Back in March I celebrated one year post treatment with apointments with my ENT and RO and both were as pleased as could be . . . as was I of course. My ENT wanted me to get a scan in order to contribute it to a library of post-treatment scans he is compiling to better understand the high incidence of false positives in PET/CTs. So I got a scan . . . and all was well (sort of). No indication of cancer. Yeah!!, right?

Sort of. The scan showed some mild glycolitic activity in the lower esophagus and some thickening of the distal wall. So off I went to the GI doctor and and endoscopic exam. That showed umbilicated nodules, gastric ulcers and Barrett's esophagus.

The good news is that all of the biopsies came back clean of cancer, the bad news is the Barrett's. While I understand that very few people actually get cancer, I can't help but wonder whether I am predelicted to SCCs (of which esophageal cancer is one). Any one know?

In the end, everyone is pretty much agreed that the Barrett's and other stuff was a result of the chemo and associated heartburn that never really went away, though it was never more than an off and on annoyance and didn't interfere with life at all.

In any case, please, if you are suffering from heartburn during treatment tell your doctors and if possible schedule an appointment with a GI if it doesn't go completely away after treatment. Saves on anxiety.

Tim

Tim,

Of course Brian will have the ultimate answer, but my understanding is that we are at a higher risk for a second primary cancer, especially in the aerodigestive tract, because we have had head and neck SCC. Therefore, I have had endoscopy with biopsies to check for Barrett's esophagus and I take Nexium to prevent the whole situation from happening because I do sometimes get heartburn if I don't take the medication. I'd rather be safe than sorry. The endoscopy will be repeated every 3 years.

Barb

I can't add much to Barb's comments, she is absolutely right. I too have GERD, take a proton pump inhibitor daily, (not just the 14 day course) and have an ANNUAL endoscope procedure, because I too have GERD which is not controlled. As she stated screening less frequently would be in order for those who have it under some sort of control. I have had Barrett's found and later a very small adeonocarcinoma, (the type most likely to result from all this, SCC's are less liely to be Barrett's related though we are at risk for them) which was surgically removed not long ago.

Esophageal cancers are the cancer that is occurring at the highest rate in the US today. If the GERD cannot be completely controlled with PPI's like Nexium or the OTC version, the next step is to do a surgical procedure (mine is on June 2), to have the sphincter which controls the opening at the top of the stomach (where it connects to the esophagus) reinforced by a collar of the actual stomach pulled up around it and tightened with a few stitches to make this less likely to let the acids from your stomach enter the esophagus. One of the issues in all this is that if you have had radiation that includes some exposure to the upper chest (as I did leaving the upper 25% of my lungs fibrotic and non functional) it also screws up the motility of your esophagus or the peristalsis waves that move the food down through it. It can also cause strictures which I do not have. No motility means that if you have the sphincter area tightened, it is possible that you will not be able to, after swallowing food, actually get it easily into the stomach. What fun.

Barb is correct in stating that second primaries are most likely in the aero digestive tract BESCAUSE we have had a previous cancer - and the GERD/ Barrett

Having just had the endoscopy in conjunction with a colonoscopy (nothing unusual found) I highly recommend scheduling them at the same time as one is put blissfuly to sleep only to awaken when it is all over. During my treatment, I wanted to know what was happening every minute. Not so with the latter mentioned tx (grin.

Very interesting discussion! My IM doctor is having me do "both ends" next time as well. My mom had colon CA with a resection of intestine so have been have colonoscopies every 3 years since I turned 40. I have had polyps both times, and have no problem with her requesting the additional test, especially with current discussion.

While I used to suffer occaisional heartburn, when I was in the hospital after my tongue surgery, my HNO had me taking pepcid twice daily and I have done so ever since. He did the upper endoscopy, bronchoscopy etc when I had my surgery and they were waiting on the path reports and all were clear. Looking forward to more of the same, but remain cautiously optomistic, hoping for the best, preparing for the worst.

Sincerely,
Lisa

Thanks for the words of wisdom. I am not that concerned. Mostly just VERY annoyed and frustrated . . . I'll get over it. It just is a bit maddening when you go through all of this only to have something else crop up.

I suppose that I find it a bit odd that the administration of PPIs isn't considered to be the standard of care for a period after the end of chemo. I took protonix, but that ended the day treatment ended, so I thought the occasional, mild heartburn I suffered thereafter was simply something to live with. Guess not.

Anyway, I will now be in line for annual endoscopies, hope that the Barrett's stays were it is, continue taking Protonix and move on!

Brian -- I understand that adenocarcinoma is related to Barrett's but I was also under the impression that SCC was very commonly associated too as the esophageal lining is epithilial in structure. AM I under a misimpression?

Oh, by the way, there are now several treatments for Barrett's. Specifically the Halo360 system by Barrx . . . FDA approved and very successful. It is in use in a number of major institutions, including Mayo and Cleveland. Let's hope the long-term data continues to indicate that it works.

Tim

This has been a valuable thread for us. i printed it out and gave it to my husband and he let me know that, along with GERD, he has also had a pain in his stomach area pretty much since he was diagnosed. We're scheduling an endoscopy right away - not something his ENT has ever suggested. Guess that is one of the advantages of having had a PEG inserted during treatment - they did have a look around then.

Anita

Tim you are right, both cancers occur in the esophagus. For those with no previous SCC involvement adenocarcenomas are more prevalent. SCC