Did you miss our #EsophagealCancer Twitter Chat?

On Tuesday, April 8th, The Salgi Esophageal Cancer Research Foundation teamed up with medical experts from around the web to answer your important questions regarding prevention, detection, diagnosis, and treatment of esophageal cancer.  If you missed the chat, not to worry!  We’ve put together the complete transcript from the #EsophagealCancer Twitter chat.

This was the very first chat dedicated to #EsophagealCancer and we are very excited to share the important information that was discussed that day!  We will be hosting more Twitter Chats dedicated to esophageal cancer in the future, so if there is a question that was not answered, please contact us and let us know what you want answered at the next #EsophagealCancer Twitter Chat!

Question 1:

@SalgiFoundation: Q1. Explain the differences between esophageal adenocarcinoma and squamous cell carcinoma. #EsophagealCancer

Answers:

@RoswellPark: A1. Beside microscopic differences, adeno tends to be low down near the stomach while squamous arises in the upper portions #EsophagealCancer

@RoswellPark: A1. Squamous often occurs w/ irritation/ingestion of alcohol, tobacco, irritating foods & environmental factors #EsophagealCancer

@UCD_ChestHealth: A1. Adeno EsophagealCancer often occurs @ the bottom of esoph, caused by GERD. Squamous mid & top of esoph. Caused by smoking & alcohol.

@UCD_ChestHealth: A1. Squamous #EsophagealCancer can also be caused by chronic irritation problems like Achalasia and caustic injury

@UCD_ChestHealth: A1. Consumption of foods high in nitrates can also cause Squamous #EsophagealCancer

@RefluxMD: A1. Our Scientific Director, Dr. Para Chandrasoma, wrote a great article on this subject – refluxmd.com/learn/resource #EsophagealCancer

Question 2:

@SalgiFoundation: Q2. What are the risk factors associated with esophageal adenocarcinoma? #EsophagealCancer

Answers:

@RoswellPark: A2. Besides the other factors, the chronic irritation/changes of stomach juices cause adenocarcinomas over time #EsophagealCancer

@UCD_ChestHealth: A2. Acid reflux or GERD is a big risk factor for adenocarcinoma #EsophagealCancer. Causes Barrett’s which can degenerate into cancer

@UCD_ChestHealth: A2. Yes, food sits in esoph, and irritates lining > RT : Achalasia is a swallowing disorder? #EsophagealCancer

@UCD_ChestHealth: A2. Obesity also is a risk factor for Adeno #EsophagealCancer, mainly because obesity can lead to acid reflux

@UCD_ChestHealth: A2. Yes Barrett’s > low grade dysplasia > high grade > adenocarcinoma MT: Barrett’s esophagus is a precancerous condition? #EsophagealCancer

@UCD_ChestHealth: A2. Yes, leads to acid reflux > injury > Barrett’s RT : So, would a hiatal (sp?) hernia be a risk factor for #EsophagealCancer?

@AmerGastroAssn: A2. Overall diet, rather than specific foods, affect risk for #EsophagealCancer. More info: ow.ly/vzruO

@DanaFarber: A2.  Obesity, Barrett’s esophagus, smoking, and being male are all risk factors for #EsophagealCancer. bit.ly/1mUwWHf

@BrendonStilesMD: A2. Adeno. Some links with reflux disease and obesity. Probably some genetic factors that need to be better explored. #EsophagealCancer

@Aiims1742: A2. Risk factors include Barrett esophagus (most important) high BMI, alcohol smoking @SalgiFoundation#EsophagealCancer

Question 3:

@SalgiFoundation: Q3. What is Gastroesophageal Reflux Disease (GERD) and how is it related to esophageal cancer#EsophagealCancer

Answers:

@RoswellPark: A3. GERD is symptoms (heartburn) or damage caused by stomach juice spending too much time in the esophagus. #EsophagealCancer

@RoswellPark: A3. Over time, the acid juices can burn to produce a precancerous (Barrett’s) change or simply induce cancers directly. #EsophagealCancer

