Esophageal & Gastric Cancer Program
INCIDENCE AND PREVALENCE
The National Cancer Institute estimates that 17,290 individuals in the
U.S. will be diagnosed with esophageal cancer in 2018, and an estimated
26,240 individuals will be diagnosed with gastric cancer. Both esophageal
and gastric cancers are more common in men than in women.
PROGRAM OVERVIEW
From early detection and prevention to multidisciplinary, leading-edge
treatment, Hoag Family Cancer Institute’s Esophageal & Gastric
Cancer Program provides the full continuum of esophageal and gastric cancer
care. Under the leadership of John Lipham, M.D., program director for
Hoag Esophageal & Gastric Cancer Program, James & Pamela Muzzy
Endowed Chair in GI Cancer, and professor of surgery at Keck School of
Medicine of USC, the program combines the best of academic and community
medicine through Hoag’s collaboration with the USC Norris Comprehensive
Cancer Center. Specialists in surgery, medical oncology, radiation oncology,
gastroenterology, interventional gastroenterology, pathology, and radiology
work as a team to provide expert and coordinated treatment.
DIAGNOSTICS
Hoag’s interventional gastroenterologists are experts in advanced
endoscopy techniques including endoscopic ultrasound for the most accurate
staging. Dedicated GI pathologists at Hoag add unique pr oficiency in
the right diagnosis, staging, and lymph node count. In addition, Hoag’s
Radiology Department provides MRI, CT and PET CT imaging for staging and
evaluation of both primary and recurrent disease.

TREATMENT
Tumor Board
Every esophageal and gastric cancer case is presented at the GI Cancer
Program bi-weekly multidisciplinary tumor board, a practice that has improved
patient outcomes (complication, mortality, and survival rates). It is
attended by GI surgeons, GI medical oncologists, gastroenterologists and
advanced interventional gastroenterologists, radiation oncologists, pathologists,
radiologists, palliative care specialists, and the GI cancer nurse navigator.
GI Tumor Board is held on the 2nd and 4th Monday of every month at 12:30 p.m. at the Patty & George Hoag Cancer
Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine.
It is moderated by John Lipham, M.D., James & Pamela Muzzy Endowed
Chair in GI Cancer.
To submit a case for the GI Tumor Board, contact the GI Cancer Nurse Navigator,
Diane Eadie, R.N., at 949-764-8267 or [email protected] or Rosana Figueroa
at 949-764-7044 or [email protected]

Surgery
Over 95% of the esophagectomies and gastric cancer surgeries at Hoag are
performed using a minimally invasive approach, a statistic that sets our
program apart from many community and academic programs. The Hoag-USC team conducted and published a research study comparing minimally
invasive esophagectomies to open en bloc esophagectomies.1 The results showed the minimally invasive approach improved complication
rates, decreased length of stay, decreased blood loss, and reduced the
need to transfuse patients while providing the same cancer outcome.
The program’s GI surgeons bring a depth of experience that is advantageous
to patients. The average 30-Day Mortality Rate After Esophagectomy at
academic hospitals is 3% and often higher at community hospitals. Hoag’s is 0%.
In 2017, Hoag purchased the Spy Fluorescence Imaging System, an intraoperative
tool that gives GI surgeons real time assessment of the blood supply to
the stomach during esophagectomy, helping reduce complications and often,
the need for additional surgeries.
Two clinical fellows per year train at Hoag and USC through the GI Surgical
Fellowship Program. The program not only benefits the fellows who engage
in patient care, learning and engaging in research at Hoag and USC, it
also benefits the patients whose specialized surgical team is extended
through the fellows’ participation.
Medical Oncology
Skilled medical oncologists, including a subspecialized GI medical oncologist,
add unique expertise, and achieve improved response rates with neoadjuvant
chemotherapy. Patients who have a favorable response to neoadjuvant therapy
have a 60-70% survival rate after surgical resection.
Patients with advanced gastric and esophageal cancers benefit from a precision
medicine approach as part of Hoag’s program. A sample of the patient’s
tumor is sent for comprehensive tumor genomic profiling at the start of
treatment to help guide clinical decisions based on reported genomic mutations
or alterations. Liquid biopsies are sometimes done during treatment for
additional molecular genomic profiling to determine if there are new resistance
mechanisms developing in the tumor. Considerations for additional options
for treatment are available through Hoag’s clinical trials portfolio.
Radiation Oncology
Hoag Radiation Oncology offers image guided radiation therapy and 3D conformal
radiation therapy (3DCRT) using state-of-the-art linear accelerators –
TomoTherapy®, Elekta Versa HD™, and Elekta Agility™ –
when radiation therapy is warranted for patients with esophageal and gastric cancers.
Under daily CT image guidance, TomoTherapy uses hundreds of pencil beams
of radiation, rotating in a spiral around the tumor and hitting it with
varying intensity from all directions, providing incredible precision.
The radiation can be sculpted to fit the shape of the tumor, improving
accuracy, precision, and efficiency.
Additionally, Hoag’s Elekta machines deliver Volumetric Arc Therapy
(VMAT), an advanced technology that delivers radiation in single or multiple
arcs around the patient under 3D image guidance. The Hexapod iGuide Couch
(6D) of the Elekta Versa HD machine adjusts the patient during each treatment
into the exact location with submillimeter accuracy.
