This is Roswell. Rookie by Roswell Park Cancer Institute. European opinion or your total options. Your host -- -- welcome back to Roswell listen comprehensive look at all aspects of cancer care treatment diagnosis and research. From a comprehensive source. Roswell Park Cancer Institute in Buffalo, New York. That's where I am I'm -- Wenger and today on the program we're going to be talking about gastric. And esophageal cancers. What they are what you need to know about them and how they may be or may not be related to one another doctor Stephen -- quotas in studio. He's the vice chair in chief of gastrointestinal. Surgery here it. Roswell park doctor Koppel thanks for taking time thanks for having me appreciate -- -- good to see you and along with you today you brought. John course -- who was recently treated Forsythe to -- cancer John thanks for sharing your story today. And thank you Dan looking forward to hearing. -- entire story from beginning to where you stand right now and doctor high quality you know with the open -- mentioned you know gastric and -- -- to deal. Two separate. Cancers how are they or not related to one another. Well love they have some relation to each other but they've they've definitely have differences as well the cancer that is really dramatically rising in this country is esophageal cancer of the instances it really going up quite alarmingly. Quickly. And it's thought to be related to. The increase in obesity in this country contributing who is in large part to it. Because with obesity that comes increased reflux and with the increase reflects there's damage to the lower esophagus from that gastric contents reflecting into the esophagus and that is a big. -- leading cause four in the development of cancer of the lower esophagus now some -- just naturally develop reflux and and I can develop damage in and have cancer caused. And don't have to be obese that's for sure but there's certainly an increase going on the suffering of cancer. You know one of the of the big concerns with the with -- any cancer is is how it is or when it is found in what what what point of its development it's found. It's my understanding that this these two categories of cancer. Can be found or are often found late in the game now fortunately even though there there's -- in the intestinal track and do you think. Pace who would have symptoms that are relatively early on often they don't they don't have symptoms until. That to emerge. Can be relatively advanced or can have spread to other parts of the body so. Fortunately there -- not found that early on and and disease cancers. Are relatively aggressive and these survival from these cancers is not as good as -- like. Is your way too early detect these categories of cancer I mean when we go to our primary position is -- something they're looking for. Where is this something that unfortunately just presents itself with symptoms and then it's time to he'll find out if cancerous issue. The error there is absolutely. Way to detect these cancers messed with an endoscopy in any what we call an upper endoscopy which is -- Long. Telescope type device into the esophagus and stomach and -- cancers can be diagnosed early on but. The index of suspicion for having these cancers is relatively low in this country despite the increasing incidence of the esophageal cancer that I mentioned. That makes us wanna do massive screening. Endoscopy for these cancers that we Wafer. Frequently for patients to tell us that they have difficulties. With swallowing or pain or some other associated as us and them and they start investigating. Yeah I was gonna say endoscopy is not only going to get a simple blood test -- mean passes this is something that takes them. You know would -- be similar in nature to what we go through for a colonoscopy. It would be but it's actually less. Involved because for Cosby you have to take. Solutions to clean out your intestinal track and here for the upper endoscopy to look at the esophagus and stomach you don't. These days they just can't either drink for a period of time before the procedure in the -- -- days ago. Sorry before -- get to John in in his story let's talk a little bit about stomach cancer. Obviously it is the cancer of the -- tell me about it what what the disease is and how it presents itself and what people need to know. Right -- stomach cancer. Has traditionally gone down in the instance in this country over the last many years has taught us the countries get more developed than they have less use of preservatives in their food. That the incidence of stomach cancer would would go down. However. Over the last twenty years there was has been a slight increase in the cancer of the upper part of this summit. So we did see an increase in that unfortunately has stabilized so the upper part of the stomach cancers who have gone up but. That happens more stable recently. But the typical risk factors for a stomach cancer. Would be smoking. And then also -- one other they risk factor is an infection with what's called H pylori. So it's the type of bacterium that can lead to a chronic inflammation in the stomach that