Cancer Education Slides

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Cancer Education Slides

• Esophageal Cancer

2009
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What is Cancer?

• A group of 100 different diseases
• The uncontrolled, abnormal growth of cells
• Cancer may spread to other parts of the body

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What is Esophageal Cancer?

• An estimated 16,470 new cases in the United
  States in 2009
• Three to four times more common among men than
  women
• Seventh most frequent cause of cancer-related
  death among men
• A disease in which cells in the lining of the
  esophagus grow uncontrollably and form a tumor

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Types of Esophageal Cancer

• Two major types of esophageal cancer squamous
  cell carcinoma and adenocarcinoma
• Squamous cell carcinoma starts in squamous cells
  that line the esophagus and usually develops in
  the upper and middle part of the esophagus
• Adenocarcinoma begins in the glandular tissue in
  the lower part of the esophagus at the junction
  between the esophagus and the stomach
• Treatment is similar for both of these types
• Rare tumors of the esophagus occur in less than
  1 of cases and include small cell neuroendocrine
  cancer, lymphoma, and sarcoma

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What is the Function of the Esophagus?

• A 10-inch long, hollow, muscular tube that
  connects the throat to the stomach
• The walls of the esophagus contract when a person
  swallows which pushes food down into the stomach

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What are the Risk Factors for Esophageal Cancer?

• Age
• Gender
• Race
• Tobacco
• Alcohol
• Barretts esophagus, a condition that can develop
  in people with chronic gastroesophageal reflux
  disease (GERD) or esophagitis (inflammation of
  the esophagus)

• Diet/Nutrition
• Obesity
• Lye ingestion
• Achalasia (a condition when the lower muscular
  ring of the esophagus fails to relax during
  swallowing of food)

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What are the Symptoms of Esophageal Cancer?

• Difficulty and pain with swallowing, particularly
  when eating meat, bread, or raw vegetables
• Pressure or burning in the chest
• Indigestion or heartburn
• Vomiting
• Frequent choking on food
• Unexplained weight loss
• Coughing or hoarseness
• Pain behind the breastbone or in the throat

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How is Esophageal Cancer Diagnosed?

• Diagnosis is confirmed with a biopsy
• Barium swallow (esophagram)
• Upper endoscopy (esophagus-gastric-duodenoscopy
  or EGD)
• Endoscopic ultrasound
• Bronchoscopy
• Computed tomography (CT or CAT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

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XX Cancer Staging

• Staging is a way of describing a cancer, such as
  the size of a tumor and if or where it has spread
• Staging is the most important tool doctors have
  to determine a patients prognosis
• Staging is described by the TNM system the size
  and location of the Tumor, whether cancer has
  spread to nearby lymph Nodes, and whether the
  cancer has Metastasized (spread to other areas of
  the body)
• Some stages are divided into smaller groups that
  help describe the tumor in even more detail
• Treatment depends on the stage of the cancer
• Recurrent cancer is cancer that comes back after
  treatment

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Stage I Esophageal Cancer

• Cancer is in the lamina propria and submucosa
  (the two inside layers of the esophagus)
• Cancer cells are in the lining of the esophagus

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Stage IIA Esophageal Cancer

• Cancer is in either of the two outer layers of
  the esophagus

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Stage IIB Esophageal Cancer

• Cancer is in the inner layers of the esophagus
• Cancer has spread to some lymph nodes near the
  tumor

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Stage III Esophageal Cancer

• Cancer is in the outside layer of the esophagus
  or in the tissue near the esophagus
• Cancer has spread to lymph nodes, either near the
  tumor or somewhere else in the body

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Stage IVA Esophageal Cancer

• Cancer has spread to the lymph nodes in the
  abdomen or neck

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Stage IVB Esophageal Cancer

• Cancer has spread to other parts of the body
  besides the lymph nodes

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How is Esophageal Cancer Treated?