Palliative Care
The team is proactive in integrating palliative care to improve quality
of life during treatment as well as extend and enhance life for patients
who are not candidates for curative treatment. In addition to advanced
endoscopy for palliation of advanced cancers, the team works closely with
Hoag’s Palliative Care team, CARES, to address pain and discomfort
at all disease stages.
CLINICAL RESEARCH
Several early phase clinical trials testing novel agents that apply to
esophageal and gastric cancer patients are available at Hoag, which expands
treatment options for a number of patients, especially those with advanced
disease. The following clinical trials have opened for patients with gastric
or esophageal cancer. For a list of trials currently open, please contact
Leila Andres, M.S., at 888-862-5318.
(155-17) 0C 17-1: Phase I Multi-center Study of the Safety of Pharmacokinetics
and Preliminary Efficacy of CBT- 101 in Subjects with Advanced Solid Tumors
and C-Met Dysregulation (Phase 1 clinical trial, appropriate for patients
with advanced solid malignancies.)
(187-17) 0C-17-11: Phase 1 trial of ZW25 in patients with locally advanced
(unresectable) and/or metastatic HER2- expressing cancers (Phase 1 clinical
trial, appropriate for patients with HER2 expressing cancers.)
157-17/0C-18-2: A Phase I Study of FID-007 in Patients with Advanced Solid Tumors
(211-17) 0C-17-14: An Open-Label, Non-Randomized, Multicenter Study to
Determine the Pharmacokinetics and Safety of Niraparib Following a Single
Oral Dose in Patients with Advanced Solid Tumors and Either Normal Hepatic
Function or Moderate Hepatic Impairment (Phase 1 Clinical trial appropriate
for patients with advanced solid tumors)
181-17/0C-14-2: An Open-Label, Phase 2 study of Neratinib in Patients with
Solid Tumors with Somatic Human Epidermal Growth Factor Receptor (EGFR,
HER2, HER3) Mutations or EGFR Gene Amplification
SCREENING AND HIGH RISK SERVICES
Early detection and prevention of esophageal cancer is a major focus of
the program. Barrett’s Esophagus, caused by long term gastroesophageal
reflux disease (GERD), is the precursor to esophageal cancer. The team
is aggressive in screening for Barrett’s using Hoag’s sophisticated
endoscopic and imaging equipment. Interventional gastroenterologists treat
early cancers (carcinoma in situ) using endoscopic mucosal resection followed
by an ablation to remove the Barrett’s precancerous tissue, sparing
the patient an esophagectomy.
Beginning in 2017, endoscopic submucosal dissection (ESD) is also available
at Hoag for the treatment of very early esophageal and gastric cancers
localized to the mucosa. The technique requires a high degree of expertise
and is not widely available.
Hoag’s GI Lab is one of only a few with WATS 3D® technology,
acquired in 2017. The two-part technology is comprised of a special brush
that samples a wider area and targets only the layer of the esophagus
where dangerous cells develop and a computer imaging system that forms
a 3D image. It has been shown to increase detection of Barrett’s
or early cancer by 40%.
In addition, Hoag’s GI surgeons are experts in surgical techniques
that treat GERD including traditional nissen fundoplication, partial fundoplication,
laparoscopic implantation of the LINX® Reflux Management, transoral
incisionless fundoplication, and repair of large hiatal hernieas, which
help prevent Barrett’s Esophagus and esophageal cancer.
Cryoablation was also added to the program in 2017 and serves as an additional
tool to remove pre-cancer or early cancer without the need for surgery.
Following radiofrequency ablation, 10-20% of patients will have some residual
Barrett’s Esophagus, which can be eradicated with cryoablation.
SUPPORT AND EDUCATION
Diane Eadie, R.N., is the GI cancer nurse navigator. She helps patients
connect the dots of their multidisciplinary treatment plans, answers questions,
and helps in addressing other issues that arise during their care. Diane’s
ability to offer emotional support and education is a key benefit to patients
and their families. The GI Cancer Support Group meets monthly at the Hoag
Cancer Center in Newport Beach.
In addition to Hoag Family Cancer Institute’s range of patient support
services, classes, and workshops, esophageal and gastric cancer patients
benefit from the integration of two oncology dietitians who assist with
nutrition needs during and after care. Their role is especially crucial
during neoadjuvant chemotherapy to ensure the patient’s weight and
nutrition are optimal for surgery.
The team puts on several GERD education programs and seminars throughout
the year in Orange County to provide awareness and education on esophageal
cancer risk factors and prevention. Thanks to funds from the James &
Pamela Muzzy Endowed Chair in GI Cancer, Hoag annually hosts a half-day
GERD Symposium open to anyone in the community. Approximately 60 community
members attended the 2017 event.
Hoag is one of the highest volume centers in Southern California for the
placement of the LINX Reflux Management System, a tool for treating GERD.
truFreeze Spray Cryotherapy utilizes liquid nitrogen to ablate tissue of
the esophagus affected by both
dysplastic and non-dysplastic Barrett’s esophagus. This technique has been
shown to have a reduction in post-procedural pain and increased patient
tolerance.
1 *Cash JC, Zehetner J, Hedayati B, Bildzukewicz NA, Katkhouda N, Mason
RJ, Lipham JC. Outcomes following laparoscopic transhiatal esophagectomy
for esophageal cancer. Surg Endosc. 2014 February
For more information call:
949-722-6237