In five years (2015-2020), in Italy, new cases of esophageal cancer increased by 26%, from 1,900 to 2,400, but mortality decreased by 12.4% in women and 6.7% in men. A significant result, to which he contributed the best ability to manage the disease, especially in the preoperative phase with chemo-radiotherapy for squamous forms and chemotherapy for non-squamous ones. However, the fact remains that this neoplasm, often discovered at an advanced stage, unfortunately among those with the worst prognosis: 5 years after diagnosis, in fact, only 13% of patients are alive. This is also why prevention is still our most important weapon today – he underlines Stefano Cascinu, head of Oncological Medicine at the IRCCS San Raffaele Hospital in Milan and professor of Medical Oncology at the Vita-Salute San Raffaele University -: smoking, alcohol, obesity and gastroesophageal reflux they increase the risk of getting sick. And this, unfortunately, also explains why cases in Europe are on the rise, together with the spread of unhealthy lifestyles.
Too many patients discover advanced disease
There are two main types of esophageal cancer: squamous cell carcinoma, mainly due to excessive drinking and tobacco use, and adenocarcinoma, mainly caused by reflux disease and obesity. The non-scaly form of esophageal carcinoma is the most frequent in Western countries – continues Cascinu -, while the scaly form represents about 40% of the total cases we treat at San Raffaele, one of the main centers of reference for surgery and treatment. of this neoplasm. Having a substantial certain histological diagnosis to decide the treatment, which is based on surgery, chemotherapy and radiotherapy performed before or after surgery: the type of tumor makes a difference in deciding in which order to proceed between these options. If the neoplasm is discovered already at an advanced stage, as happens in about two thirds of cases, the neoplasm is no longer operable and survival on average does not exceed 10 months. The situation is even more complicated because many sick people are frail people, often of advanced age and also affected by other diseases, with a low quality of life. Hence the need for effective and tolerable therapies. The breakthrough may come from immunotherapy, which strengthens the immune system against cancer.
The study: first benefits from immunotherapy
A new immunotherapy molecule, tislelizumab, in fact, showed a marked improvement in survival in patients with inoperable or metastatic advanced squamous esophageal cancer and already treated with other treatments. In a phase three international study (Rationale 302’1), 512 patients from 11 countries with unresectable or metastatic advanced squamous esophageal cancer and already treated were enrolled. Tislelizumab was compared with chemotherapy and, for the first time, there was an improvement in overall survival. Immunotherapy destined to play a fundamental role also in the other phases of the disease, from preoperative to the first line – concludes the expert -. The challenge is to be able to “bring” its advantages to people not yet undergoing treatment or at an earlier stage, such as preoperative.
Symptoms not to be overlooked
Almost always the initial symptoms of esophageal cancer are progressive weight loss preceded by dysphagia, i.e. difficulty in swallowing, which usually appears gradually, first for solid foods and then for liquid ones, along with pain when swallowing. In more advanced cases the growth of the tumor can provoke a drop or alteration in the tone of voice because it involves the nerves that govern the mobility of the vocal cords. Also persistent cough, burning behind the breastbone, feeling of acidity that arrives in the mouth should not be neglected: it is better to go to the doctor to be prescribed a gastroscopy, which serves to establish the presence of any pre-cancerous lesions, and possibly a visit to a specialist.
May 16, 2021 (change May 16, 2021 | 9:00 pm)
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