Esophageal Cancer

Esophageal cancer forms inside the esophagus, which is the muscular tube that carries food from the mouth to the stomach.  Esophageal cancer is not as common as some other cancers, such as breast, lung, and prostate cancer.  But the number of people with one particular type of esophageal cancer, called adenocarcinoma, has risen dramatically in the past few decades.  Adenocarcinoma is the most common type of esophageal cancer in the U.S.  Let's talk about more about it, including what symptoms you should be aware of.

What causes esophageal cancer?

Unfortunately, we don't know exactly what causes esophageal cancer.  It is thought that chronic irritation of the inner lining of the esophagus may contribute to causing changes in cells within the esophagus that can make them grow and divide out of control. 

Here are some of the things that cause irritation in the cells of the esophagus that appear to increase your risk of developing esophageal cancer:

• Smoking
• Having gastroesophageal reflux disease (GERD)
• Drinking alcohol
• Having Barrett's esophagus, which is the name given to precancerous changes in the esophagus
• Being obese
• A steady habit of drinking very hot liquids
• Not eating enough fruits and vegetables
• Having bile reflux (reflux of bile from the gall bladder)
• Having an esophageal sphincter that won't relax (called achalasia), which usually cause trouble swallowing
• A history of radiation treatment to the chest or upper abdomen

What are the symptoms of esophageal cancer?

• Weight loss without trying
• Difficulty swallowing
• Progressively worsening heartburn or indigestion
• Coughing or hoarseness
• Chest pain or pressure, or a burning sensation in the chest.

How is the diagnosis of esophageal cancer made?

• Barium swallow test - You swallow a liquid containing barium, then have X-rays. The barium will show the contour of your esophagus on the X-ray.
• Endoscopy or EGD - This involves your doctor putting a flexible lighted tube through your mouth and throat, into your esophagus. During the EGD, a biopsy can be done of any suspicious areas to send to the lab for testing. 
• CT scan of the chest - Can show the tissues in the esophagus.

What can you do to help reduce your risk of esophageal cancer?

• If you have been told that you have Barrett's esophagus, be sure to maintain follow up with your doctor and undergo screening tests when recommended.
• Quit smoking
• Avoid alcohol consumption or drink only in moderation
• Maintain a healthy weight. If you are overweight, talk with your doctor or one of our dieticians about strategies to help you lose weight.
• Eat more fruits and vegetables, aiming for a variety of colors.
• If you have GERD, follow your doctor's recommendations regarding treatment as well as lifestyle precautions you should take.

If you have any questions about esophageal cancer, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Sarcoidosis - Part II

Last week, we talked about sarcoidosis which is an inflammatory disease that can affect any organ in the body.  Let's continue our discussion today focusing on diagnosis, treatment, and possible complications.

How is the diagnosis of sarcoidosis made?

Diagnosing sarcoidosis can be difficult.  The disease often causes few or vague symptoms in early stages and the symptoms often mimic those of other diseases.  Your doctor will need to do a thorough physical examination to check all the areas that might be affected by sarcoidosis.

Your doctor will also usually recommend some tests to help make the diagnosis and to determine what body systems are involved and the extent or severity of involvement.  These tests include:

• Blood and urine tests
• Chest X-ray
• CT scan of your chest
• Pulmonary (lung) function tests
• Electrocardiogram
• Eye exam
• Biopsies - Usually from the lung, lymph node, or skin.
• MRI or PET scan - especially if there is suspicion of heart or central nervous system involvement

What are the possible complications of sarcoidosis?

Sarcoidosis often goes away without causing any complications, or responds well to treatment, but long-term problems can happen.  These complications can sometimes be life-threatening.  They include:

• Lungs - Permanent scarring with fibrosis in the lungs can make it difficult to breathe and can sometimes cause high blood pressure in the arteries within the lungs.
• Heart - Granulomas in the heart muscle can disrupt the electrical system of the heart, causing abnormal rhythms. They can also impair blood flow and normal heart function, which can cause congestive heart failure and even lead to death.
• Eyes - Inflammation within the eye can eventually cause blindness if not treated.
• Nervous system - Granulomas that form in the brain, nerves, or spinal cord can cause a variety of neurologic symptoms, the most common is facial paralysis on one side.
• Kidneys - Kidney stones, reduced kidney function, and rarely kidney failure can occur.

How is sarcoidosis treated?

Sarcoidosis cannot be cured, but it can be treated.  In many cases, it goes away completely without treatment.  Mild cases may not be treated at all.  If you have severe symptoms or extensive involvement, then treatment may include:

• Corticosteroids - These are powerful anti-inflammatory drugs that are usually the first line treatment for sarcoidosis. They may be taken by mouth, put on the skin in a cream, or put into the eye in drops. 
• Immune suppressants - Act to reduce inflammation.
• Hydroxychloroquine - Can help with skin lesions and elevated blood calcium levels.
• Certain other rheumatoid arthritis medications - Are sometimes used to treat sarcoidosis that has not responded to other treatment.

Ongoing monitoring by your doctor is very important in sarcoidosis, to determine if treatment is needed and monitor for treatment response and complications.

In rare cases, organ transplant may be considered if sarcoidosis has caused severe organ damage that cannot be treated with medication.

For more information about sarcoidosis, use this link:

Sarcoidosis - What Is Sarcoidosis? | NHLBI, NIH

If you have any questions about Sarcoidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Sarcoidosis

Sarcoidosis is a disease in which there are tiny collections of inflammatory cells, called granulomas, that grow in the body.  They are most common in the lungs and lymph nodes, but can grow in any part of the body, including the eyes, heart, skin, and any other organ of the body.  Most people have never heard of it, or don't know much about it. 

What causes sarcoidosis?

We are not sure of the exact cause of sarcoidosis.  Experts believe that it is a result of the body's immune system reacting to an unknown substance.  There is probably a genetic predisposition that causes the body to form these granulomas in response to various substances that the immune system perceives as foreign, such as bacteria, viruses, dust, or chemicals.

There are some things that seem to increase your risk of developing sarcoidosis, including:

• Age - Most often occurs between age 20-60 years old
• Sex - Women are at slightly higher risk
• Race - People of African descent and Northern European descent have a higher incidence of sarcoidosis.  African Americans are more likely to have involvement of organs besides the lungs.
• Family history - You are at higher risk if a family member has had sarcoidosis.

What are the symptoms of sarcoidosis?

Symptoms can vary depending on what part of the body is affected.  The symptoms will sometimes develop gradually over several years but can sometimes appear suddenly.  Some people with sarcoidosis have no symptoms.  They may be found to have sarcoidosis after a chest X-ray that was done for an unrelated reason.  Here are some of the possible symptoms of sarcoidosis:

Lung Symptoms - Because the lungs are most often affected, common symptoms include:

• Persistent cough - usually dry
• Shortness of breath
• Wheezing
• Chest pain

General symptoms

• Fatigue
• Fever
• Swollen lymph nodes
• Weight loss
• Pain and swelling in joints

Skin symptoms

• Rash - Usually red or purple bumps on the shins or ankles
• Sores on the nose, cheeks, or ears - which can be disfiguring
• Variation in skin pigment with darker or lighter areas
• Growths under the skin - often around or under scars or tattoos

Heart symptoms

• Chest pain
• Fainting
• Irregular heartbeat
• Palpitations
• Swelling - usually in the legs

Eye symptoms

• Blurry vision
• Eye pain, burning, itching, or dryness
• Severe redness
• Light sensitivity

Next week, we will continue our discussion with more about diagnosis, treatment, and possible complications of sarcoidosis.

If you have any questions about Sarcoidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor