Esophageal cancer doesn't get as much attention as more common malignancies such as breast or prostate cancer, but rates of the deadly disease in Northern California, including the Sacramento and Central regions, are among the highest in the state.
As April is Esophagus Awareness month, UC Davis Comprehensive Cancer Center aims to raise awareness of the risk factors, signs and symptoms of the disease to foster early diagnosis and treatment.
The chance of getting esophageal cancer increases with age, and men have a three to four-fold higher rate of the disease. Gastroesophageal reflux disease (GERD), which can cause heartburn, and Barrett's esophagus, which is caused by chronic acid reflux, pose a risk for the cancer, as well. Use of tobacco and alcohol and obesity all put people at higher risk for esophageal cancer. Esophageal cancer has claimed the lives of many well-known Americans, including actor Humphrey Bogart, former Texas Governor Ann Richards, and more recently Hall of Fame Baseball player Harmon Killebrew and essayist Christopher Hitchens.
The most recent California Cancer Registry data show that the state's highest esophageal cancer rates during 2004-2009 were concentrated in the 10 Northern-most California counties - between 4.44 and 5.11 cases per 100,000 people, compared with 3.98 per 100,000 in the state as a whole. In the Sacramento region, the esophageal cancer rate was 4.21 to 4.42, also well above the state average. And unlike breast, prostate, lung and colon cancer, which are decreasing in incidence, esophageal cancer is among the cancers in which the incidence has continued to increase.
Although esophageal cancer does not always produce obvious symptoms, signs of the disease may include difficulty swallowing, unexplained weight loss, chest pain, pressure or burning, fatigue, frequent choking while eating, indigestion or heartburn, and coughing or hoarseness. People with chronic reflux can manage their symptoms with drugs that reduce stomach acid.
Fortunately, new treatment approaches have lowered the death rate from esophagus cancer, which at one time killed 95 percent of those diagnosed with the disease. Today, about 16 percent of all esophageal cancer patients will survive five years or more. As with most types of cancer, survival odds increase when the disease is caught and treated early.
JoAnn Charlene Cannon, a 62-year-old retired professor of Italian studies who lives in Davis, Calif. was diagnosed with esophageal cancer in September of 2011. Predisposed to the disease because of a condition called achalasia, which causes food to collect in the esophagus and makes swallowing difficult, Cannon was examined regularly for signs of cancer. When doctors found a tumor that had penetrated the esophageal muscle, she opted for surgery to remove the esophagus.
David Tom Cooke, the UC Davis thoracic surgery oncologist who performed the operation, said Cannon was lucky because the tumor was caught early, and she did not require chemotherapy or radiation treatment. Cooke was able to remove the esophagus using small incisions, minimizing potential post-surgery complications and reducing healing time.
The UC Davis Comprehensive Cancer Center's esophageal cancer team has developed a program designed to streamline esophageal cancer patient care. The so-called "pathway" guides the nursing staff, medical residents, surgeons and other care providers in eight patient categories ranging from tests and treatments to diet and discharge planning. Use of the pathway has significantly reduced the amount of time patients stay in the hospital, are readmitted after their surgery or suffered pulmonary complications.
For Cannon, recovery has been encouraging. Although adjusting to a very short esophagus and smaller stomach has required significant dietary changes, she can now eat almost anything in small portions. She has also resumed her very active lifestyle, which includes playing golf, skiing and playing tennis.
"It's true that after surgery you have to figure out what among your normal activities you can return to, and what part of your life has to change," she said. "I feel very good. I am getting back to a 'new' normal."
UC Davis Comprehensive Cancer Center is the only National Cancer Institute-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its specialists provide compassionate, comprehensive care for more than 9,000 adults and children every year, and access to more than 150 clinical trials at any given time. Its innovative research program engages more than 280 scientists at UC Davis, Lawrence Livermore National Laboratory and Jackson Laboratory (JAX West), whose scientific partnerships advance discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis collaborates with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer care. Its community-based outreach and education programs address disparities in cancer outcomes across diverse populations. For more information, visit cancer.ucdavis.edu.