Share ThisIn our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this interview, we learn about esophageal cancer from AHN board-certified surgeon, Dr. Kirsten Newhams.
Dr. Kirsten Newhams, director of the Allegheny Health Network (AHN) Esophageal Institute and Chair of Foregut Surgery, says that esophageal cancer remains a relatively rare cancer, and lifestyle modifications can greatly decrease the risk of developing it. Thanks to new treatment options and early detection, more patients diagnosed with esophageal cancer are seeing better outcomes following diagnosis.
Unlike breast cancer, colon cancer, and prostate cancer, there is no preventive schedule for average-risk Americans to get screened for esophageal cancer — making awareness and education the most powerful tools against the disease.
Read on for my full conversation with Dr. Kirsten Newhams — including discussing diagnostic procedures like upper endoscopy, the advancements made in immunotherapy and early detection methods, and crucial preventive measures individuals can take to reduce their risk.
Emily Beatty: Let's talk about esophageal cancer. What is it and what are the main types?
Dr. Newhams: The two main types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. Adenocarcinoma is associated with Barrett's esophagus due to chronic acid reflux. As we've seen increasing rates of obesity in the United States, we've also seen increasing reflux disease, which has contributed to an increasing incidence of adenocarcinoma.
Squamous cell carcinoma historically was the most prevalent type of esophageal cancer, and is associated with alcohol, smoking, and history of radiation to the chest. In the United States, squamous cell carcinoma has been on the decline but is still a prevalent disease.
Emily Beatty: You've described some of the primary causes and risk factors. Anything else you want to add regarding specific lifestyle choices or medical conditions?
Dr. Newhams: There are risk factors that we can’t change, such as Caucasian men being a bit more at risk for developing esophageal cancer. Modifiable risk factors include tobacco use, alcohol use, untreated acid reflux, and obesity. These are many of the targets we look at when we talk about preventing or reducing the risk of esophageal cancer. For people who have acid reflux, whether it's daily or on an intermittent basis, it's important to discuss evaluation with your doctor.
Emily Beatty: You touched on demographics and populations more prone to esophageal cancer. Are there any common symptoms of esophageal cancer that individuals should be aware of, or any subtle signs that people dismiss or often miss?
Dr. Newhams: The most common symptom people experience with esophageal cancer is difficulty swallowing, or dysphagia. Usually, it will start with bulkier foods sticking or not passing well, but over time, it can include liquids. Additionally, a gastrointestinal or GI bleed, may be a sign of esophageal cancer. More subtle changes can include increased heartburn or painful swallowing, and weight loss. Any new or worsening issues with swallowing or heartburn should be discussed with a doctor.
Emily Beatty: How is esophageal cancer typically diagnosed, and what are the diagnostic tools and procedures used?
Dr. Newhams: The most common and effective way to diagnose esophageal cancer is through an upper endoscopy. The patient is typically sedated, and a long, flexible tube with a camera on it is placed through the mouth and into the esophagus. From there, we can take samples of an area if there's concern for cancer. Other ways people may come to a diagnosis include a CT scan that could show a tumor, or sometimes a radiology study called a barium swallow, where a patient drinks contrast, and that can also similarly show a mass or a tumor.
Emily Beatty: Can you tell me a little more about the endoscopy procedure? Is it a same-day, outpatient procedure, and what about anesthesia?
Dr. Newhams: An endoscopy is a straightforward procedure. It takes about 15 to 20 minutes. It involves light sedation, but sometimes, depending on patient factors, a deeper sedation can be used. Discomfort is minimal. You may have a sore throat for a day or so. By the next day, patients generally feel better and return to their usual activities. Sometimes medications may need to be held in advance of the procedure, but the team reviews that prior to scheduling for a patient.
Emily Beatty: What are the current treatment options for esophageal cancer, and do they vary based on the stage or different type of esophageal cancer?
