turmoil of this frightening disease.
	Carcinoma of the Esophagus (Contemporary Issues in Cancer Imaging) by Sheila C. Rankin (Editor) Esophageal cancer is a relatively uncommon but highly lethal malignancy. The incidence of adenocarcinoma is rapidly increasing and improved survival will depend on prevention, earlier diagnosis, improved staging and appropriate treatment. The multidisciplinary team approach toward patient care is critical in determining the management of patients with esophageal cancer. This volume provides a detailed review of new endoscopic methods of diagnosis, staging using both conventional and functional imaging and assessment of surgical and medical methods of therapy, providing all members of the team with a detailed overview of the diagnosis and management of this malignancy.
	100 Questions & Answers About Esophageal Cancer by Pamela K. Ginex (Author), Manjit S. Bains (Author), Jacqueline Hanson (Author), Bart L. Frazzitta (Author) This book gives you authoritative, practical answers to your questions about treatment options, post-treatment quality of life, sources of support, and much more. Written by three esophageal cancer experts and an actual patient.
	Esophageal Cancer: Principles and Practice by Blair Jobe MD (Author), Thomas Charles MD (Author), Dr. John Hunter MD (Author) Gastroesophageal cancers are the most common form of cancer incidents, and the second most common cause of death among cancer patients. In 2000, it was estimated that over one million new cases of gastroesophageal cancers were diagnosed worldwide, and over 900,000 individuals died from the disease. Using a multi-disciplinary approach, Esophageal Cancer: Principles and Practice addresses the complexities encountered in the understanding and management of esophageal cancers. Written by the world s leading experts in surgery, medical oncology, radiation oncology, gastroenterology, pathology, radiology, nutrition, nurse specialists, palliative medicine, and research relating to neoplasia of the esophagus, this text will serve as the definitive resource and enable practitioners to provide the...
	Cancer of the Esophagus: Approaches to the Etiology (Cambridge Monographs on Cancer Research) by Valda M. Craddock (Author) The book deals briefly with the normal structure, functioning and biochemistry of the esophagus and with the histological and genetic changes accompanying the development of esophageal cancer in humans and animals. Factors implicated in causing esophageal cancer are described in relation to its very dramatic epidemiology. Thus dietary deficiencies and consumption of foods contaminated by Fusaria mycotoxins are discussed in connection with the extremely high incidence of the disease in certain sharply demarcated regions in China and South Africa, and alcohol and tobacco use are discussed in relation to the epidemiology in Europe and USA. Other hazards mentioned include opium in Iran, betel nut in Asia and bracken in Japan. The sole group of chemicals known to be very potent esophageal...
	Dx/Rx: Upper GI Cancer by Manish A. Shah (Author) Tightly Organized Into A Super-Condensed, Outline Bulleted Format, This Handy, Pocket-Sized Manual Details Precise, Up-To-Date Information For Diagnosis And Treatment Of Esophageal And, Gastric Cancers. Comprehensive And Concise, The Book Covers Epidemiology, Diagnosis, Staging, Treatment, And Complications. Throughout The Handbook, Tables And Figures Summarize Important Clinical Data And Current Professional Society Recommendations, While Salient References Direct Readers To Additional Information. Current, Quick, And Concise, For Instant Access On Ward Or In The Clinic!
	Cancer of the Liver, Esophagus and Nasopharynx by Gustav Wagner (Author), You-Hui Zhang (Editor)
	Surgery for Cancer of the Esophagus by Hiroshi Akiyama (Author)