Esophageal cancer is rare and complex. We believe every patient is unique and our esophageal cancer experts approach cancer treatment on an individual and personal basis. Our gastrointestinal team also treats many patients with Barrett’s esophagus, a condition that may lead to esophageal cancer.
In this informative podcast, Christos Fountzilas, MD, discusses the need for Esophageal Cancer Awareness, and the promising new therapies and efforts to develop an organoid/spheroid approach, allowing for testing of new esophageal cancer drugs.
Selected Podcast
Esophageal Cancer Awareness
Featured Speaker:
Learn more about Christos Fountzilas, MD
Christos Fountzilas, MD
Dr. Fountzilas is a board certified medical oncologist in the gastrointestinal medical oncology department at Roswell Park Comprehensive Cancer Center with a focus in pancreatic cancer. His research interests include oncolytic virotherapy, biomarker discovery, and immunotherapy for gastrointestinal cancers.Learn more about Christos Fountzilas, MD
Transcription:
Esophageal Cancer Awareness
Bill Klaproth (Host): Esophageal cancer is rare and complex, and many people experience no symptoms before diagnosis and may remain symptom free for years; so, what do you need to know? Here to talk with us about esophageal cancer awareness is Dr. Christos Fountzilas, assistant professor of oncology at Roswell Park Comprehensive Cancer Center. Dr. Fountzilas, thank you for your time today. So, generally speaking, who is at risk for esophageal cancer?
Dr. Christos Fountzilas, MD (Guest): So, esophageal cancer as you said, is a very complex disease. There are many different diseases in one organ and generally speaking, we have two main diseases. One that is called the adenocarcinoma and one that’s called the squamous carcinoma. Adenocarcinoma is the most frequent type in the United States and it is very closely related to our lifestyles. We are getting more inactive. We are gaining weight. We are not eating that well and we develop a very common disease that is called gastroesophageal reflux disease, heartburn, that more or less everybody has. So, a percentage or a very small percentage of patients with reflux disease can develop a condition that is called Barrett’s esophagus. This is a condition that is premalignant and we have screening programs in patients who suffer from heartburn for many years and they fulfill certain criteria like being men, up over the age of 50, so that we can identify this premalignant condition and watch them with endoscopies every six months or every year and when they start developing any changes that put them in a really higher risk of developing adenocarcinoma, then we can very easily intervene with procedures like endoscopic resections and radiofrequency ablations, very minimally invasive procedures to try to treat those premalignant conditions and prevent really, adenocarcinoma. Further, with those screening programs, if adenocarcinoma does develop, we can identify it in a very early stage and treat it with multimodality therapies that can cure more than half the patients.
Bill: Dr. Fountzilas can we talk about those lifestyle factors just a little bit more. When you were talking about those, if someone were to eliminate those bad choices, does the risk of esophageal cancer then go down?
Dr. Fountzilas: Yes, because the risk of severe Barrett’s esophagus goes down. So, really if we try to live a healthier lifestyle, exercise more, avoid high fat diet, try to control blood sugars; our risk can go down. And we have evidence here from Roswell Park from our labs that in general, high glucose can be something that can drive esophageal cancer. Esophageal cancer cells can grow in the presence of glucose despite the presence of any other growth factors. So, really trying to modify our lifestyles, it is important to try to prevent that disease. Of course, reflux disease is a very, very common disease and everybody has experienced reflux symptoms. So, discussing – everybody should discuss with their primary care doctors about the severity of their reflux symptoms and if they are in a certain high-risk category, then they should get those enrolled in screening programs for Barrett’s esophagus and esophageal cancer.
Bill: So, Dr. Fountzilas, you mentioned reflux disorder, that’s something we need to be aware of. Now esophageal cancer doesn’t normally present with symptoms, but it can and when it does what are symptoms that we should be on the lookout for?
Dr. Fountzilas: Yes, the number one symptom is problems swallowing. And this can be – this can lead to weight loss. Sometimes patients may start vomiting blood or see blood in the stool in the form of black stool. Also, patients may start having symptoms that are compatible with esophagus cancer spreading to other organs such as having pain in their abdomen from cancer spread in the liver or start coughing from cancer spread in the lungs. Really when someone starts having problems swallowing, this tells us that the disease is not very early disease, but it starts affecting deeper into the esophagus wall and may be lymph nodes in the area. That’s why it is imperative that we do a very accurate staging as we say, more or less trying to see with special scans and endoscopies what the spread of the cancer is before we recommend an ideal treatment strategy.
