Selected Podcast

Bringing Awareness to Esophageal Cancer

Dr. Keith Mortman brings awareness to a lesser known and talked about disease, esophageal cancer.
Bringing Awareness to Esophageal Cancer
Keith Mortman, MD
Keith Mortman, MD, FACS, FCCP is board-certified in cardiothoracic surgery. He is the Director of Thoracic Surgery and an Associate Professor of Surgery with The George Washington University School of Medicine & Health Sciences. 

Learn more about Keith Mortman, MD

Dr. Michael Smith (Host): Esophageal cancer is a devastating and aggressive disease. But it can be beaten. Welcome to The GW Hospital HealthCast. I’m Dr. Mike Smith and today’s topic Bringing Awareness to Esophageal Cancer. My guest is Dr. Keith Mortman. Dr. Mortman is Director of the Division of Thoracic Surgery and an Associate Professor with the George Washington University School of Medicine and Health Sciences. Dr. Mortman, welcome to the show.

Keith Mortman, MD, FACS, FCCP (Guest): Thank you for having me.

Host: So, esophageal cancer I think when you say the word cancer to most people, lung cancer, brain cancer, colon cancer, breast, prostate; those are I think the cancers that come to mind the most and maybe a lot of people don’t realize that there is also a type of cancer in the esophagus. So, can you tell us a little bit about esophageal cancer and how common it is?

Dr. Mortman: Sure. So, the esophagus is essentially the food tube which connects the mouth to the stomach. That tube is made of muscle. It’s actually made of a couple of different layers of muscle so, the esophageal cancer tends to start from the very inside lining of the esophagus and it can occur really anywhere along it’s tract. So, it can occur in the esophagus, the part that is in the neck, the part that’s in the chest and then there’s a small part in the upper abdomen before it hits the stomach. So, it can really occur anywhere along the tract. As a disease process, esophageal cancer – there are not as many patients diagnosed in the US with esophageal cancer compared to some other cancers such as lung, breast, or colorectal cancer, but it can be an extremely important disease process just because patients tend to ignore their symptoms sometimes so that the disease can progress a little bit further before this comes to medical attention.

Host: Yeah. I definitely want to talk with you about that Dr. Mortman and you and I have actually discussed this before, the importance of getting checked out, early diagnosis when it comes to beating really any type of cancer. So, let’s talk a little bit then about who is at risk for esophageal cancer and what are some of those symptoms that people should be aware of?

Dr. Mortman: So, when it comes to the type of cell that the esophageal cancer can arise from; we break it down to two types essentially, something called an adenocarcinoma which is more common in the United States and then the squamous cell carcinoma. Basically, with the first type, the adenocarcinoma, the person who is most at risk for that usually has a long history of reflux and with that, they can get changes to the inside lining of the esophagus to the lower part of the esophagus near the stomach. Some of these changes can be discovered on a routine endoscopy with a gastroenterologist where they may be able to see some of these subtle changes directly when they visualize the lining and then it can be confirmed with biopsies.

The second type, the squamous cell carcinoma tends to occur a little higher up in the esophagus and these are patients who typically have a history of alcohol abuse and smoking use.

Host: I assume the symptoms are similar regardless whether it’s the adenocarcinoma or the squamous cell. Tell us a little bit about the things people should be aware of. Like if somebody has reflux, what are some of those symptoms?

Dr. Mortman: So, the symptoms are more the heartburn symptoms which typically occur lower in the chest but if it is severe enough it can actually come higher up the chest and into the throat. So, certainly, we encourage any patient if they have a history of reflux that has not been evaluated, that has not been treated to certainly start with their primary care physician. There is a variety of different medications that can be used for mild cases of reflux and oftentimes more severe cases, cases that don’t respond to some of these straightforward medications; some of these patients may require an upper endoscopy or direct visualization with a gastroenterology expert.

Host: When you mentioned reflux, is there a difference between occasional heartburn and reflux? Are those two different processes?

Dr. Mortman: They are essentially the same process. The heartburn is the symptom that a patient feels from the reflux.

Host: So, when somebody – so again if somebody has chronic issues with reflux, maybe they haven’t been fully evaluated; we want to get that person in, get checked out, right because again, like I mentioned, and we’ve talked before Dr. Mortman that early detection is really key, right with just about any cancer?

Dr. Mortman: That is the case. That is the case. And in patients who have these symptoms for, and we are not talking about somebody who just started having reflux or maybe has had it for a couple of weeks or a couple of months. It’s usually more of a chronic process. So, if somebody has had this for a long time, whether it’s several months or more and they either haven’t been treated at all or their symptoms are not responding to their current treatment; that’s really when they want to follow up with their primary care physician to go onto that next step. Because if somebody does have an upper endoscopy and if a biopsy shows certain types of changes, some of the changes can be more precancerous in nature and there’s different surveillance or follow up protocols that we can follow with those patients. They don’t necessarily need an operation right away.

Host: If somebody is diagnosed with esophageal cancer; what are the treatment options and what usually is the outcome from those treatments?

Dr. Mortman: So, again, I would say the most common symptoms that patients have from esophageal cancer are two. One is what we call dysphagia or the sensation of food getting stuck somewhere in the middle part of the chest. That’s the most common symptom that we see. And it’s usually more to solid foods before it then progresses to difficulty getting liquids down. And then the other one would be weightloss. Those are the two most common symptoms that we see.

When it comes to treatment, the treatment like most other cancers that we see really depends upon the stage of the cancer, how early or advanced it is. So, if we have a patient that presents with an early stage 1 esophageal cancer for instance; that’s somebody who can potentially be cured with surgery alone. Patients who might present for instance with a stage 3 esophageal cancer where the tumor is a little bit bigger, now it’s starting to involve some of the adjacent lymph nodes; most of these patients are going to require what we call multimodality treatment where we might need to treat them with chemotherapy and radiation possibly then followed by an operation. So, the important thing again is do not ignore your symptoms, follow up with your primary care doctor so this can be evaluated further.

Host: Right and so, a lot of information we covered in this short time Dr. Mortman so is there anything that you would like - in summary, is there anything that you would like the audience to know about esophageal cancer?

Dr. Mortman: I think any cancer can certainly be a daunting or scary diagnosis to face. I think it’s important to know that a place like GW, we have multidisciplinary care teams that involve surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists as well as other experts so that we can really individualize our treatment for each patient and to really optimize their outcomes.

Host: Dr. Mortman, I want to thank you for the work that you are doing and thank you for coming on the show today. You’re listening to The GW Hospital HealthCast. For more information go to that’s I’m Dr. Mike Smith. thanks for listening.