HJBR May/Jun 2022

HEALTHCARE JOURNAL OF BATOON ROUGE I  MAY / JUN 2022 57 Jonathan Edward Fletcher, PA-C Thoracic Surgery Our Lady of the Lake Physician Group – Surgeons Group of Baton Rouge oligometastatic tumors. According to the National Comprehensive Cancer Network (NCCN) guidelines, surgical resection of early-stage lung cancer is the recommended treatment for patients who are deemed good or appropriate surgical candidates. In addition to minimally inva- sive approaches for diagnosis and staging, the treatment of early-stage lung cancer can also be performed through a robotic assisted approach via surgical resection. A wedge resection, segmentectomy, or lobectomy are all forms of surgical resection of NSCLC and carcinoid tumors with surrounding tissue, while leaving healthy, unaffected tissue be- hind. These minimally invasive procedures, paired with our Enhanced Recovery After Thoracic Surgery (ERATS) protocol, assists with postoperative pain control secondary to smaller incisions, which can decrease the length of stay during the patient’s hospital- ization and require less narcotic medication throughout their stay or in the postopera- tive/recovery period. Esophageal Cancer There are nearly 17,000 new cases of esophageal cancer diagnosed per year in the United States. The twomost common types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. They tend to develop in different parts of the esophagus and are driven by different genetic changes. Adenocarcinoma begins in glandular cells from within the lining of the esophageal lu- men, usually starting near the gastroesopha- geal (GE) junction. Squamous cell carcinoma forms in the thin, flat cells lining the inside of the esophagus and is most often found in the upper andmiddle part of the esophagus but can occur anywhere along the esophagus. If stomach acid refluxes into the lower part of the esophagus over a long period of time, the squamous cells can be replaced by glandular cells, leading to Barrett’s esophagus — a pre- malignant condition. Based on their location within the thoracic cavity, these cancers are typically followed by thoracic oncology sur- geons for surgical resection after completing neoadjuvant chemoradiation. Screening and Diagnosis There are no standard or routine screen- ing tests for esophageal cancer, but some minimally invasive procedures are being used and studied as potential tests for diag- nosis and staging. These procedures include: esophagoscopy (such as EGD) to obtain a bi- opsy of the esophageal lumen, brush or bal- loon cytology, or fluorescence spectroscopy. Staging Once esophageal cancer is identified, staging becomes a very important process to determine survival rate and overall qual- ity of life. Staging of esophageal cancer is based on the depth of tumor invasion into the different layers of the esophagus or sur- rounding tissue. An endoscopic ultrasound (EUS) is a minimally invasive procedure that allows for an appropriate assessment of tu- mor depth into the mucosa or submucosal layers, as well as the ability to biopsy sur- rounding lymph nodes if they appear in- volved or enlarged. Treatment While neoadjuvant chemoradiation and possible immunotherapy are considered first line treatment for esophageal cancer, trimodality with neoadjuvant chemoradia- tion followed by surgical resection (if they patient is deemed a good surgical candidate) is the standard of care for esophageal cancer. If the esophageal cancer is considered early stage without deep penetration or if the area is considered premalignant, an endoscop- ic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), paired with close surveillance, may be all that is required for treatment. If there appears to be deeper involvement of the esophageal layers or fur- ther evidence of spread, an esophagectomy may be recommended. This procedure, also able to be performed robotically, connects a tubularized section of the stomach to the remaining, healthy portion of the esopha- gus after removal of the malignant area. If an advanced stage is identified, the goals of care may shift to a more palliative ap- proach, allowing for endoscopic dilation or stent placement, as well as feeding tube placement and pain control. Conclusion Thoracic oncology has made great strides over the past few years, from its widening of screening access and capacity to its in- novative advances in and out of the oper- ating room. These technological advances continue to improve patient outcomes by lengthening survival rates and assisting with postoperative recovery. n REFERENCES 1 Walters, S.; Maringe, C.; Coleman, M.P.; et al. “Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study 2004- 2007.” Thorax. 68 (2013): 551-564. 2 Potter, A.L.; Rosenstein, A.L.; Kiang, M.V.; et al. “Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study.” The BMJ. March 30, 2022 .http://dx.doi.org/10.1136/ bmj-2021-069008 In his role as a physician assistant,Jonathan Fletcher, PA-C, particularly enjoys interpersonal communica- tion with and providing education and support to patients and their families. He has specific training in the medical model to diagnose and treat illness and to provide preventative care in partnership with a physician. Fletcher holds a Master of Medical Science in Physi- cianAssistant Studies fromFranciscanMissionaries of Our Lady University in Baton Rouge.He is licensed by the Louisiana State Board of Medical Examiners and is board certified by the National Commission on Certification of PhysicianAssistants.He is amember of the Louisiana Academy of Physician Assistants and theAmericanAcademy of PhysicianAssistants.