Bill: And speaking of those treatment strategies, you were mentioning therapies before. Can you tell us a little bit more about any promising new therapies for treatment?
Dr. Fountzilas: Yes so, for localized esophagus cancer, the state of the art treatment is a combination of chemotherapy and radiation before surgical resection. That’s the main way approximately 2/3rds to 75% of patients with locally advanced esophagus cancer are treated. Of course, for earlier disease, simple esophagectomy, meaning without any chemotherapy and radiation may suffice. And of course, in the very early diseases we are discussed previously endoscopic resections and local approaches are the first thing we think about.
In the more advanced setting, unfortunately right now, we do not have any curative treatments. But, there is some exciting research going on trying to incorporate immunotherapy. We believe that esophagus cancer is one of those immune hot tumors and we have some very exciting initial data from clinical trials that show that people combined chemotherapy and radiation we can improve patient outcomes. So, at Roswell Park we participate in multinational studies that is trying to see what exactly is the role of chemotherapy in combination with immunotherapy for patients who have advanced esophagus cancer.
Farther, we are looking into incorporating immunotherapy in every stage of the disease. There are ongoing trials now that are looking on using immunotherapy as treatment after surgical resection. So, many times, patients get their chemotherapy and radiation and then they go in to have surgery and then the question is what do we do next. How can we – how can I decrease my chance of having my cancer coming back even more? And there are studies now that are trying to see whether using immunotherapy after surgery can help people be cured from their cancer. Yes, this is the most exciting really development in esophagus cancer over the past few years. And we are also looking into novel drugs and other biologic agents that we can incorporate with chemotherapy and shortly, we are going to have those options at Roswell Park as well.
Bill: And Dr. Fountzilas, lastly, can you talk about the organoid spheroid approach allowing for testing of new esophageal cancer drugs?
Dr. Fountzilas: That’s a very exciting approach. The traditional way we are looking into drug development in cancer is first looking at what drugs can do in cell cultures, individual cells and then trying to see what drugs are doing in tumors that are implanted into mice or other rodents. And all of those systems have their internal limitations. It is a different thing to test the drug in a petri dish, a different thing to test it in a mouse and this cannot fully recapitulate what the human biology is. So here at Roswell, we are developing the organoids, more or less little organs and we are trying to develop more or less mini esophagus cancers in the lab, mini human esophagus cancers in the lab and we hope that with this approach we can test new drugs and try to get a signal very quickly on whether a drug is active against esophagus cancer or not. And this will expedite moving these drugs into clinic and making them available for patients. So, it is a very quick way to eliminate a bad drug and help a good drug make it to the clinic and be available for patients.
Bill: Dr. Fountzilas, thank you so much for your time today talking about esophageal cancer. For more information visit www.roswellpark.org that’s www.roswellpark.org . You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
Esophageal Cancer Awareness
Bill Klaproth (Host): Esophageal cancer is rare and complex, and many people experience no symptoms before diagnosis and may remain symptom free for years; so, what do you need to know? Here to talk with us about esophageal cancer awareness is Dr. Christos Fountzilas, assistant professor of oncology at Roswell Park Comprehensive Cancer Center. Dr. Fountzilas, thank you for your time today. So, generally speaking, who is at risk for esophageal cancer?
Dr. Christos Fountzilas, MD (Guest): So, esophageal cancer as you said, is a very complex disease. There are many different diseases in one organ and generally speaking, we have two main diseases. One that is called the adenocarcinoma and one that’s called the squamous carcinoma. Adenocarcinoma is the most frequent type in the United States and it is very closely related to our lifestyles. We are getting more inactive. We are gaining weight. We are not eating that well and we develop a very common disease that is called gastroesophageal reflux disease, heartburn, that more or less everybody has. So, a percentage or a very small percentage of patients with reflux disease can develop a condition that is called Barrett’s esophagus. This is a condition that is premalignant and we have screening programs in patients who suffer from heartburn for many years and they fulfill certain criteria like being men, up over the age of 50, so that we can identify this premalignant condition and watch them with endoscopies every six months or every year and when they start developing any changes that put them in a really higher risk of developing adenocarcinoma, then we can very easily intervene with procedures like endoscopic resections and radiofrequency ablations, very minimally invasive procedures to try to treat those premalignant conditions and prevent really, adenocarcinoma. Further, with those screening programs, if adenocarcinoma does develop, we can identify it in a very early stage and treat it with multimodality therapies that can cure more than half the patients.
Bill: Dr. Fountzilas can we talk about those lifestyle factors just a little bit more. When you were talking about those, if someone were to eliminate those bad choices, does the risk of esophageal cancer then go down?
