Traditionally, esophageal cancer is one of the more challenging malignancies to treat. “For a majority of esophageal cancer cases, the five-year survival rate is lower than we would like,” says UVA Director of Thoracic Oncology programs Benjamin Kozower, MD, MPH. “It is a cancer that has early access to the lymphatics and as a result is often diagnosed at an advanced stage.”
To alter these statistics and improve outcomes for esophageal cancer patients, UVA is stepping up its efforts to implement strategies for early diagnosis and comprehensive treatment. Key to these efforts is regular screening provided to those patients with Barrett’s esophagus, a complication of GERD that increases a patient’s risk of developing esophageal cancer. “When patients with Barrett’s esophagus get regular surveillance endoscopies, we are able to catch cancers at an earlier stage when they are still very small, easier to treat and potentially curable,” says UVA gastroenterologist Bryan Sauer, MD, MS, co-medical director of Endoscopy.
Should high-grade dysplasia or early mucosal cancer be discovered during screening, UVA has the technology and multidisciplinary team in place to treat early disease utilizing advanced endoscopic procedures such as radiofrequency ablation and endoscopic mucosal resection, minimally invasive procedures not widely available in Virginia. “To successfully treat these patients, you need a gastroenterologist who has undergone additional training as an interventional endoscopist,” says UVA gastroenterologist Vanessa Shami, MD, director of Interventional Endoscopy. “This level of expertise is found most often at large centers like UVA.”
For the majority of patients diagnosed with more advanced disease, UVA utilizes multimodality therapy that includes chemotherapy, radiation therapy and surgery. There are two dedicated thoracic medical oncologists on staff who oversee every aspect of a patient’s treatment. They collaborate with gastroenterologists, radiation oncologists and thoracic surgeons to implement a customized care plan for each person. “Our multidisciplinary team works with patients to help them make the best treatment decisions and formulate a comprehensive care plan,” says Kozower.
The team also works closely with a patient’s primary care physician and — if a patient lives too far from UVA to receive therapy in Charlottesville — advises their local oncology care team in delivering the appropriate treatment over the course of the patient’s care.
Success with Surgery
Esophagectomy, the surgical removal of the cancerous part of the esophagus, is one of the cornerstones of effective esophageal cancer treatment. At UVA, the surgery is performed utilizing both traditional and minimally invasive techniques, which can decrease pain and reduce recovery times. UVA thoracic surgeons perform approximately 50 of these procedures each year. And according to results from a recent report by the Society of Thoracic Surgeons comparing large academic medical centers and private practices dedicated to thoracic surgery, UVA is setting the standard in this area.
“We have outstanding esophagectomy outcomes,” says Kozower. “We are in the top quartile for risk-adjusted complications and mortality in the Society of Thoracic Surgeons Database. In fact, the observed-to-expected ratio for major complications and mortality was 0.85 percent for 2012–2014 at UVA. “This means that our complication rates are better than expected for our patient population,” adds Kozower.
While these surgical outcomes are promising, a patient’s quality of life is just as significant. With a recent grant from the Patient-Centered Outcomes Research Institute (PCORI), UVA’s thoracic oncology team will take a closer look at which patients benefit most from surgery to treat esophageal cancer and how best to manage those patients after surgery. “With this study, we will be acquiring accurate quality-of-life information from our patients that will allow us to better predict who we should and should not operate on,” says Kozower. It is this focus on patient-centered practice that keeps UVA on the leading edge of patient care.