Originally Released: September 10, 1996
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STUDY SHOWS SURGICAL STAGING IS IMPORTANT FOR PATIENTS WITH ESOPHAGEAL CANCER

Determining the stage of a person's esophageal cancer with minimally invasive surgery can help those patients receive the most beneficial therapy, according to findings presented at the Fifth World Congress of the International Organization for the Studies of the Esophagus held in Paris on September 6. Known as thoracoscopic surgical staging, this new procedure was found to be a more accurate method of defining the spread and extent of disease than current noninvasive imaging techniques. The findings were presented by Mark Krasna, M.D., a thoracic surgical oncologist at the Marlene and Stewart Greenebaum Cancer Center at the University of Maryland in Baltimore.

In a study of 65 patients, the researchers found that surgical staging correctly determined the stage of cancer in 94 percent of cases versus only 56 percent in those who had non-invasive staging tests such as a CT scan, MRI and ultrasound.

The findings may enable physicians to more effectively tailor treatment to individual patients and decide who may benefit most from combined therapy of surgery, chemotherapy and radiation. The information from surgical staging would also help patients avoid unnecessary therapy if their cancer has spread extensively.

"The advantage of surgical staging prior to treatment is that it improves our ability to select patients who will benefit the most from aggressive therapy," Krasna said. "It also allows us to tailor treatment to the patient's specific needs. For instance, staging enables us to determine when chemotherapy and radiation therapy should be given prior to surgery to reduce tumor size and the number of lymph nodes involved. In some cases, non-surgical treatment alone may be indicated," he added.

Surgical staging involves two procedures -- thoracoscopy and laparoscopy. Both are minimally invasive, requiring only a few small holes to insert small instruments and scopes in the chest and abdomen. The scopes have miniature video cameras on them that allow the surgeons to see inside the chest and abdomen, and find the location and number of lymph nodes that have been affected by cancer. Lymph node involvement is the most significant predictor of how a patient will respond to therapy, according to Dr. Krasna.

Cancer of the esophagus, which is increasing at a rate faster than any other cancer in the United States, is associated with poor outcomes, including relapses and death, despite aggressive therapy. One of the most disturbing factors about esophageal cancer is that there are few warning signs before it has progressed and spread to other areas of the body. According to Dr. Krasna, almost 70 percent of patients in the U.S. are diagnosed in advanced stages. Symptoms include difficulty swallowing, pain and burning in the chest area.

Dr. Krasna and his colleagues at the Greenebaum Cancer Center's Thoracic Oncology Program were the first in the country to study surgical staging and train physicians across the U.S. in the technique.

Dr. Krasna is head of the cancer center's Thoracic Oncology Program and is leading a national study on combined treatments for esophageal cancer. Also part of the study team are: Austin Doyle, M.D., medical oncologist; Bruce Greenwald, M.D., gastroenterologist; Mohan Suntharalingam, M.D., radiation oncologist; and Charles White, M.D., radiologist.

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This page was last updated on: March 12, 2008.