Dr. Fountzilas: Yes, because the risk of severe Barrett’s esophagus goes down. So, really if we try to live a healthier lifestyle, exercise more, avoid high fat diet, try to control blood sugars; our risk can go down. And we have evidence here from Roswell Park from our labs that in general, high glucose can be something that can drive esophageal cancer. Esophageal cancer cells can grow in the presence of glucose despite the presence of any other growth factors. So, really trying to modify our lifestyles, it is important to try to prevent that disease. Of course, reflux disease is a very, very common disease and everybody has experienced reflux symptoms. So, discussing – everybody should discuss with their primary care doctors about the severity of their reflux symptoms and if they are in a certain high-risk category, then they should get those enrolled in screening programs for Barrett’s esophagus and esophageal cancer.
Bill: So, Dr. Fountzilas, you mentioned reflux disorder, that’s something we need to be aware of. Now esophageal cancer doesn’t normally present with symptoms, but it can and when it does what are symptoms that we should be on the lookout for?
Dr. Fountzilas: Yes, the number one symptom is problems swallowing. And this can be – this can lead to weight loss. Sometimes patients may start vomiting blood or see blood in the stool in the form of black stool. Also, patients may start having symptoms that are compatible with esophagus cancer spreading to other organs such as having pain in their abdomen from cancer spread in the liver or start coughing from cancer spread in the lungs. Really when someone starts having problems swallowing, this tells us that the disease is not very early disease, but it starts affecting deeper into the esophagus wall and may be lymph nodes in the area. That’s why it is imperative that we do a very accurate staging as we say, more or less trying to see with special scans and endoscopies what the spread of the cancer is before we recommend an ideal treatment strategy.
Bill: And speaking of those treatment strategies, you were mentioning therapies before. Can you tell us a little bit more about any promising new therapies for treatment?
Dr. Fountzilas: Yes so, for localized esophagus cancer, the state of the art treatment is a combination of chemotherapy and radiation before surgical resection. That’s the main way approximately 2/3rds to 75% of patients with locally advanced esophagus cancer are treated. Of course, for earlier disease, simple esophagectomy, meaning without any chemotherapy and radiation may suffice. And of course, in the very early diseases we are discussed previously endoscopic resections and local approaches are the first thing we think about.
In the more advanced setting, unfortunately right now, we do not have any curative treatments. But, there is some exciting research going on trying to incorporate immunotherapy. We believe that esophagus cancer is one of those immune hot tumors and we have some very exciting initial data from clinical trials that show that people combined chemotherapy and radiation we can improve patient outcomes. So, at Roswell Park we participate in multinational studies that is trying to see what exactly is the role of chemotherapy in combination with immunotherapy for patients who have advanced esophagus cancer.
Farther, we are looking into incorporating immunotherapy in every stage of the disease. There are ongoing trials now that are looking on using immunotherapy as treatment after surgical resection. So, many times, patients get their chemotherapy and radiation and then they go in to have surgery and then the question is what do we do next. How can we – how can I decrease my chance of having my cancer coming back even more? And there are studies now that are trying to see whether using immunotherapy after surgery can help people be cured from their cancer. Yes, this is the most exciting really development in esophagus cancer over the past few years. And we are also looking into novel drugs and other biologic agents that we can incorporate with chemotherapy and shortly, we are going to have those options at Roswell Park as well.
Bill: And Dr. Fountzilas, lastly, can you talk about the organoid spheroid approach allowing for testing of new esophageal cancer drugs?
Dr. Fountzilas: That’s a very exciting approach. The traditional way we are looking into drug development in cancer is first looking at what drugs can do in cell cultures, individual cells and then trying to see what drugs are doing in tumors that are implanted into mice or other rodents. And all of those systems have their internal limitations. It is a different thing to test the drug in a petri dish, a different thing to test it in a mouse and this cannot fully recapitulate what the human biology is. So here at Roswell, we are developing the organoids, more or less little organs and we are trying to develop more or less mini esophagus cancers in the lab, mini human esophagus cancers in the lab and we hope that with this approach we can test new drugs and try to get a signal very quickly on whether a drug is active against esophagus cancer or not. And this will expedite moving these drugs into clinic and making them available for patients. So, it is a very quick way to eliminate a bad drug and help a good drug make it to the clinic and be available for patients.
Bill: Dr. Fountzilas, thank you so much for your time today talking about esophageal cancer. For more information visit www.roswellpark.org that’s www.roswellpark.org . You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.