By Catherine Danko
For most of his life, James Barber never questioned his symptoms. Severe indigestion and heartburn, he thought, were common side effects of eating a meal.
He never thought of them as precursors to esophageal cancer.
When he started losing weight rapidly and was unable to swallow food, James — who was 44 years old at the time of his diagnosis — sought medical attention for what turned out to be stage three esophageal cancer, which eventually spread to his skull and surrounding tissue resulting in metastasis.
"At that point, I was given only 12 months to live," says James, who is from Peterborough, Ont. and was referred to UHN's Toronto General Hospital (TGH) for an esophagectomy and a resection of the brain lesion — two high-risk, potentially life-threatening surgeries — to remove the tumours.
"James is now disease-free, which is not something we can say often about someone with metastatic esophageal cancer," says Dr. Elliot Wakeam, a staff thoracic surgeon at TGH, who performed James' esophagectomy.
According to Dr. Wakeam, most metastatic cancer patients are informed that their condition cannot be fully treated. Typically, they are offered palliative chemotherapy, which can alleviate symptoms and enhance quality of life, though it does not offer a complete resolution.
Esophageal cancer is particularly aggressive, with only a 20 per cent survival rate over five years.
"James' success is really a testament to the esophageal program at UHN," Dr. Wakeam says.
At UHN, a combination of new drugs used by medical oncologists and innovative clinical trials has allowed surgical teams to successfully perform the "aggressive" surgeries on patients who might not have ever been considered for treatment.
Dr. Jonathan Yeung, a staff thoracic surgeon at TGH, says that the thoracic surgery clinic has the expertise to do all aspects of an esophagectomy — from "taking out the esophagus and reconstructing it with parts of the stomach, colon or small bowel" — a surgery performed anywhere between 40 to 50 times a year either openly, minimally invasively or robotically.
Thanks to a new clinical trial conducted at TGH, Mount Sinai Hospital and UHN's Princess Margaret Cancer Centre, some of these surgeries now involve patients whose cancer has spread to other organs, such as James. The trial focuses on surgical candidates who have had a positive response to chemotherapy and radiation and can proceed with the surgeries even if their metastases are limited in scope.
"We want patients to know that even if you have a metastasis, we won't give up on you," says Dr. Yeung, who serves as co-investigator on the trial.
The objectives of the trials are to assess overall survival outcomes for patients receiving systemic treatment — primarily with chemoimmunotherapy — followed by surgery. Additionally, the trials aim to evaluate surgical safety, progression-free survival, quality of life and patterns of recurrence.
And, according to Dr. Wakeam, James' story is one that's becoming more frequent: young people, predominately male, who have never had medical problems prior are "presenting to hospital with very advanced stages of esophageal cancer and in need of lifesaving, challenging surgeries."
One similar example is Christopher Pearce, a 44-year-old man who was referred UHN's Toronto Western Hospital (TWH) for a biopsy after consulting a gastroenterologist when he was having trouble swallowing.
Christopher, who had never struggled with digestive issues before, says he was "caught off guard" by his esophageal cancer diagnosis considering his age and general health. By the time he began receiving chemotherapy at the Princess Margaret, the cancer had metastasized, spreading to his lymph nodes, making him at the time an unlikely candidate for surgery.
It wasn't until after a tough nine months of chemotherapy and success with clinical trial drugs to eradicate the metastases in his lymph nodes, that Christopher was a surgical candidate, which was when he became a patient of Dr. Wakeam.
"Dr. Wakeam gave me the confidence that my surgery was possible not just because of his knowledge and expertise, but because of his collaboration with the team at UHN," says Christopher.
