NOTE: color endoscopic video is available.
IN CHICAGO: ESOPHAGEAL CANCER
Doctors at the University of Illinois at Chicago Medical Center on Friday used a minimally invasive procedure to remove an early-stage esophageal cancer, sparing the patient, a 72-year-old grandmother from Chicago, from major surgery to remove all or most of the esophagus.
The two-hour endoscope procedure was a first for a Chicago area institution. It is performed at only a few centers worldwide. Doctors expect the patient, who was listed in good condition following the procedure, to go home tomorrow.
In standard therapy, esophageal cancer patients face major surgery to remove a large portion of the esophagus, the muscular tube that takes food from the throat to the stomach. The surgeon reattaches the upper esophagus to the stomach, usually with permanent effects on the diet and eating habits of the patient. The surgery, done under general anesthesia, often requires a two-week hospital stay.
In contrast, the endoscopic excision is performed in a treatment suite on a sedated but conscious patient by digestive disease specialists. It is only recommended for patients whose cancer is at the earliest stage and has not invaded the deeper tissue layers of the esophagus.
"We can excise cancerous lesions from the mucosa or innermost layer of the esophagus only," says UIC gastroenterologist Dr. Rama Venu, who led the treatment team. "The skill of the endoscopist is essential to allow detection of such early lesions."
Guided by a miniature videocamera, Venu advanced the tip of the endoscope - a long, flexible tube about half an inch in diameter - to the site of the lesion. He then used a tiny ultrasound probe to make sure the cancer had not spread beyond the mucosal layer. The lining of the esophagus was then stained with iodine to make the cancerous tissue stand out. That region was sucked into the tip of the endoscope, and a wire loop was used to encircle the tissue, pinch it off and cauterize the wound at the same time. The whole procedure is viewed and captured on color video.
Esophageal cancer strikes 12,300 Americans each year, according to the American Cancer Society, and causes nearly the same number of deaths. The five-year survival rate is only 13 percent for Caucasian patients and 9 percent for African-Americans. The disease is three times as prevalent in men as in women and three times as prevalent in black patients as in whites.
The patient treated Friday suffered from unrelated heartburn and received a routine endoscopic exam. In the course of that exam, doctors discovered an early squamous cell cancer, a cancer that produces no early symptoms and is rarely diagnosed soon enough to allow cure even by surgery. The other common type of esophageal cancer, which accounts for half of all cases, is adenocarcinoma, which is often preceded by a precancerous condition called Barrett's esophagus and may be related to chronic heartburn. Patients with Barrett's esophagus or early adenocarcinoma of the esophagus will likely be the best potential candidates for endoscopic excision in the future, according to Dr. Russell Brown, director of the GI laboratory at UIC.
In addition to Brown, who is assistant professor of medicine, and Venu, clinical professor of medicine at UIC, other members of the UIC team included Dr. Richard Kenney, a fellow in the section of digestive and liver diseases, and Dr. Allan Halline, assistant professor of medicine.
The UIC College of Medicine is the nation's largest medical school. One out of six Illinois doctors is a graduate of the college, as are 70 percent of the minority physicians practicing in Chicago. The college produces more medical school faculty than all but five schools in the country.
With 25,000 students, the University of Illinois at Chicago is the largest and most diverse university in the Chicago area and one of only 88 national Research I universities. Located just west of Chicago's Loop, UIC is a vital part of the educational, technological and cultural fabric of the entire metropolitan region.
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