Dr. Newhams: There are a lot of options for treatment depending on the stage of the cancer, patient health, and other individual factors. For early-stage cancers, ones that are in the topmost layer of the esophagus, we can remove tumor cells endoscopically. We have specialized instruments and tools that can remove that entirely. When cancer has progressed into deeper layers of the esophagus, there are several options that range from chemotherapy, radiation, and surgery.
More recently, over the last several years, there's been the evolution of immunotherapy, which has been a gamechanger for esophageal cancer treatment and has been very impactful for our patients. The decision on what treatments are best is based on the type of cancer, stage, and individual factors and preferences.
Emily Beatty: What advancements has the AHN Esophageal Institute made in research, diagnosis, or treatment of esophageal cancer?
Dr. Newhams: Our site was a contributor to the development and use of immunotherapy in the treatment of esophageal cancer. We've seen over the last several years expansive use of immunotherapy in many different types of cancer. The use of immunotherapy for esophageal cancer has been tremendously impactful for our patients.
Additionally, at AHN, we've continued work on liquid biopsy, which is a way of looking for cancer cells in a microscopic way in the blood to track for recurrence and treatment effect.
More recently, we've been working on what we call sponge-based technology, which is a tiny little sponge in a capsule that a patient can swallow. It's attached to a string, and we can then remove it just a few minutes later. The hope is to use the sponge technology for early screening for pre-cancerous changes, called Barrett’s esophagus.
Our research department and the AHN Cancer Institute are always involved in clinical trials to ensure that patients have access to the newest treatments for esophageal cancer.
Emily Beatty: Is there a role for screening and early detection of esophageal cancer, especially for high-risk individuals? For example, is there a recommendation for an endoscopy every five years, like colonoscopy?
Dr. Newhams: There's a growing interest in trying to identify patients who may be more at risk for esophageal cancer and developing surveillance and screening for them, but there are no current established guidelines for the general population. People who have a family history of esophageal or gastric cancer warrant a conversation with their physician about considering an upper endoscopy for screening.
For people who have Barrett's esophagus, there are well-established surveillance programs for them, so those are folks who are going to have an endoscopy every three to five years, depending on the nature and findings on endoscopy.
Certainly, there are conditions and lifestyle choices that may put people at higher risk, such as alcohol and smoking, and obesity, but right now, there are no current guidelines that include those as a basis for general screening.
For more information on the AHN Esophageal Institute, call (412) 359-GERD (4373).
Dr. Kirsten Newhams is the director of the Esophageal Institute at Allegheny Health Network (AHN). She is a board-certified surgeon with expertise in a broad spectrum of esophageal and gastric conditions, including reflux disease, Barrett’s esophagus, hiatal hernia, esophageal and gastric cancer, motility disorders, Zenker’s diverticulum, and swallowing disorders. Dr. Newhams is fellowship-trained in minimally invasive esophageal and gastric surgery and advanced endoscopy and is also certified in robotic surgery.
Dr. Newhams earned her medical degree and a Master of Public Health from the University of Texas Health Science Center at Houston. She completed her internship and residency at Virginia Mason Medical Center in Seattle, followed by a minimally invasive foregut fellowship at AHN. Before her directorship, she served as the associate program director for the Minimally Invasive Foregut and Advanced Endoscopy Fellowship at the AHN Esophageal Institute.
Recognized for her leadership and clinical skills, Dr. Newhams is an active member of professional organizations such as the American College of Surgeons, the American Foregut Society, the Society of American Gastrointestinal and Endoscopic Surgeons, and the International Society for Diseases of the Esophagus. She frequently shares her knowledge at community and professional conferences. Dr. Newhams is dedicated to providing high-quality care and furthering the legacy of innovation and excellence at the AHN Esophageal Institute, which is based at West Penn Hospital and has physicians at various AHN locations.
Learn more about esophageal and gastric cancer from Dr. Newhams in this AHN Med Talks podcast.
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