• Treatment depends on stage of cancer
• More than one treatment may be used
• Surgery
• Chemotherapy
• Radiation therapy
• Photodynamic therapy

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Cancer Treatment Surgery

• The most common treatment
• Esophagectomy removal of part of the esophagus
  remaining portion is connected to the stomach
• Lymph nodes around the esophagus may also be
  removed
• Rarely, surgery may also be used to create a new
  pathway to the stomach, insert a feeding tube, or
  other methods to help a person if unable to eat

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Cancer Treatment Chemotherapy

• Use of drugs to kill cancer cells
• A combination of medications is often used
• Systemic chemotherapy is delivered through the
  bloodstream, targeting cells throughout the body
• Side effects include fatigue, risk of infection,
  nausea and vomiting, loss of appetite, and
  diarrhea

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Cancer Treatment Radiation Therapy

• The use of high-energy x-rays to destroy cancer
  cells
• Different methods of delivery
• External beam outside the body
• Internal radiation or brachytherapy radiation is
  given by temporarily inserting a radioactive wire
  into the esophagus
• Side effects may include fatigue, mild skin
  reactions, upset stomach, and loose bowel
  movements

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Cancer Treatment Photodynamic Therapy

• Lasers or light therapy to destroy cancerous
  tissue and relieve blockages
• Used in people who cannot or choose not to
  receive surgery, radiation therapy or
  chemotherapy
• Often used to relieve swallowing problems, not as
  a curative therapy

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Current Research

• Chemoprevention substances that may reduce the
  risk of developing esophageal cancer
• Combination therapy combinations of different
  types of treatment or chemotherapy
• Targeted therapy drugs that target faulty genes
  or proteins that contribute to cancer growth or
  development

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The Role of Clinical Trials for the Treatment of
Esophageal Cancer

• Clinical trials are research studies involving
  people
• They test new treatment and prevention methods to
  determine whether they are safe, effective, and
  better than the standard treatment
• The purpose of a clinical trial is to answer a
  specific medical question in a highly structured,
  controlled process
• Clinical trials can evaluate methods of cancer
  prevention, screening, diagnosis, treatment,
  and/or quality of life

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Clinical Trials Patient Safety

• Informed consent participants should understand
  why they are being offered entry into a clinical
  trial and the potential benefits and risks
  informed consent is an ongoing process
• Participation is always voluntary, and patients
  can leave the trial at any time
• Other safeguards exist to ensure ongoing patient
  safety

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Clinical Trials Phases

• Phase I trials determine the appropriate dose of
  a new treatment in a small group of people and
  provide preliminary information about the drugs
  safety
• Phase II trials provide information about the
  safety of the new treatment and provide the first
  evidence as to whether or not the new treatment
  is effective in treating the cancer that is being
  studied
• Phase III trials compare two or more different
  treatments. Most commonly, they test whether a
  new treatment is better than the standard
  treatment. Patients are typically divided
  randomly into two or more different groups. Each
  group gets a different treatment, and the
  researchers evaluate which group has had the best
  results. This is the best way to measure whether
  a new treatment results in longer life or better
  quality of life for patients

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Clinical Trials Resources

• Coalition of Cancer Cooperative Groups
  (www.CancerTrialsHelp.org)
• CenterWatch (www.centerwatch.com)
• National Cancer Institute (www.cancer.gov/clinical
  _trials)
• EmergingMed (www.emergingmed.com)

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Coping with Side Effects

• Side effects are treatable talk with the doctor
  or nurse
• Fatigue is a common, treatable side effect
• Pain is treatable non-narcotic pain-relievers
  are available
• Antiemetic drugs can reduce or prevent nausea and
  vomiting
• For more information, visit www.cancer.net/sideeff
  ects

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After Treatment

• Talk with the doctor about developing a follow-up
  care plan
• Doctor may recommend regular physical
  examinations, CT scans, and upper endoscopies
• People who have had an esophagectomy may need to
  sleep with the head of the bed elevated to avoid
  acid reflux
• Fear of recurrence is common talk with your
  doctor about ways to cope

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Where to Find More InformationCancer.Net Guide
to Esophageal Cancer(www.cancer.net/esophageal)

• Overview
• Medical Illustrations
• Risk Factors
• Symptoms
• Diagnosis
• Staging With Illustrations
• Treatment

• Clinical Trials
• Side Effects
• After Treatment
• Current Research
• Questions to Ask the Doctor
• Patient Information Resources

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Cancer.Net (www.cancer.net)

• Comprehensive, oncologist-approved cancer
  information
• Guides to more than 120 types of cancer and
  cancer-related syndromes
• Coping resources
• Survivorship information
• Cancer information in Spanish
• Weekly feature articles
• The latest cancer news
• For patient information resources, please call
  888-651-3038