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Johns Hopkins Bayview News - Battling Esophageal Cancer

Winter 2013

Battling Esophageal Cancer

By: Karen Tong
Date: February 4, 2013

Minimally invasive technique gives new hope to patients with this difficult diagnosis

Portrait of Daniela Molena, M.D., thoracic surgeon
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Daniela Molena, M.D., thoracic surgeon

Claire Miller* felt perfectly fine and took pride in living a healthy life. She enjoyed exercising and had never touched a cigarette. Miller was looking forward to traveling abroad with friends over the summer.

When a routine stool sample test came back positive for blood in the stool, Miller was surprised, and worried. Her primary care physician sent her for a colonoscopy and endoscopy. After one of the biopsy samples from the endoscopy procedure showed abnormal cells from her esophagus, Miller had a CT scan done, which confirmed a stunning diagnosis—esophageal cancer. Her doctors then referred her to Johns Hopkins. “It was a bolt out of the blue,” remembers Miller. “I was in a state of shock. I didn’t know anyone with this type of cancer.”

Understanding Esophageal Cancer

But Miller is far from alone. Esophageal cancer is the fastest growing cancer diagnosis in the United States. This year, more than 17,000 people are expected to be diagnosed with it, and more than 15,000 people are expected to die from it, according to the National Cancer Institute. Men are three times more likely than women to develop esophageal cancer.

There are two types of esophageal cancer, squamous cell and adenocarcinoma. Squamous cell carcinoma begins to grow in the flat cells lining the esophagus. Risk factors include smoking history, poor nutrition and alcohol usage. It is found in men and women, is generally rarer than adenocarcinoma and is more common in African Americans.

Adenocarcinoma is cancer that begins in mucus gland cells and is usually found in the lower part of the esophagus. It is much more common in men than women. People with GERD (gastroesophageal reflux disease), Barrett’s esophagus, smoking history or who are obese are at higher risk for it.

In the early stages, esophageal cancer does not usually cause noticeable symptoms. As it progresses, symptoms can include trouble swallowing, food caught in the throat, chest pain or weight loss.

Next Steps

Miller’s care team at Johns Hopkins used ultrasound to map and stage her cancer, trying to determine its severity. Fortunately, her cancer was diagnosed early and had not progressed very far. When an endoscopic procedure done to remove the cancerous cells was not successful, Miller was sent to see Johns Hopkins thoracic surgeon Daniela Molena, M.D.

“Because the cancer in Ms. Miller’s esophagus was found so early on, she didn’t need chemotherapy or radiation to treat it. Surgery was her best option,” says Dr. Molena.

Miller says, “Dr. Molena told me that we had one chance for a cure, and that was to remove my esophagus. I was apprehensive, as anyone would be.” Miller was concerned about the surgery and what life would be like after it. Dr. Molena connected her with another patient who offered support and friendship. Miller was grateful to talk with someone who had already gone through the same surgery. It was helpful and reassuring to hear that patient’s perspective and learn from his caregiver what to expect.

Minimally Invasive Esophagectomy

Dr. Molena recommended a minimally invasive esophagectomy for Miller. During the surgery, small incisions were made in her abdomen and chest so that lights, cameras and other tools could be used to remove the cancerous part of the esophagus and reposition a part of the stomach to rebuild an esophagus. Anne Lidor, M.D., a Johns Hopkins minimally invasive surgeon, performed the surgery with Dr. Molena. “Almost anyone with esophageal cancer can be a good candidate for this type of surgery, except people with severe lung disease or previous multiple abdominal surgeries,” says Dr. Molena. “Performing this surgery as a team with Dr. Lidor is important because we each have special skills.”

“Although nervous, I was pleased to hear about this minimally invasive option,” says Miller. Patients undergoing this surgical approach usually have a shorter hospital stay, an easier recovery and decreased pain. In general, patients tolerate this procedure much better than other approaches using larger incisions, and they are out of bed the day after the surgery. This approach gave Miller the opportunity to recover quickly and keep her long-anticipated travel plans.

Miller remembers, “After the surgery, I walked the hospital halls multiple times a day, and I didn’t have much pain. I think everyone was surprised at how well I did.”

Preparing for Vacation

About a month after her surgery, Miller gradually got back into her normal routines, exercising and eating small meals throughout the day. She started with 10-minute sessions at the gym and regained her strength. Now, she exercises every morning.

The best part is that she was able to go on vacation for two weeks with friends. They toured the countryside, explored castles and enjoyed learning about a different culture. Miller is grateful for the care she received. “I can’t speak highly enough of Dr. Molena. She’s a very talented, knowledgeable and caring physician.”

For more information or to schedule an appointment with a thoracic surgeon, call 410-933-1233.