I saw Dick yesterday. He was sitting at a small lunch table in the lounge. But he wasn’t eating and looked like he hasn’t been eating much lately. When I first met him, he was robust and a little overweight. Now he is drawn and instead of fitting into his clothes, he looks surrounded by them.
About 4 years ago, Dick was diagnosed with esophageal cancer. Now when I was training, esophageal cancer hit mainly men who smoked and drank. African-Americans seemed particularly susceptible. Now it has become a disease of older, overweight, white guys. And, while the number of esophageal cancer cases is moving up slowly (one of the few cancers whose rate is rising) the rate in older white guys is climbing by almost 2% a year.
The reasons for the increase in numbers are unclear. Most experts finger overweight as the main culprit – although smoking can contribute and perhaps heavy drinking. Many people with esophageal cancer may have years of heartburn behind them before the cancer develops, but most do not. The cancer just makes itself known when a person starts having a little trouble getting their food down. It may seem to get stuck just above the stomach.
Some people with a lot of heartburn that doesn’t get better with the usually acid blocking pills have a condition called Barrett esophagus. This is an abnormality in the lining of the esophagus just above where it empties into the stomach. People with Barrett esophagus have a very high rate of esophageal cancer and are often screened yearly with esophagoscopy –a thin scope to look into the esophagus – to look for early signs of cancer.
Treatment of esophageal cancer is tough. Usually there is chemotherapy along with radiation to the site of the cancer. Doctors are divided on whether surgery is needed after all this, but in my experience there is a tendency to do everything, so typically the radiation and chemotherapy are followed by surgery. If the cancer is caught early – it hasn’t gone to lymph nodes - about one-third of people with Dick’s type of cancer will live 5 years.
Dick had all these treatments, including surgery, but about a couple of years ago, he became hoarse and a recurrence was found that was somehow interfering with the nerves leading to his vocal cords. More radiation. He was fine for a while and was even able to talk again although he sounded more like Marlon Brando as the Godfather than his old self.
But now, no speech. He sits quietly listening to the others. Also, eating is hard which is why he looks the way he does. This is a sneaky cancer. It tends to come back in other parts of the esophagus and spread around it and is often hard to spot. Eventually, eating becomes impossible and then a feeding tube has to be placed into the stomach. But, life becomes more difficult with this, and the cancer keeps growing. It’s hard to keep weight up and most people continue to lose till there is little left.
So remember, keep slim and avoid smoking and excessive alcohol. It’s the best you can do.