Barrett's / Cryotherapy -
At Jersey City Medical Center / Barnabas Health
While the incidence of colon cancer has actually decreased with screening and preventative polyp removal, the incidence of esophageal adenocarcinoma has skyrocketed in the US since 1975, possibly caused by changes in the American diet, obesity, and other factors.
|If you are around fifty and in good health, but have Barrett’s with dysplasia, esophageal cancer becomes your major health risk. Your chance of getting esophageal cancer will be about 5 times the chance of getting any other type of cancer or even significant
heart disease per year.
Barrett’s esophagus is a condition where the type of cells that line the stomach start to line the esophagus.
Cells in the stomach normally handle stomach acids well. When these cells develop in the esophagus they seem to protect it from acid refluxing from the stomach, but those cells are not supposed to be in the esophagus. This condition, called Barrett’s after Dr Norman Barrett who first noted it, appears to be the first step toward further cellular changes, or dysplasia, that too often may culminate in cancer.
Dyplasia means that some cells can be found that are abnormal or “funny-looking’. They don’t need to be found everywhere. In fact, like cancer cells, they easily be missed on biopsy because they may be just sparsely scattered about. Low-grade dyplastic cells are sort of funny-looking, or a little bit abnormal; high-grade dysplastic cells are more abnormal.
The assumed usual progression is to go from Barrett’s, to having low-grade dysplasia (some low-grade dysplastic cells), to high-grade dysplasia (the presence of some high-grade dysplastic cells), to cancer. It’s not always seen this way because a step could be missed.
However, for people who do have any high-grade dysplastic cells found, the rate of developing cancer is reported as 6 to 10% per year (19% in one recent study published in the New England Journal); making a very conservative estimate, we say there is a minimum 30% lifetime chance of getting esophageal cancer. Surveillance, just watching to see if and when cancer develops, for high-grade dysplasia is no longer considered appropriate care, even by the most traditional standards.
Low-grade dysplasia has about a 13% per year rate of progressing to high-grade dysplasia or cancer. Barrett’s or low-grade dysplasia can progress to cancer without intermediate stages being found, perhaps without even occurring.
Most types of cancer, when found early, can be removed with the hope that it is not an aggressive type that had already spread microscopically. Like with colon polyps, with Barrett’s, we can find abnormal cells or growths that can be eliminated before they evolve into cancer.
Studies have shown that if a treatment could eradicate Barrett’s at least 40% of the time, it would be more cost-effective than what we do now, which is to continue to repeat screening endoscopies and biopsies hoping to catch any early cancer and then remove it. In Dr. Snady's practice to date, endoscopic freezing ablation treatments have been more than 90% effective in eradicating patients’ Barrett’s altogether, and more importantly, 100% effective in eliminating dysplasia.
Cryotherapy represents more effective while less harmful or traumatic treatment. Rather than cutting or burning, removing the top layer of the esophagus by traumatic injury, freezing is more controlled and less damaging, allowing only the superficial layer of tissue containing the abnormal cells to slough off gradually over a few days. It is a comparatively gentle method, without the side effects of other treatments.
Getting rid of Barrett’s, with no side effects, before it develops into cancer, is cancer prevention at its best.