“The most important factor that determines a patient’s likelihood of survival is their initial stage. The hope of long-term survival is greatest if a patient is a candidate for curative intent therapy (treatment that aims to cure the cancer and restore health to what it was precancer),” says Sugarman.
There are other factors besides stage at diagnosis that play a role as well.
Stage at Diagnosis
“It is important to stage esophageal cancer, because it will help determine the goals of therapy (curative versus palliative), the type of therapy recommended, as well as the prognosis,” says Sugarman.
Doctors use a variety of methods to assess the size and spread of the cancer. This information, along with the cancer’s location in the esophagus (upper, middle, or lower) is used to classify the cancer into stages, ranging from 0 to 4, which guides treatment decisions and provides insights into the patient’s chances of survival.
Speed of Metastasis
Age and Gender
Lifestyle Factors
There are risk factors associated with a higher risk of developing esophageal cancer. They include conditions and lifestyle factors that cause irritation in the esophagus.
- Drinking very hot liquids on a regular basis
- Bile reflux
- Achalasia, a condition that causes difficulty swallowing because a muscle in the esophagus won’t relax
- Alcohol consumption
- Gastroesophageal reflux disease (GERD)
- A diet lacking in fruits and vegetables
- Obesity
- Barrett esophagus, which is precancerous changes in the cells of the esophagus
- Radiation treatment to the chest or upper abdomen
- Smoking
Treatment Response
People can respond to the same treatment in different ways, and those with a stronger response increase their likelihood of five-year survival.
In people with advanced disease there are biomarkers that determine how likely a patient is to respond to a treatment, says Sugarman.
“For example, tumor tissue can be tested for proteins, and if a patient expresses high PD-L1 (programmed death–ligand 1) or deficiency of mismatch repair protein they are more likely to respond to immunotherapy. If a patient has overexpression of the HER2 protein, there is an anti-HER2 therapy that can be added to chemotherapy,” he says.
A protein called claudin has been found to be a targetable protein, and there is now an approved treatment, Vyloy (zolbetuximab) that is used in combination with chemotherapy to treat claudin-expressing gastroesophageal cancer, says Sugarman.
“If a patient has additional treatment options, I am generally more optimistic about their chances of longer term survival than if there are more limited options,” he says.
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