Re: Esophageal Cancer risks?

[Guest guest]

Barbara wrote:

>

> If you have had an esophagectomy with a gastric pull up - then are

> your chances for esophageal cancer reduced?

>

The answer to that is a bit complicated.

First, no one really knows what the risk of esophageal cancer is for

people with achalasia. Second, no one really know what the risk of

cancer is after a gastric pull-up. The risk probably depends on how much

exposure there was to food rotting in the esophagus, acid reflux and

burns from stuck pill or even very hod foods. It may also depend on

exposure to certain viruses, smoking and alcohol. It also probably

depends a lot on genes.

It is believed that there is an increase risk of cancer for people with

achalasia. Studies vary in how great that risk is. Some put it around 3%

but some don't find it that high. The risk of esophageal cancer in the

general population for people not smoking or drinking is low. When

something is low enough you can double it or even make ten times more

and it could still be low. I like to think that even with achalasia the

risk is still low, whatever it actually is. I don't want to worry about

it. There are better things in life to worry about if one is so

inclined. I do think it is worth making a effort to be safe by reducing

things and situations that irritate the esophagus or are known to carry

a risk for esophageal cancer. It could be a good idea to get checked for

cancer once in a while but probably not for some years after achalasia

first developed and then not all the often after that.

If there is acid reflux, not common before treatment, then the risk of

cancer probably goes up. For a number of reason, not just cancer, it is

important to control the acid exposure in the esophagus. If a person

needs a PPI to do that then a PPI is probably worth any risk that comes

with the PPI. Such PPI risks are low anyway or easy to deal with.

It could be a good idea to get checked for cancer once in a while but

probably not for some years after achalasia first developed and then not

all the often after that. But it depends on what the other health of the

esophagus is when checked and if there is reflux. Kind of like getting a

colonoscopy, some people don't need them very often and can go a decade

without while others are on the frequent flyer program. While some

studies find an increased risk of cancer, studies on life expectancy do

not find a reduced life expectancy. This implies that most of the people

with achalasia that die of esophageal cancer are doing so at a late age

when they would be at a high risk of dieing from something even if they

didn't have achalasia.

If an esophagectomy is done because the esophagus has gone to end stage

achalasia (megaesophagus) after many years then there may have been lots

of exposure to things that have put the esophagus at risk. Mostly that

risk is going to be in the lower esophagus where things sat in it. If

that portion is removed that would take way the risk of it producing a

cancer. Some of the upper esophagus must remain after the esophagectomy

so the gastric pull-up has a place to attach the stomach to. They call

that an esophageal stump. There is still some risk that cancer could

form in the stump, but so far that should have been the least exposed

part of the esophagus to cancer causing damage. After the esophagectomy

there is no sphincter, like the LES, to protect the stump. Reflux from

the stomach to the stump can increase the risk of cancer. Again, this is

something to be aware of but if one needs an esophagectomy then the

benefits probably outweigh the risks so why worry about them. Do be wise

though and minimize damage and control acid and reflux as much as needed.

The short answer is that the risk may be reduced for some people and

increased for others depending on the damage to the esophagus before and

after the esophagectomy.

Long-term esophageal cancer risk in patients with primary achalasia: a

prospective study.

http://www.ncbi.nlm.nih.gov/pubmed/20588263

" Although the gastro-esophageal cancer risk in patients with

longstanding achalasia is much higher than in the general population,

the absolute risk is rather low. "

Barrett's esophagus (BE) and carcinoma in the esophageal stump (ES)

after esophagectomy with gastric pull-up in achalasia patients:

a study based on 10 years follow-up.

http://www.ncbi.nlm.nih.gov/pubmed/18618179

" 101 patients submitted to esophagectomy and cervical gastroplasty were

followed-up prospectively for a mean of 10.5 +/- 8.8 years. ...

Esophageal stump cancer was detected in the setting of chronic

esophagitis in five patients: ... "

For more like those see:

https://www.zotero.org/groups/achalasia_atheneum/items

Click on the arrow next to the Complications folder and then click on

the Cancer folder.

notan

[Guest guest]

Thank you for a very informative answer - appreciate very, very much. I was

diagnosed at age 12 - not a lot done for it until age 26 - had heller myotomy -

4 yrs later an emergency esophagectomy - doctor stated the upper portion of the

esophagus was stretched out over 4 x times normal. They left the stump for the

pull thru - said either 2 cm or 2 in? Something like that. My reflux was

horrible for several years before the 1st surgery. Led to aspiration pneumonia.

In 2007 had a roux en y (sp?) procedure due to the excessive bile that was

coming up very frequently and making me very ill.

Another surgery for scar tissue about 4 months later.

Am now dealing with aspiration pneumonia - and was just scheduled to see a lung

specialist - which I cannot get into until June 11.

Hard to get a good breath in - hurts and chest is tight.

Reason I ask about the cancer is only because of the extreme reflux I have had

over the past 30 years off and on. Thank you again for your post - I have read

several of your posts over the years and appreciate your dedication and

knowledge you offer to others.

Barb

[Guest guest]

Barbara wrote:

>

> Am now dealing with aspiration pneumonia - ...

>

I meant to respond to this in the other message and forgot. Your doctors

probably already did this but it can be surprising what slips through.

Aspiration can cause exotic pneumonia infections. Not the typical

pneumonias, hospital or community. If they don't do cultures to identify

the infection they may use typical antiboitics for pneumonia that are

useless for some of these infections. It could even be lipoid pneumonia

(aspirated fat or oil) and the cultures will be useless and someone will

just have to recognize it on an X-ray.

