New Treatment at The Queen’s Medical Center Curbs Cancer of the Esophagus

An increasingly common precancerous condition called Barrett’s esophagus can lead to a deadly cancer called esophageal adenocarcinoma, which has a very low survival rate. Barrett's esophagus is caused by chronic GERD (gastroesophageal reflux disease). In Barrett's esophagus, cells have undergone genetic changes that leave them vulnerable to further changes that can lead to cancer. A new treatment available at The Queen's Medical Center may turn the tide on Barrett's esophagus, and hence esophageal adenocarcinoma rates in Hawaii.

Currently, about 44 percent of U.S. adults experience the symptoms of GERD almost monthly, while 18 percent have them weekly. Prolonged GERD has led to Barrett's esophagus in approximately 3.3 million Americans. The frequency of esophageal adenocarcinoma is on the rise, increasing six-fold from 1975 to 2001 in the U.S., making it the fastest growing form of cancer in America.

Until now, the standard treatment for Barrett's esophagus has been "watchful waiting," with upper endoscopies and biopsies every three months to three years to evaluate the progression of the disease. These procedures require a visit to a hospital, anesthesia, several days of recovery and eating restrictions. Certain types of advanced Barrett's and adenocarcinoma require removal of the esophagus, which has significant risks and a long recovery period. After removal of the esophagus, about 20 percent of patients may have a poor quality of life with swallowing problems, decreased food intake, hoarseness, reflux and diarrhea. The five-year survival rate for adenocarcinoma is just 17 percent.

The Queen's Medical Center Installs Advanced Technology 3T MRI

The Queen's Medical Center is the first in the State of Hawaii to install a short bore, 3 Tesla diagnostic MRI scanner used to create images of the soft tissues of the body. Queen's also has two 1.5T short bore units. The new short bore 3T MRI has an extra large opening of 70 centimeters (about 27.5 inches) for patients, and the length of the bore, or tube, is short, so patients are much less likely to feel they are in a tunnel as in older models. "We want to [bring in] patients we haven't been able to examine because of claustrophobia or size," said radiologist Darren Lum, MD, who noted that most MRIs have an opening of only 60 centimeters. The extra large opening can accommodate a patient of up to 550 pounds. The new equipment is also fast, with scans taking as little as 15 minutes.

The high magnetic field strength of 3T means that images are sharper, producing 1 millimeter pixels. Certain types of exams, such as most neurology, vascular and orthopedic work, are better on the 3T because of the sharpness of the scans and the flexibility of the software. New software purchased with the equipment has significant features which improve MRI scanning, such as motion correction, useful particularly if a patient has an involuntary twitch. The advanced software can also be used to examine the cartilage between joints to detect damage at a much earlier stage.