symptoms of cancer

[Bonie__0__0]

  My husband has been recently diagnosed with Barrett's Escophagus, but we have not had are follow up visit with the doctor,  as we were waiting on biopsies and the doctor had to go out of town.  
  The doctor did say, that the barrett's had been there for some time and the examination sheet shows "Server reflus, induced line change & imitation, (Barrett's epithelm).  
  I have thought for some time now that he may have cancer, as he has been sick on and off for some time now.  He vomits quite often several times a week, constant pain, mostly on the right abdominal, (sometimes more severe than others) and has felt at times that he is chocking or cannot get enough air, mostly at night  after going to bed.
  We have waited 4 weeks, we will finally get to see the doctor this Monday, but one minute I think he is very sick and the other I am not sure.  He has not been able to work, due to the increased symptoms..
  What should I be looking for?  What should we ask the doctor?
  All his nurse would tell me on the phone is that the biopsies confirmed the barrett's escophagus, but she did not tell me if the biopsies were negative or positive.  
  Any information you can give me will be appreciated.  Thank you.  Bonnie
Dear Bonnie,
Barrett's esophagus is a condition where the lining of the esophagus has changed. Usually the esophageal lining is pink colored and the stomach lining is darker red in color. When the lining of the esophagus appears more like the lining of the stomach that generally implies Barrett's esophagus. Barrett's esophagus usually requires confirmation with a biopsy. If the biopsies show a change called intestinal metaplasia (the lining looks more like intestine than stomach) then it is considered a premalignant lesion that requires regular follow-up. The majority of patients with Barrett's esophagus do not develop esophageal cancer (of the adenocarcinoma type) but the risk of developing esophageal cancer is much higher in patients with Barrett's when compared to the general population. Therefore, the current recommendation is to perform surveillance endoscopy approximately every 1-2 years. The purpose of the surveillance endoscopies is to look for subtle changes in the cells of the esophageal lining which indicate malignant transformation. These changes are called dysplasia. Dysplasia can be classified as low grade or high grade. High grade dysplasia usually requires further management. Low grade dysplasia may signify more frequent surveillance.
Your husband's symptoms of vomiting, right sided abdominal pain and a choking sensation after going to bed are suggestive but not necessarily diagnostic for gastroesophageal reflux. Barret's esophagus is a consequence of prolonged damage to the lower esophageal lining from acid produced in the stomach and refluxed back into the esophagus. Barrett's esophagus may also be accompanied by inflammation in the lower esophagus called esophagitis. Many treatments including lifestyle modifications and medications are available to treat gastroesophageal reflux and its complications.  Your doctor can help you with a medical regimen that is right for you. You should also ask your doctor if he feels that surveillance endoscopy is warranted, whether or not dysplasia is present and if so is it low grade, high grade or indefinite for dysplasia.
It is often difficult to predict whether a person has cancer based solely on symptoms. Nevertheless, symptoms that you should not ignore include: severe vomiting and abdominal pain, dysphagia (difficulty swallowing), weight loss and bleeding (both vomiting blood, rectal bleeding or black stools).
Good luck to you. I hope you find this information helpful. If you are seen at our institution I look forward to personally meeting you.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat one of our experts in Gastroenterology.
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*Keywords: Barrett's esophagus, intestinal metaplasia, dysplasia, surveillance

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