Top Doctors: Esophageal cancer

Esophageal cancer is one of the deadliest types of cancer, and the prognosis is usually grim. What's important, then, is to do what you can to prevent it, which medical experts say includes taking heartburn, sore throat and coughs seriously.

Here's what you should know:

The U.S. National Cancer Institute estimates that 16,980 people in the United States will be diagnosed this year with esophageal cancer, and 14,710 will die from the disease. The diagnosis rate for men is 1 in 125 and for women, 1 in 400, said Dr. Maurice A. Cerulli, an associate professor of medicine at Hofstra North Shore-LIJ School of Medicine.

There are two types of esophageal cancer -- squamous, which is almost entirely linked to smoking and alcohol consumption, and adenocarcinoma, which is associated with acid reflux. "The increasing incidence of acid reflux has led to the increase in adenocarcinoma, especially in white, middle-aged men," Cerulli said.

Smoking, drinking and overeating that leads to obesity are all risk factors, but smoking is the riskiest, said Dr. Alan Spielberg, chairman of the gastroenterology section at St. Catherine of Siena Medical Center in Smithtown.

Another risk factor is infection with the human papillomavirus, or HPV, a sexually transmitted virus that has been linked to esophageal and head and neck cancers, Cerulli said. "Therefore, the HPV vaccine might also reduce the number of patients with esophageal cancer," he said. The federal government recommends the vaccine, marketed as Gardasil and Cervarix, for young women and young men before they become sexually active.

"People should pay attention to daily heartburn and not take medication to control it without being sure that they do not have damage to the esophagus, especially if they are over 50," Cerulli said.

Chronic heartburn, or acid reflux, can lead to a condition called Barrett's esophagus in which the esophagus becomes continually inflamed, Spielberg said. The condition greatly increases the risk for esophageal cancer, he said, apparently because of the chronic inflammation.

People who have acid reflux on a regular basis, such as a few times a week, should be screened for esophageal problems, Spielberg said. The same goes for those who have unexplained coughs, hoarseness and regurgitation of fluid or acid, even without burning, he said.

"Any difficulty in swallowing solid food could be a warning sign of narrowing of the esophagus, which could be due to esophageal cancer," Cerulli said. "Weight loss is often associated with the difficulty swallowing."

If someone is diagnosed with Barrett's esophagus and tests show precancerous cells, they can be removed through burning, cutting or freezing, Cerulli said. Early cancers can be cut out using an endoscope, he said.

However, the prognosis for people diagnosed with esophageal cancer is not good. Spielberg said that although chemotherapy and radiation are also used to treat the cancer, they won't cure it but can slow its progression.

The National Cancer Institute reports that the five-year survival rate for people with localized esophageal cancer is just 37 percent, falling to 18 percent if the cancer has spread nearby and 3 percent if it has spread to distant parts of the body.

Gastroenterologists

This is the 24th installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.

1103 Stewart Ave.

516-248-3737

Div. Gastroenterology

300 Community Dr.

516-562-4281

158 Hempstead Ave.

516-593-3541

700 Old Country Rd.

516-681-1200

270-05 76th Ave.

718-470-7281

3400 Nesconset Hwy.

631-751-8700

4 Levitt Pavilion

300 Community Dr.

516-562-4281

887 Old Country Rd.

631-727-6122

2001 Marcus Ave.

516-326-2700

146A Manetto Hill Rd.

516-822-4404

152 E. Main St.

Huntington

631-421-2185

850 Hicksville Rd.

516-796-9000

310 E. Shore Rd.

516-487-7677

1103 Stewart Ave.

516-248-3737

270-05 76th Ave.

718-470-7281

222 Station Plaza N.

516-663-2066

375 E. Main St.

631-968-8288

1000 Northern Blvd.

516-466-2340

48 Route 25A

631-862-3680

2800 Marcus Ave.

516-622-6076

206 W. Park Ave.

516-432-8021

2001 Marcus Ave.

516-775-7770

Hepatology Associates

1097 Old Country Rd.

516-939-2626

1103 Stewart Ave.

516-248-3737

48 Route 25A, Smithtown

631-724-1178

233 E. Shore Rd.

516-487-2444

2800 Marcus Ave.

516-622-6076

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.