thought to increase the chance of developing stomach cancer. You know we when we talk about tobacco use and smoking obviously most of us think of lung cancer and and you know it it's. Prep -- you predominant cause of of that type of cancer. But as I've found out you know hosting this program through the years. The tobacco really if it reaches out and your body in affects so many different organs and systems how does tobacco use effect this coming. I don't think we know the exact details but there's been larger of these epidemiology. Studies that are really have shown a association between. Tobacco use and stomach cancers so we know that people people who smoke. Higher chances though it's my stomach cancer. But how exactly how. And not that is not quite fully understood as far as I know -- what we know it's a risk factor and that's an important one and we always stress here on the program that tobacco use. Not only affects or impacts lung cancer probability or likelihood. But reaches out to rupture your body and causes problems both treated here Roswell and you know systems. Outside of the reach here at this this facility what type of symptoms. Does a patients present with tour need to be concerned with when it comes to stomach or gastric cancer. So for stomach cancer. And it can be a little bit insidious. But -- people can now. Did develop a feeling that they get fully easily. They can smoke. Have sort of and discomfort or sort of a nagging pain. The pain can get worse actually with eating. And they can get I would guess some gas pains and regurgitate some type of feeling. But. It's sometimes see it these symptoms are really relatively non specific. And so people with esophageal cancer. Have a little bit more pain with swallowing. And so they really good discomfort. Closely related to the actual swallowing time. Lower stomach cancer it's really more. That they have they can't tolerate is bigger meal as they used to. And they make a full easier. Unfortunately when the tumors probably more eventually develop pain. You know the concerning thing the perplexing thing I know in your field come in in all different aspects of the carrier hospital. Is symptoms and the symptoms you know as I look at them. I'm -- his you presented them you know the loss of appetite nausea. You know weakness maybe some weight loss. Those are all relatively. The nine things normally and we can experience those. When is it that. You know we as people should see some of these things and wonder. If we should be checked out for something. Like this I think we all have to have ever. You know relatively. High alert factor for. Things that change in our bodies and so we have to be really in tune with things -- -- persistent nagging discomfort or change. That's not you know that's that's there for more than a couple days duration. I think we have to try to think -- think hard about giving them little things investigative. Relatively early on. We we have patients that definitely have symptoms for months and don't. -- don't really bring it -- light -- day or don't tell their family or their physicians about it. And after suffering for months with a with a certain symptoms. But then we also patients who say well I was feeling fine and then just a few weeks ago I started to have. Discomfort which is. You know the difficulty with diagnosing stomach cancer for instance so it does very but I think. Symptoms that are present for more than a few days and duration that a persistent. Such as the for stomach cancer. Difficulty with the evening significant change in how they tell you tolerate food. Definitely bring it to the attention of some comment is gastric cancer and -- how you characterize them with numbers or you know it's it's. Vincent has gone down overall in this country but there's about 25000 cases in this country per year which is a fair number of patent cases. But it's put in perspective. You know it's probably 110 is common as lung cancer for instance on cancer being. The most common cancer. It in finally in the subject of -- -- the gastric cancer that we're speaking about today. Once someone has determined or position is determined that yes we've we've you know your symptoms are to a point where we think we should check you out forecaster for stomach cancer. What is then done you mentioned in the endoscopy but that's not the only thing that that a patient what would go through. Right at this concern for some cancer endoscopy would be the that topic and number one that -- to do first. If stomach cancer is suspected of biopsies performed to the area of concern. And then the diagnosis has to be confirmed on their microscope by the pathologist. And then you need to have a good pathologists of course -- Read their read those -- And then. If stomach cancers found a biopsy and then. There are there are tests first staging of the cancer -- seeing the extent of the cancer there done that includes a cat scan. I can't stand -- via a common that test for that and there's other. Test that I can be done endoscopy is an ultrasound to see the extent of the cancer that I've done as well. That one of the two cancers were talking about