Non-tuberculous mycobacteria masquerading as aspiration pneumonia in

patients with gastrointestinal problems.

http://www.ncbi.nlm.nih.gov/pubmed/16500097

Pulmonary infection with rapidly growing mycobacteria in a singer with

achalasia: a case report.

http://www.ncbi.nlm.nih.gov/pubmed/17316814

Lipoid pneumonia: a challenging diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/21349583

notan

[Guest guest]

Our surgeon (a very elite academic, for whatever it's worth) said that he no

longer knew what to make of old literature that suggested an increased risk of

esophageal cancer in achalasians. He said they have not noticed it clinically

over many years of treating achalasia. He did not feel it was worth worrying

about, or looking for.

Similarly, based on their experience, in response to my asking about it he said

he did not see a strong argument for doing endoscopies to look for evidence of

silent reflux damage, nor taking PPI's in the absence of reflux symptoms, with

or without achalasia. I believe the reason is that they've seen so very few

problems post HM that could be attributed to symptomless acid damage.

He acknowledged there is little believable science to guide these fears and

judgments, so he relies on his experience in giving advice.

> >

> > If you have had an esophagectomy with a gastric pull up - then are

> > your chances for esophageal cancer reduced?

> >

>

> The answer to that is a bit complicated.

>

> First, no one really knows what the risk of esophageal cancer is for

> people with achalasia. Second, no one really know what the risk of

> cancer is after a gastric pull-up. The risk probably depends on how much

> exposure there was to food rotting in the esophagus, acid reflux and

> burns from stuck pill or even very hod foods. It may also depend on

> exposure to certain viruses, smoking and alcohol. It also probably

> depends a lot on genes.

>

> It is believed that there is an increase risk of cancer for people with

> achalasia. Studies vary in how great that risk is. Some put it around 3%

> but some don't find it that high. The risk of esophageal cancer in the

> general population for people not smoking or drinking is low. When

> something is low enough you can double it or even make ten times more

> and it could still be low. I like to think that even with achalasia the

> risk is still low, whatever it actually is. I don't want to worry about

> it. There are better things in life to worry about if one is so

> inclined. I do think it is worth making a effort to be safe by reducing

> things and situations that irritate the esophagus or are known to carry

> a risk for esophageal cancer. It could be a good idea to get checked for

> cancer once in a while but probably not for some years after achalasia

> first developed and then not all the often after that.

>

> If there is acid reflux, not common before treatment, then the risk of

> cancer probably goes up. For a number of reason, not just cancer, it is

> important to control the acid exposure in the esophagus. If a person

> needs a PPI to do that then a PPI is probably worth any risk that comes

> with the PPI. Such PPI risks are low anyway or easy to deal with.

>

> It could be a good idea to get checked for cancer once in a while but

> probably not for some years after achalasia first developed and then not

> all the often after that. But it depends on what the other health of the

> esophagus is when checked and if there is reflux. Kind of like getting a

> colonoscopy, some people don't need them very often and can go a decade

> without while others are on the frequent flyer program. While some

> studies find an increased risk of cancer, studies on life expectancy do

> not find a reduced life expectancy. This implies that most of the people

> with achalasia that die of esophageal cancer are doing so at a late age

> when they would be at a high risk of dieing from something even if they

> didn't have achalasia.

>

> If an esophagectomy is done because the esophagus has gone to end stage

> achalasia (megaesophagus) after many years then there may have been lots

> of exposure to things that have put the esophagus at risk. Mostly that

> risk is going to be in the lower esophagus where things sat in it. If

> that portion is removed that would take way the risk of it producing a

> cancer. Some of the upper esophagus must remain after the esophagectomy

> so the gastric pull-up has a place to attach the stomach to. They call

> that an esophageal stump. There is still some risk that cancer could

> form in the stump, but so far that should have been the least exposed

> part of the esophagus to cancer causing damage. After the esophagectomy

> there is no sphincter, like the LES, to protect the stump. Reflux from

> the stomach to the stump can increase the risk of cancer. Again, this is

> something to be aware of but if one needs an esophagectomy then the

> benefits probably outweigh the risks so why worry about them. Do be wise

> though and minimize damage and control acid and reflux as much as needed.

>

> The short answer is that the risk may be reduced for some people and

> increased for others depending on the damage to the esophagus before and

> after the esophagectomy.

>

> Long-term esophageal cancer risk in patients with primary achalasia: a

> prospective study.

> http://www.ncbi.nlm.nih.gov/pubmed/20588263

> " Although the gastro-esophageal cancer risk in patients with

> longstanding achalasia is much higher than in the general population,

> the absolute risk is rather low. "

>

> Barrett's esophagus (BE) and carcinoma in the esophageal stump (ES)

> after esophagectomy with gastric pull-up in achalasia patients:

> a study based on 10 years follow-up.

> http://www.ncbi.nlm.nih.gov/pubmed/18618179

> " 101 patients submitted to esophagectomy and cervical gastroplasty were

> followed-up prospectively for a mean of 10.5 +/- 8.8 years. ...

> Esophageal stump cancer was detected in the setting of chronic

> esophagitis in five patients: ... "

>

> For more like those see:

> https://www.zotero.org/groups/achalasia_atheneum/items

>

> Click on the arrow next to the Complications folder and then click on

> the Cancer folder.

>

> notan

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>

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