@UCD_ChestHealth: A3. GERD = gastroesophageal reflux disease, or spilling of acid from stomach to esoph. This leads > Barrett’s, which can cause #EsophagealCancer

@UCD_ChestHealth: A3. If one has GERD symptoms that do no respond to PPI after 4-8 weeks, they should get screening endoscopy per ACP. #EsophagealCancer

@AmerGastroAssn: A3. GERD = heartburn occurring when acid or other stomach contents back up in the esophagus. #EsophagealCancer ow.ly/vzsdO

@DanaFarberA3. GERD is backward flow of stomach acid contents into the esophagus – another risk factor for #EsophagealCancer. bit.ly/1mUwWHf

@BrendonStilesMD: A3. Reflux leads to chronic inflammation and injury, which may initiate/promote cancer growth. #EsophagealCancer

@BrendonStilesMD: A3. Important for people with GERD to be evaluated by GI doctors & considered for endoscopy, particularly with persistent sxs #EsophagealCancer

@BrendonStilesMD: A3. Q: @LungCancerFaces:  Do meds such as PPIs really lessen risk, or just treat symptoms? #EsophagealCancer

@BrendonStilesMD: A3. @SalgiFoundation @LungCancerFaces:  #EsophagealCancer Wish we knew. Some thought PPIs may even increase risk or mask symptoms.

Question 4:

@SalgiFoundation: Q4. Define Barrett’s Esophagus and explain how it is diagnosed. #EsophagealCancer

Answers:

@RoswellPark: A4. Barretts is damaged esophagus lining that gets recovered w/ a surface similar to the stomach #EsophagealCancer

@RoswellPark: A4. Treatment options for Barretts: goo.gl/ssF1Ft   #EsophagealCancer

@UCD_ChestHealth: A4: Barrett’s columnar epithelium w/ gobletcells (?) the esoph tries to look like intestine to protect itself from acid #EsophagealCancer

@UCD_ChestHealth: A4. Risk for adeno #EsophagealCancer is increased 30-125 fold for patients with Barrett’s metaplasia

@DanaFarber: A4. Barrett’s esophagus is a pre-cancerous or, in some cases, early form of #EsophagealCancer. bit.ly/1mUwWHf

@DanaFarberA4. Barrett’s esophagus often due to chronic inflamm from acid reflux & appears as abnormal cells lining the esophagus. #EsophagealCancer

@DanaFarberA4. If diagnosed, it’s important to treat Barrett’s esophagus to prevent the development of #EsophagealCancer.

@DanaFarberA4. Depending on form Barrett’s esophagus treatment may include medication, lifestyle changes, or radiofrequency ablation #EsophagealCancer

@DanaFarberA4. Q: @LungCancerFaces: @DanaFarber What is radiofrequency ablation?

@DanaFarber: A4. @LungCancerFaces: Great question! It’s a procedure that uses radio waves to heat and destroy abnormal cells.

@RefluxMD: A4. Quick overview by Dr. Chandrasoma of Barrett’s and diagnosis: refluxmd.com/connect/physic  #EsophagealCancer

@RefluxMD: A4. FYI – “If you’ve been diagnosed with Barrett’s” refluxmd.com/learn/resource  #EsophagealCancer

@BrendonStilesMD: A4. Barretts has to be diagnosed by endoscopic biopsy. Need to r/o dysplasia and cancer. Surveillance.

@Aiims1742: A4. Barrett esophagus is columnar epithelium with goblet cells within the tubular esophagus (sorry -GI Pathologist lingo) #EsophagealCancer

@Aiims1742: A4. Barrett esophagus shares many genetic alterations with esophageal cancer for example see Streppel, Maitra papers #EsophagealCancer

@Aiims1742: A4. GI Pathologists at MDAnderson and other places are looking for DYSPLASIA in biopsies of Barrett esophagus #EsophagealCancer

@Aiims1742: A4. patients with low grade Barrett dysplasia merit follow up, high grade need very close follow up or local ablation. #EsophagealCancer

Question 5:

@SalgiFoundation: Q5. Currently there are no standard/routine screening tests for EC, what are options to detect EC in early stages? #EsophagealCancer

