In recent decades the risk factors of diseases that develop in the esophagus have changed a lot: starting from the causes and several influencing elements, including the environment, lifestyle, and eating habits. As a result, the clinical approach has also changed, as has the spread of diseases, the prognosis and ultimately the therapeutic options for esophageal diseases. Great progress has been made in particular in the area of malignant tumors and medical and surgical approaches, which are constantly being renewed in order to improve the chances of recovery and reduce possible outcomes.

We talked about this topic with Professor Carlo Castoro of General Esophageal and Gastric Surgery in Humanitas.


Cancer in the esophagus: how it has changed

“In the 1980s, the most frequent esophagus cancer was squamous carcinoma, in the upper tract, compared to adenocarcinoma, which is located in the lower tract and the cardias (the junction between the esophagus and the stomach) – explained the professor. Over time the incidence, i.e. the number of new cases, of esophageal cancer has increased and in particular the number of cases of adenocarcinoma has risen.

“The reason for these changes – clarified Castoro – has not yet been perfectly interpreted, but we think of a number of possible environmental elements related to food, smoking, alcohol, the type of therapies used to inhibit acid secretion of the stomach, the increase in cases of Barrett esophagus, and the aging of the population.


New therapeutic frontiers: long-term survival doubled

As explained, over the years, thanks to the study and research work, the therapeutic possibilities for treating the tumor have changed: “Once the prognosis of esophageal cancer was inauspicious: there was a clear improvement in the results of remote surgical treatment combined with chemotherapy and radiotherapy. Not everyone heals, but long-term survival, 10 years after surgery, has more than doubled,” said Professor Castoro.

“This improvement is due to several factors: the better quality of the surgery (minimally invasive surgery, both thoracoscopic and laparoscopic, robotic surgery), the growth of the oncological culture of the surgeons, the association of treatments (surgery with chemotherapy and radiotherapy), with a multidisciplinary evaluation of the therapeutic strategy”.


Teamwork is better for the patient

These successful numbers, stresses Professor Castoro, come from the cases followed by the centers of reference for these diseases: “They are centers that follow a large number of patients and where the quality of care is not only linked to the skill of the surgeon, but also to the surgical culture, anesthesia, and the overall medical culture in taking charge of the patient in general.

A group work that allows, associating different treatments, to modify the radical aspects of the intervention, to choose the best approach in view of the different characteristics of the patient: “What we are learning is to individualize the treatment: we follow the guidelines and clinical studies, but each patient is different, it is essential to adapt our knowledge to the individual case,” concluded Professor Castoro. “Today’s specialist has to take the patient (and his family) by the hand and accompany him throughout his journey, in a comprehensive approach, from accessibility to treatment and examinations, to the correct interpretation of the latter. Before being specialists in surgery or super-specialists in a branch we are doctors and each patient is unique.

Among the main diseases that the surgeon approaches in multidisciplinary mode, in conjunction with other specialists, there are in addition to malignant and benign tumors, the so-called Barrett esophagus, achalasia and disorders of motility of the esophagus, gastroesophageal reflux with hiatal hernia and diverticulosis of the esophagus.