today and that is gastric or stomach cancer and really had a good view here from doctor -- call them -- what the cancer is how it is. Detected one final question before we move on to esophageal cancer and really get an up close and and personal look at that with John. Is how do you treat it once we determine that someone has muscled stomach cancers are are not found that is very or. -- stage in most cases in this country. Like like we've talked about its instances not that common and we don't do math a mass of screening for of these cancers so. Unfortunately they're not found that the earliest stage so most patients. Who present with stomach cancer or need really aggressive therapy that what we call the multi modality of therapy and typically we think that they are a surgery candidate. Because certain surgery is is really a very important part of the therapy. We would offer -- to them but we would consider giving them chemotherapy. Prior to surgery. And then commit therapy after surgery as well. So more many patients -- very cool would get more than one treatment delicate surgery. Plus -- the therapy and sometimes after the surgery even actually -- radiation therapy depends on. How aggressive the tumors found to be after it's removed and the nearby lymph nodes are removed as well. And the outcomes. Vary are they pretty good. Well. Unfortunately if you took about a hundred people patients with stomach cancer only about 25 we'll be cured. So some of these 5% of patients would not be cured of the stomach cancer. Her gastric in us or stomach cancer. One of the two cancers were talking about today -- this is -- bonus and then as the voice of doctor Stephen -- called. He is the vice chair and chief of gastrointestinal. Surgery here at Roswell park. Esophageal cancer. Doctor high -- -- with us today one of your patience or I should say former patients. And that would be John of course -- -- and John thanks again for for being here willing to. Share it could be here yeah let's start. With you cancer of the esophagus how did this all come about for you. Well. I'll be sixty tuna and marriage and currently for forty years I've always carried comes around here rolling through some because that always has some kind of cancer summer when a you know so -- kind of burning hicks and well was over a year ago that I noticed that. Every once while -- -- I would. Regurgitate it right so I thought I had something do it as a reflex. So at that point and went through like immediate care. And -- a series of tests there was nearly six hours and they came up with a -- -- and -- -- that analysts that I had from my gallbladder. So from the airline to. A surgeon and they took it out. Am six weeks later seem like -- still had the same problems. -- -- study says with -- cure him of because telescope. -- and then dust and -- to be excited knowing never had that done well when I had it done. They discovered a man's hand. Who is like three days later I was in Roswell and the ball started rolling and from there. That factored -- on here he's performed his major economy and hopefully it's. Can do the trick how long ago was this -- sense. I developed this yet. Over here okay in this developed over a mean you've you've been experiencing the symptoms that you -- -- years yet. If not longer -- talking you know forum forum for the good portion your -- to -- you guys together and -- retirement. I feel like catch up over a cup of coffee here and I think it. But I just pretty common thing O'Neal thumbs down review our doctor how it was a so a fairly common but he. Use your you can you can see despite what John says that difficulty would make -- -- -- noses he when he comes in with a pretty classics symptoms. Having the stuff that you problem and possibly. Esophageal cancer -- education and difficulty with the -- certain foods. He won the payment is gallbladder removed first because in that suspicion was in there. We have that I index of suspicion for these kind of problems for sure. And he gives us. Long history of having reflux and issues related to reflects. For decent forty years of having me heartburn and having discomfort there's so. I think. It's pretty clear to him that heartburn and damage so lower esophagus from acid reflux. Probably led to this kind of problem. What are some of them the risk factors for this. Particular disease the stuff you cancer right so. -- such a cancer has a couple different components I think we're we're talking more about. Cancer of the lower esophagus which is at no carcinoma. And that is really -- of related in large part to this damaged lower esophagus from reflux disease that's a big component of it. I think smoking also contributes -- that there is another type of stuff to -- squamous cell cancer this toughness and fortunately the instance of that has not been going up and that's more heavily related to. Drinking alcohol and smoking so these are the ones that are early. A major more concerning nowadays is the at no -- -- or cancer -- -- tough person like you mentioned smoking plays a role. And the -- -- -- -- what is that this I've heard this term before and if it's in my notes today