Answers:

@RoswellPark: A5. Best option to detect EAC while curable/superficial is to find it w/ endoscopy. More on EUS: goo.gl/U6tI18#EsophagealCancer

@UCD_ChestHealth: A5. Everyone w/ Barrett’s should be in an endoscopic surveillance program ever 3 years

@UCD_ChestHealth: A5. Everyone with Barrett’s metaplasia should be in an endoscopic surveillance program at least every three years #EsophagealCancer

@UCD_ChestHealth: A5. Everyone should get a screening endoscopy if they have heartburn [GERD] + additional symptoms (e.g. trble swallowing) #EsophagealCancer

@UCD_ChestHealth: A5. Men over 50 with chronic GERD and additional risk factors should get screening endoscopy #EsophagealCancer

@LungCancerFaces: A5. Endoscopy is a breeze. Much easier than a colonoscopy. Don’t hesitate to do it if necessary. #EsophagealCancer

@AmerGastroAssn: A5. Researchers have developed markers to identify patients with BE at greatest risk for developing #EsophagealCancer http://agajournals.wordpress.com/2013/08/05/which-patients-with-barretts-esophagus-will-develop-esophageal-cancer/ 

@Aiims1742: A5. Most #EsophagealCancer  (adenocarcinoma) present with advanced dz while high grade Barrett or early EC do very well 

Question 6:

@SalgiFoundation: Q6. What are some warning signs associated with esophageal cancer#EsophagealCancer 

Answers:

@RoswellPark: A6. Difficulty with food because it “sticks” or causes pain during swallowing are the main symptoms of #EsophagealCancer 

@RoswellPark: A6. Unfortunately any symptom or sign means that the tumor has gotten quite large and is harder to treat. #EsophagealCancer 

@UCD_ChestHealth: A6. Difficulty swallowing. If your heart burn goes away for no reason, it may be a sign that Barrett’s has developed. #EsophagealCancer 

@UCD_ChestHealth: A6. Also black tarry stools, vomiting blood. Chronic anemia #EsophagealCancer 

@DanaFarberA6. The early stages of #EsophagealCancer  typically have no symptoms. As the disease advances, symptoms start to become more noticeable.

@DanaFarber: A6. Advanced #EsophagealCancer  symptoms include painful/difficult swallowing, weight loss, & regurgitation of food. bit.ly/1mUwWHf

@RefluxMD: A6. We recently spoke with a stage 4 cancer patient that only had uncontrolled burping after meals as a symptom. #EsophagealCancer 

@BrendonStilesMD: A6. Patients and physicians can’t ignore heartburn or difficulty swallowing. Low threshold for endoscopy.

Question 7:

@SalgiFoundation: Q7. What are methods of detection and diagnosis for esophageal cancer? #EsophagealCancer 

Answers:

@RoswellPark: A7. Tests like CT/PET Scans, ultrasound (on the endoscope), help to characterize the tumor & measure its spread #EsophagealCancer 

@UCD_ChestHealth: A7. Endoscopic screening and early detection can save lives bit.ly/YRUIDM#EsophagealCancer 

@UCD_ChestHealth: A7. Endoscopy goal standard for evaluation of potential #EsophagealCancer 

@AmerGastroAssn: A7. Patient brochure offers tips for preparing for an upper GI endoscopy: ow.ly/vzx6U#EsophagealCancer 

@DanaFarber: A7. Tests typically include chest X-rays, barium swallow, esophagoscopy, endoscopy, blood chemistry studies, CBC, or EUS. #EsophagealCancer 

@BrendonStilesMD: A7. EGD is a lot easier than colonoscopy. (And less messy and far to go!). More of an effort to find early.

@BrendonStilesMD: A7. Endoscopic biopsy. If cancer need endoscopic ultrasound to determine depth and bx nodes, CT, and PET.

Question 8:

@SalgiFoundation: Q8. When diagnosed with esophageal cancer what are available treatment options? #EsophagealCancer 

@SalgiFoundation: Q10. Stage IV survival rate is only 3%. What can be done to increase chances of survival? #EsophagealCancer 

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