Life With Esophageal Cancer

11/22/2025

At the end of every , you should get a report card of how your surgeon did including how straight, narrow and well-connected your new conduit is- how well it functions, how well you swallow. You should be able to compare your individual outcomes to that of others and know if you are an outlier. You should have ready access to the results and outcomes of the surgeons you go to to potentially perform your surgery, interviewing them like your life depended on it. The upper digestive disease (UDD) tool is the first step to bring transparency to the specialty so patients can have a clear understanding of what their problems are and know when they need to seek help. The STS database rates programs and compares safety in different hospitals. Look for programs that have an enhanced recovery pathway. Look for high volume programs with experienced teams. Measure your results and compare them to others and understand your disease so you have the best chance to have your best life. Ask questions. (Image used with permission from Annals of Thoracic Surgery) Measure the following: Dysphagia, heartburn, regurgitation, pain, aspiration, systemic dumping, hypoglycemic dumping, weight loss, nutritional parameters, dyspnea, physical health, mental health and more. Understand your disease.

11/18/2025

Esophageal Adenocarcinoma Management simplified:
🧬 Ask to be genetically tested
🧬 Look on Clinicaltrials.gov for trials
🧬 Read the Matterhorn Trial
🧬 Ask for a high volume (>20 esophagectomies/year) thoracic surgeon who works with a tumor board to do minimally invasive esophagectomy
🧬 Follow NCCN Guidelines
🧬 Get a 2nd opinion

09/06/2025

If your voice is weak after recurrent laryngeal nerve damage, this podcast talks about options for renewing the voice.

07/26/2025

What is the biggest question you had that your doctor did not explain well when you were first diagnosed?

07/24/2025

Our Summary of Esophageal Cancer

If you have had reflux for >5 years, get an upper endoscopy to screen for esophageal cancer.

Esophageal cancer is a malignancy that arises from the esophagus, the muscular tube that connects the throat to the stomach. There are two primary types:
1. Squamous Cell Carcinoma – Originates from the squamous cells lining the upper and middle parts of the esophagus; more common in areas with to***co & alcohol use.
2. Adenocarcinoma – Develops from glandular cells, typically in the lower esophagus, often associated with Barrett’s esophagus & chronic gastroesophageal reflux disease (GERD).

Risk Factors:
• Smoking and heavy alcohol use (squamous)
• Chronic GERD & Barrett’s esophagus (adenocarcinoma)
• Obesity
• Male s*x and older age
• Diet low in fruits/vegetables
• Human papillomavirus (HPV) infection (less common)

Symptoms:
• Dysphagia (difficulty swallowing)
• Weight loss
• Chest pain or discomfort
• Hoarseness or chronic cough
• Vomiting or regurgitation of food

Diagnosis:
• Endoscopy with biopsy (definitive)
• Barium swallow for structural assessment
• CT, PET-CT, or endoscopic ultrasound (EUS) for staging and metastasis detection

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Staging Esophageal Cancer (TNM System – AJCC 8th Edition)

Staging is crucial for determining prognosis and treatment. It uses the TNM classification:

T – Tumor (Depth of Invasion)
• Tis: Carcinoma in situ (high-grade dysplasia)
• T1: Invades lamina propria, muscularis mucosae, or submucosa
• T1a: Limited to mucosa
• T1b: Invades submucosa
• T2: Invades muscularis propria
• T3: Invades adventitia
• T4: Invades adjacent structures
• T4a: Resectable (pleura, pericardium, diaphragm)
• T4b: Unresectable (aorta, vertebral body, trachea)

N – Nodes (Lymph Node Involvement)
• N0: No regional lymph node metastasis
• N1: 1–2 regional lymph nodes
• N2: 3–6 regional lymph nodes
• N3: ≥7 regional lymph nodes

M – Metastasis
• M0: No distant metastasis
• M1: Distant metastasis present

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Stage Groupings (Simplified):

Stage T N M
0 (in situ) Tis N0 M0
I T1 N0 M0
II T2–T3 N0 or N1 M0
III T3–T4a N1–N3 M0
IV Any T Any N M1

Note: Location (upper, middle, lower esophagus), histology (squamous vs. adeno), and grade also affect stage classification.

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Staging Modalities:
• Endoscopic Ultrasound (EUS): Best for T & N staging
• CT/PET-CT: Detects distant metastasis
• Laparoscopy/Thoracoscopy: May be used in select patients to evaluate resectability. When the tumor is low, a staging laparoscopy with washing can rule-out malignant peritoneal disease.

07/24/2025

This video explains how to repair a tracheoesophageal fistula. It is the best example we have seen when patients develop a high tracheal connection to the esophagus and explains which ones can be stented and which ones can be repaired.

Dr. Blackmon and her team at Baylor College of Medicine work together to present their approach to TEFs and specifically demonstrate a lateral cervical appro...