what is Barrett's esophagus. Well that say that to change in the in the lining of the esophagus esophagus where it's of course from. And normal type aligning to lay and damage landing basically and there it is just describing. Certain picture to the damage. -- and backhand. Over time that Barrett's can change it progressed to can't have cancerous or precancerous condition. Okay John -- tell -- where you fit into the the puzzle is part is. The risk factors that you know about now that you've been treated for this. You know we know about your symptoms that. Mean as far as smoking or drinking -- in -- -- both goals for long periods of time. I mentioned and had a lot to do with the legacy it. I was smoking it poignant but I still had done. The problems for this brief moment Nicholas reflects now but it is close to him anything. -- just couldn't tolerate high density foods and album you know. Don't know if you had that first initial surgery which was you know you don't did not correctly probably underwrite the gallbladder removal. Re surprised when he came to the point of these analysts is very. I was disturbed but there's other things that I had jury duty at the time and you know we had to put up a bunch of appointments of mail. The surgeon and had a that the -- operations of my -- got to see him in question in my opinion it was still happen. He says with a theory of this scope and that point in which. Was disturbing to me because I know what I mean for kind of person doesn't just as ridiculous stuff you know. So. From their. After they're great at the scope -- whom -- damn hole it turned upside down. Course it and doctor -- we'll talk about the treatment plan that John went through an analyst John. Give give us the diversion from the patient's point of view which is always very different. This so and assessing what we think is the best therapy. There are few options for us up to cancer which is the good news but we have to assess. But we think. Patient like John could tolerate and again these chances are relatively aggressive and we wanna hit it is hard and doing it as hard as we tend to. If the tumor that we think we can remove all of disease and wanna give it first. Chemotherapy and radiation treatment which is what John perceived. We've received that for a couple months in duration and -- that is to try to shrink the tumor down. And treat the tumor. Part of the surgery because we think patients can tolerate treatment better if it's done prior to surgery. And we shrink the tumor down so that we can more easily remove. Whatever tumors left behind after the chemotherapy and radiation. Who commit their organization is done first. And then the surgeries done afterwards after things settle -- for a couple and then post surgical is there and post surgical we sometimes. Recommend further chemotherapy. -- I think -- commitment that's insane talk about the type of surgery and no you know there is open surgery there's laparoscopic surgery robotic surgery. What type of surgery is predominantly used in cases like times. -- there's been -- revolutionize and techniques and so. In the all things cuts -- years ago we would say that this kind of surgery what can only be done with open surgery which is relatively invasive because. The -- is a long -- courses from you know the chain down into the into the abdomen and so together at the esophagus you have to. Split ridge or get into you know get into the test like had an arm surgery and emails opening cameo right right we don't vote the same route that the open heart surgery does but we do have to go with cigarette. And it's. It's it's a big deal and plus. Within also going through the -- because if you take out portion is now it's got to replace them something so replaces typically with a stomach. And so we have to move the stomach from its current location to. -- it -- this northwards. And going up higher. Third place is tough so we can do this operation I've been doing this for good for five years now Iowa. Through little decisions are minimally invasive alien and I can do this in. Over 90% of patients nowadays. And I think it really helps because take it turns. Invasive. Operation into -- much less invasive operation. And so I think discomfort after the surgery is not as much as it used to be and we -- and -- John what his experience and that is and then. Also willing to stay and in the hospitals is less and and that. Complications. One of the big complications is lung infections. After this surgery and he's. And couple reasons that one is because we have to work in this. Chest cavity in her in and around the lungs and also. It was tough to cancer smokers or worse smokers and so these couple reasons that people government. So -- tell me your experience you know maybe start with the with the -- -- -- know how about the pre surgical you know he went through the Q what are you going to radiation yeah okay what was that like for. I guess they say was pleasant. The chemo wasn't just very pleasant. -- I was. Was okay it was an Afghan I'm. I can say that -- was a long day because they get here it like it is collecting more going to deploy -- the -- And indeed like 10:11 o'clock and then sit for like six hours through chemo and also ahead radiation and they so -- -- care of but then the radiation was only half an hour come up here every day you -- radiation. And it was a right spurs so what I knew about the surgery before and -- well. People tell me as they actually fully open you know it finishes. Appeal open and these few scares and everything. So sort of nervous about all that work. As you see him I'm Holy -- now I mean I had very minimal scars I don't think. My kids know what the check me out for scares since it's just to CNN itself. It's amazing it really means and what -- he does. And we're -- what was your recovery like your recovery for a cozy little I think as the days it was announced with great days. Which my -- Pretty quick and -- up and walking. Like the very next day you know things. You know you're receiving post surgical treatment is doctor apple to mention I'm doing chemo again right for six weeks. This is fairly typical course but he don't plan of action as far as esophageal. I think so and in this day -- -- I -- say yes I think I don't tend to tell pace that the physical recovery is is relatively quick quickly after the this surge of people are back on their feet in their moving around relatively well. Especially as we do this to the small -- what takes a longer period of time is the eating. And because who we have to. Moved to stomach can make two longer to -- the stomach can really stretch it. To replace this stuff is that's removed we believe that patience we'll have to -- sort of frequent small meals. And it takes time for that to improve but it does improve over time. And so I can't -- people are eating like they were before they ever were sick with this problem but. A lot of people are eating three meals a day. Short of your post surgical treatment what is your -- you know -- maybe you have it's now I'm still -- feel when you read. It's still a training thing -- I'm still learning like. Take for example -- couple adversary you know. Well fashion and done it because. As soon they hit the -- and -- the doctor says you can stand or do some BA to truly you know playing to 45 minutes. But -- -- Floyd said Donna could feel it was great like at the top might. My throat there and this was. Justin Peelle also I have to realize and if you thought the won Hamburg maybe couple hours later you somewhere else. That's a distill out and learning curve I'm still learning. When I can even when I can how much -- can he. In the -- between meals that's -- I think it's gonna be awhile before going to the steel -- open. -- believe more in the future you know. Yeah I think you're I think we are relatively early on after this surgery but it I think improvement last takes six months there's no maybe even more but people continue to improve his time as -- doctor -- well you know as we move forward I mean I think it's John is very thankful that he did not have to is he mentioned he you know I think the -- politically in the open surgery. That was once. It seems always required for this type of and maybe still is in some cases but I'm moving forward DC technology developments in me in in treating and and performing that type surgery. Yeah I mean I with. I would think that at some point we may not. Need to do surgery at some point and we have enough therapies that are available that will be able to treat this kind of ultimately. That's who we would hope I mean obviously we don't. The premier business in this area but. But though -- the though obviously but I can't say that where there yet though they are -- better drugs and and new therapies come along level. May reduce the need for surgery for this type of cancer of -- right now. I think we can do the this surgery quite safely. In the vast majority of people and and also. -- try to minimize some of the some of the side effects and the recovery period the increase and improve -- The recovery time. He John thank you for being here and sharing it's always important and effective I think for people to hear from someone who has gone and he's going through. You know we talked about so thank you very much problem though and best of luck in the hand and continued. And health as you move forward post surgically here that is John course -- Who is recently treated for esophageal cancer thanks to him. For his story today and doctor -- well thank you so much for being here appreciate it thank you very much some interest thing. Dialogue here on two cancers we don't hear that much about and that is gastric and esophageal cancers doctor Stephen Harper called vice chair -- in chief. Gastrointestinal. Surgery here at Roswell park that is -- -- thanks for joining us that he'd like to hear this show in its entirety or any others. He can always do so at the website Roswell park dot org. Give any questions for Roswell you can call them told free anytime at 877 ask our PCI. It's 8772757. And there. Listen to Roswell this Sunday mornings at 630 young WB -- -- by Roswell Park Cancer Institute your team opinion for your total options on line at Roswell this god of war. Hanging. And hanging do you. Then.