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Published on April 05, 2016

Learn about treatments for digestive cancers

In observance of Esophageal Cancer Awareness Month, UHS will host a free seminar featuring gastroenterologist Atif Saleem, MD, on Thursday, April 14, at 3:30 p.m., at the UHS Stay Healthy Center at the Oakdale Mall.

A leading expert on the treatment of cancers of the gastrointestinal tract, Dr. Saleem will provide an explanation of conditions such as Barrett's esophagus and others that can lead to cancer or other serious digestive problems.

To sign up, call Stay Healthy at 763-5092 or click here to register online.

UHS is a regional leader in the diagnosis, staging and treatment of a wide range of cancers and other gastrointestinal disorders. In fact, UHS offers such highly specialized procedures as endoscopic ultrasound and endoscopic mucosal resection, and is a leading site for the treatment of Barrett's esophagus with an ablation technique.

"We can diagnose and treat diseases of the entire gastrointestinal tract," Dr. Saleem said. "This includes the esophagus, stomach, duodenum, colon and rectum. We use the latest techniques and methods available to give our patients the best possible chance for full recovery."

A clear picture with sound waves

Endoscopic ultrasonography (EUS) allows a gastroenterologist to examine a patient's esophageal and stomach linings, as well as the walls of the upper and lower gastrointestinal tract. The upper tract consists of the esophagus, stomach and duodenum; the lower includes the colon and rectum. EUS is also used to study other organs that are near the gastrointestinal tract, including the lungs, liver, gall bladder and pancreas.

The specialist uses a thin, flexible tube called an endoscope that has a built-in miniature ultrasound probe. The endoscope is passed through the mouth or anus to the area to be examined, then sound waves are used to create visual images of the digestive tract. This process gives the doctor more information than other imaging tests because it produces very clear, detailed images of the digestive tract. EUS can be used to diagnose certain conditions that may cause abdominal pain or abnormal weight loss.

EUS is also used to evaluate known abnormalities, including lumps or lesions, which were detected by a prior endoscopy or seen on X-ray tests, such as a computed tomography (CT) scan. EUS provides a detailed image of the lump or lesion, which can help the doctor determine its origin and guide treatment decisions. It can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive or conflicting.

"EUS helps the physician determine the extent of spread of certain cancers of the digestive and respiratory systems," Dr. Saleem said. "It is a very useful tool in the diagnosis and staging of cancer." The procedure enables gastroenterologists to accurately assess the cancer’s depth and whether it has spread to adjacent lymph glands or nearby vital structures, such as major blood vessels. In some patients, EUS can be used to obtain a needle biopsy of a lump or lesion, enabling the medical team to determine the proper treatment.

A precise, accurate approach

Endoscopic mucosal resection (EMR) is a specialized technique used by gastroenterologists at UHS to diagnose and remove large areas of early cancers arising in the gastrointestinal tract, including the esophagus, stomach, small intestine and colon. EMR has become an important and safe alternative to surgery for the treatment of early cancer arising from conditions such as Barrett’s esophagus.

EMR gives specialists access to areas of diseased tissue about the size of a penny. It may be recommended for patients with suspected high-grade dysplasia, or early cancer. It allows the gastroenterologist to not only accurately diagnose the stage of growth but also to provide complete therapy by removing the diseased tissue.

During EMR, a thin, flexible tube called an endoscope is inserted through the mouth and into the esophagus, the pathway that connects the mouth to the stomach. The tip of the flexible endoscope has a lens and a light source, which allow images to be sent to a monitor for close inspection of the lining of the upper gastrointestinal tract.

Using an instrument attached to the tip of the endoscope, the gastroenterologist can suction small nodules or growths and trap them in a small rubber band. The tissue is then removed using a cutting instrument. This technique can be repeated in nearby areas, as necessary, to ensure all abnormal tissue is removed. The tissue that has been removed is then carefully evaluated by a pathologist.

Patients with high-grade dysplasia or intramucosal carcinoma (the earliest stage of esophageal cancer) often undergo an endoscopic ultrasound exam before undergoing the resection to ensure there is no deeper tissue involvement.

A treatment with energy

Barrett's esophagus is a potentially serious complication of gastroesophageal reflux disease, commonly called GERD. With Barrett's, the normal tissue lining of the esophagus hardens. If a patient has Barrett's, he or she will notice symptoms of GERD, but probably no direct symptoms of Barrett's.

However, there is a slightly higher risk of developing esophageal cancer - an often-deadly disease. That's where radiofrequency ablation (RFA) can come to the rescue. RFA is regarded as the most efficient treatment, as it has been shown to successfully eradicate Barrett's safely and reliably.

"This technology has quickly become the standard approach for patients with Barrett's esophagus," Dr. Saleem noted. Radiofrequency energy is delivered via a catheter to the esophagus to remove diseased tissue while minimizing injury to healthy esophagus tissue. This is called ablation, which means the removal or destruction of abnormal tissue.

While the patient is sedated, a device is inserted through the mouth into the esophagus and used to deliver a controlled level of energy and power to remove a thin layer of diseased tissue. Less than one second of energy removes tissue to a depth of about one millimeter. The ability to provide a controlled amount of heat to diseased tissue is one reason why this therapy has a lower rate of complications than other forms of ablation.

Larger areas of Barrett’s tissue are treated with a balloon-mounted catheter. Smaller areas are treated with an endoscope-mounted catheter. Both are introduced during an upper endoscopy procedure, in which a thin, flexible tube is inserted through a patient’s mouth. RFA for Barrett's esophagus has been used in tens of thousands of cases nationwide, and the devices are cleared by the U.S. Food and Drug Administration.

About the Presenter:
Atif Saleem, MD, graduated from King Edward Medical College, one of Pakistan’s leading medical schools, and completed a residency at Mount Sinai School of Medicine in New York City. He received advanced training via a fellowship at the University of Florida for the GI treatments in which he now specializes. A gastroenterologist and board-certified internist, he practices with UHS Gastroenterology.

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  • Learn about treatments for digestive cancers