Endoscopic Surveillance Leads to Early Detection of Two Cancers

Keeping a Close Watch on an Esophageal Condition, Interventional Gastroenterologist Finds Tumors at Readily Treatable Stages

Barbara Schwarz, Irving Waxman, Ron Schwarz
While monitoring Ron Schwarz, right, for signs of esophageal cancer, interventional gastroenterologist Irving Waxman, MD, center, identified pancreatic and esophageal tumors at stages that were readily treatable. After having therapy for both cancers, Schwarz is back to enjoying retirement with his wife, Barbara, left.

When it comes to bouncing back after being treated for two cancers, Ron Schwarz likens himself to a cat with many lives. His wife, Barbara, laughs and says, "I call him the Energizer Bunny."

Doctors at the University of Chicago Medicine diagnosed Schwarz with pancreatic cancer in 2008 and esophageal cancer in 2012. The conditions -- which have poor prognoses if advanced -- were found early thanks to endoscopic surveillance that kept a close watch on an esophageal condition. After treatment for both cancers, the 77-year-old is back to enjoying life in his Huntley, Ill., retirement community.

Five years ago, in July 2008, Schwarz learned that his Barrett's esophagus -- a serious complication of gastrointestinal reflux disease (GERD) -- showed signs of progressing to esophageal cancer. Damage to the lining of the organ was causing normal cells to transform into abnormal, precancerous ones. Schwarz’s gastroenterologist told him that Irving Waxman, MD, an expert in gastrointestinal interventional endoscopy, was the best doctor to see for the condition.

"Ron had Barrett’s with high-grade dysplasia which is the single most important risk factor for esophageal cancer," Waxman explained. "This gave him a 70 percent chance of developing the disease." Waxman’s team uses advanced endoscopic techniques to monitor and treat patients with Barrett’s esophagus in order to reduce the cancer risk.

"It’s worthwhile making the trip to see Dr. Waxman," Barbara Schwarz said.

In Schwarz’s initial outpatient visit, Waxman completed two endoscopic procedures. Passing a thin, lighted tube through Schwarz’s mouth into his esophagus, Waxman first performed endoscopic ultrasound (EUS). A transducer at the tip of an ultrasound probe gathered and sent data to a nearby computer that then created an image of the esophagus on a screen. Visualizing the abnormalities in Schwarz’s esophagus, Waxman performed EMR (endoscopic mucosal resection) -- lifting, cutting and removing the affected tissue. The goal of EMR is to prevent the abnormal cells from reaching deeper layers and to allow healthy cells to grow back.

A Surprise Finding

During the same procedure, Waxman also inspected organs surrounding the esophagus. Looking at the pancreas, he spotted a 1-2 centimeter tumor. Guided by a camera and the ultrasound probe, Waxman carefully positioned the endoscope over the tumor and passed a fine needle into the pancreatic lesion to sample tissue cells for biopsy. A pathologist working in the endoscopy suite checked the cells under a microscope and soon verified that the medical team had removed the right amount of tissue for further examination. Laboratory tests later confirmed pancreatic cancer.

"Finding other cancers during EUS for Barrett’s is rare; in fact, we see it only 5 percent of the time," Waxman said. "But when we do, biopsying the tumor at that moment decreases the need for a follow-up diagnostic procedure. And we can get the patient started on a care plan right away."

Schwarz clearly remembers hearing the news that he had pancreatic cancer. "My first thought when Dr. Waxman told me the biopsy results was, ‘that’s the kind that is always fatal,’" he said. Waxman assured him the cancer was caught at an early stage and he had a good chance of survival.

Less than a month later, Mitchell Posner, MD, an expert in the surgical management of gastrointestinal cancers, removed a portion of Schwarz’s pancreas. After undergoing chemotherapy, Schwarz finished his treatment for pancreatic cancer in June 2009. "Although the word "cured" doesn’t often go along with a pancreatic cancer diagnosis, the likelihood of Ron having a recurrence, while certainly not zero, is very small," Posner said.

Identifying a Second Cancer

Ron Schwarz and Irving Waxman, MD Schwarz meets with Waxman during a March 2013 appointment for follow-up care.

After Schwarz finished treatment for pancreatic cancer, Waxman’s team resumed monitoring his esophagus with regular endoscopic treatment. In a November 2012 procedure, the cells in the esophagus looked unusual. An onsite biopsy showed the presence of superficial squamous cell carcinoma. Seen in the upper and middle lining of the esophagus, squamous cell carcinoma accounts for most esophageal cancers in the world. If the cancer progresses, patients can experience difficulty swallowing, bleeding, pain, and severe and sudden coughing. Treatments for advanced esophageal cancer include chemotherapy, radiation, and, in some cases, surgery to remove the esophagus.

Waxman immediately performed another EMR, this time lifting and resecting the carcinoma tissue. Because the cancer was at an early stage, Schwarz did not require any further treatment.

"It’s unusual for a patient to have two gastrointestinal malignancies," Waxman said. "But, fortunately, new endoscopic technology enabled us to catch and treat both of these before they advanced." Waxman will continue to monitor Ron’s esophagus with regular endoscopic treatment and be ready to act quickly if the cancer recurs.

Recently back to the medical campus for a follow-up endoscopy, Ron and Barbara Schwarz expressed gratitude for the great care he has received at the University of Chicago Medicine throughout the past five years. "It’s worthwhile making the trip to see Dr. Waxman," Barbara Schwarz said. "His team has given us excellent care all along."

March 2013