The late diagnosis, in the absence of screening tests that would make it possible to identify the disease at an early stage, means that the treatment options for patients are limited and their life expectancy is limited/ShutterStock
Heartburn, difficulty swallowing and feelings of suffocation when swallowing and hoarseness can be symptoms of various diseases.
One of the less happy possibilities is that the cause of these disturbances in the tube leading from the mouth to the stomach is the development of a tumor in the esophagus.
"Most patients who are diagnosed with esophageal cancer come because of these symptoms - and their appearance is evidence that the disease is already at a relatively advanced stage," explains Dr. Ofer Purim, director of the service for digestive tract tumors in the oncology department at Shaare Zedek Hospital. The late diagnosis, in the absence of screening tests that would allow identification the disease at an early stage, which means that the treatment options for patients are limited and their life expectancy is limited.
Despite this, in recent years a revolution has been taking place in cancer treatment, and its effect is also felt in dealing with esophageal cancer. This revolution is the development of immunotherapy treatments - treatments designed to re-stimulate the immune system so that it Fight cancer. Today, the addition of immunotherapy treatments to the chemotherapy used to treat esophageal cancer patients who are in the metastatic stage has been shown in studies to allow a significant extension of the patients' life expectancy. As a result, these treatments have received the approval of the regulatory authorities in the world and in Israel for the treatment of esophageal cancer patients in the metastatic stage.
The diagnosis of esophageal cancer is made with the help of gastroscopy/barges Sha'are Tzedek
"Esophageal cancer is a relatively rare tumor in the West, with 156 cancer cases diagnosed in 2020 according to data from the Ministry of Health" in Israel, explains Dr. Purim. "This type of cancer is widespread far east of us in Asia, in countries such as Russia, Iran, China, Korea, Japan and Southeast Asia". Despite its relative rarity, due to the late diagnosis, it is a fatal disease, the life expectancy of the patients is extremely short, which is why the introduction of new treatments that can extend the life expectancy of these patients is so significant.
The known factors that encourage the development of esophageal cancer They are smoking and drinking alcohol - "that's why this type of cancer is more common in countries like Russia." Other possible risk factors, the expert adds, are drinking a lot of boiling drinks and foods, such as soup and hot tea. "And this can explain why the disease is particularly common in places like Iran.
In general, trauma to the esophagus increases the risk of developing cancer, such as in those who accidentally swallowed cleaning agents as children."
Another difference between esophageal cancer in the West and the East is in the characteristics of the cancer itself. In the East, the more common cancer develops in the upper part of the esophagus and in a certain type of cells found there (called squamous cells), and in the West the more common cancer appears in the lower part of the esophagus - in the area of the connection between the esophagus and the stomach - and develops in another type of cells (called glandular cells). The people have heartburn, which causes chronic inflammation that encourages the development of cancer.
This phenomenon of reflux has been linked to obesity, which causes constant pressure on the sphincter that separates the two organs and an increase in malic acid," explains Dr. Purim.
The diagnosis of esophageal cancer is made with the help of gastroscopy - examination of the esophagus with a camera that is inserted through an optical fiber - and taking a tissue biopsy to characterize the cells, and finally imaging tests such as PET CT which are designed to determine if the tumor has already metastasized.
In cases where the disease remains without metastases, the standard treatment is a combination of radiation and chemotherapy and then, in most cases, surgery to remove the tumor.
"Subsequently, studies show that the addition of immunotherapy treatment for a year significantly reduces the risk of disease recurrence," says Dr. Purim.
In the case of a metastatic disease, whether at the initial diagnosis or if the disease returned after surgery, the standard treatment today, given as part of the health basket , is chemotherapy. "However, studies show that if you look at a certain characteristic of the tumor cells, which indicates the degree of sensitivity of the cancer to immunotherapy treatment, it is possible to significantly extend the life expectancy of patients whose tests show that there is sensitivity to immunotherapy treatment with the help of adding immunotherapy to the standard chemotherapy treatment." Dr. Purim explains.
The improvement depends on the type of cancer, whether it is the type of squamous cells or the glandular cells it adds, but in general these treatments have shown that they succeed in extending the life expectancy of the patients significantly.
Thus, for example, a study that examined the use of one of the new immunotherapy treatments showed a significant extension of life expectancy in patients with squamous esophageal cancer with the addition of immunotherapy in addition to first-line chemotherapy.
The immunotherapy treatments carry the promise both in the early stage and in the metastatic stage for increasing the chance of recovery and extending life expectancy/ShutterStock
However, even those who were unlucky and received only first-line chemotherapy and the disease continued to progress, the immunotherapy treatments offer hope for a significant extension of life expectancy even if these drugs are treated after the disease has progressed compared to the existing treatment.
A study that examined a new immunotherapy treatment versus chemotherapy in the second line of treatment showed a significant extension of life expectancy in patients whose tests showed that their tumor was sensitive to this type of treatment.
The study also showed that after a year, 35% of these patients continue to respond to treatment.
Overall, concludes Dr. Purim, between 50% and 60% of patients in Israel meet the criteria of tumor sensitivity to treatment. "Currently, immunotherapy treatments are given to esophageal cancer patients only within the framework of private health insurance, since this treatment is not yet included in the basket.
In summary: Esophageal cancer is a disease in which the life expectancy of patients with this disease is very short compared to other cancers.
The immunotherapy treatments carry the good news both in the early stage and in the metastatic stage for increasing the chance of recovery and extending life expectancy.
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