June 1, 2017 | When Mark Harper went to see his gastroenterologist last September, he wasn’t expecting a cancer diagnosis.
“I never had any symptoms,” he said. “I went in because I promised my wife I’d go see Dr. Henry Rogers before he retires.”
Harper considers himself lucky. The doctor in Pine Bluff did an endoscopy and saw something he found concerning. He ordered a biopsy and found Harper was in the early stages of esophageal cancer.
“He referred me to UAMS because they couldn’t do an ultrasound in Pine Bluff. Dr. Tharian took it from there.”
Benjamin Tharian, M.D., is an assistant professor and director of Advanced Endoscopy at UAMS who sees patients in the gastroenterology clinic.
“We rechecked the sample here with UAMS pathologists and confirmed that Mr. Harper did have cancer in the lining of his esophagus,” Tharian said.
Harper has Barrett’s disease, a relatively common pre-cancerous condition in patients with heartburn caused by the repeated exposure of the esophagus (the tube that carries food from the mouth to the stomach) to acid refluxing from the stomach. Barrett’s is found in about 7 percent of those over age 40, even more in patients with reflux disease. In a small minority, Barrett’s disease develops into esophageal cancer, which why early recognition and monitoring is important.
Before he began treating Harper’s cancer, Tharian first made sure the cancer had not spread into deeper layers of the esophagus or other parts of the body by doing an endoscopic ultrasound and CT scan. The cancer was found to be limited to the inner lining of the esophagus. “It’s great the cancer was discovered at an early stage,” Tharian said.
Most people with Barrett’s disease won’t develop esophageal cancer, though it remains the most common risk factor for this cancer. The incidence of this cancer has increased by 500-600 percent since 1970. It remains one of the fastest growing cancers in the U.S. with less than one in five surviving up to five years after diagnosis.
Patients at risk of Barrett’s disease — those with reflux symptoms, smokers, overweight, and those with history of dysplasia on previous biopsies or a family history of esophageal cancer — should be screened with an upper endoscopy.
Those with the disease should be monitored closely by a gastroenterologist with endoscopies and biopsies.
“You have to look carefully for any lumps or bumps within the Barrett’s lining and suspicious or abnormal areas. Early recognition of high-risk lesions will enable early referral to an interventional gastroenterologist.
In Harper’s case, once Tharian determined the cancer was limited to the lining of the esophagus, he performed a tissue biopsy from some lymph nodes in Harper’s chest to see if cancer was present there. It also came back negative. Tharian then endoscopically removed a portion of his patient’s esophagus with the tumor.
“Once the pathologist confirmed that the lesions were removed, I treated the rest of the Barrett’s lining of the esophageal wall using radiofrequency ablation.” The lining would heal eventually with regeneration of normal tissue.
Harper now has to make sure the disease doesn’t return. Because his esophageal junction — the place where the esophagus connects to the stomach — is not tight, Tharian said, stomach acid will continue to enter the esophagus causing a likely recurrence.
“We’ve removed the cancer,” Tharian said. “The next thing to do is prevent it from returning. He’ll need to stay on his acid suppressant medication and have the esophageal junction tightened through minimally invasive surgery. Endoscopic treatment of Barrett’s disease is a cost effective and safe treatment with excellent results. It improves the quality of life.”