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July 8, 2019

Second Opinion Leads to Less-Invasive Treatment for Esophageal Cancer

By SharingMayoClinic
When Mike DiGennaro was diagnosed with stage 1 esophageal cancer, he wanted a minimally invasive treatment option. He found that, and more, at Mayo Clinic.
Sue and Mike DiGennaro

When Mike DiGennaro was diagnosed with stage 1 esophageal cancer, he wanted a minimally invasive treatment option. He found that, and more, at Mayo Clinic.


Mike DiGennaro knew he needed surgery. But he thought he would have a procedure to correct an umbilical hernia, and that would be the end of it. After the surgery and recovery, however, Mike's surgeon revisited Mike's medical history and suggested some additional procedures.

"I have a history of acid reflux, so he said I was probably due for an endoscopy and maybe a colonoscopy, too," Mike says. "But I joked around with him and said: 'You're just looking to make more money! I'm as healthy as a horse!'"

After a month of additional prodding by his doctors and his wife, Sue, Mike relented, agreeing to go in for what he assumed would be routine examinations. They weren't.

"The endoscopy is when they found the cancer," he says. "They did a biopsy, and I honestly didn't understand the seriousness of it until I started doing my own research and discovered esophageal cancer isn't a very good thing to have."

Following the diagnosis, Mike had his cancer staged. "They determined it to be stage 1," Mike says. "After staging, they did a PET (positron emission tomography) scan that, thankfully, didn't find additional cancer throughout my body."

With the cancer contained to his esophagus, Mike's care team in Wisconsin was swift and direct in their proposed treatment plan. "They said: 'We need to get an esophagectomy done right away. We'll cure you. You have to do it,'" Mike says. "And I said, 'OK, but let me do some of my own research first.'"

Mike was concerned about the extent of the surgery. He was told the esophagectomy — a procedure that would involve removing part, or possibly all, of his esophagus — required a prolonged hospital stay. "I really didn't want to go through all of that if I didn't have to," he says.

Mike began researching other treatments. That's when he discovered a less-invasive surgery for esophageal cancer was being done at Mayo Clinic called gastrointestinal endoscopic mucosal resection. Mike took that information back to his care team.

"I asked them what they thought and whether they could do this less-invasive procedure," Mike says. "They said they could. But they didn't recommend it because they didn't think I'd be a candidate for it. That's when I came to Mayo Clinic."

Another opinion, a better option

At Mayo, Mike was introduced to Prasad Iyer, M.D., a gastroenterologist, and Kristyn Maixner, a nurse practitioner, in the Department of Gastroenterology and Hepatology. Mike says the two were open and honest about his cancer, and what they could do to treat it.

"The way Kristyn and Dr. Iyer explained it to me, they said my esophagus is like a wall. You've got your paint, your primer, and then you get into the drywall and then the studs," Mike says. "At stage 1, they explained my cancer was lying just below the paint and hadn't yet gotten into the drywall or studs (lymph nodes) yet. Explaining my cancer to me like that not only made it educational, but also relevant for me."

With the location and severity of his cancer understood, the next step was to determine whether Mike was indeed a candidate for the less-invasive endoscopic mucosal resection of his cancer. The team reviewed Mike's positron emission tomography scans, tissue samples and the ultrasound he had done when the cancer was staged.

"They said, 'We're not making you any promises, but it's worth another look,'" Mike says. "Sure enough, after that second look, they thought I was a candidate for the endoscopic route versus the full esophagectomy. They were very confident in their decision."

"Our goal is to preserve the esophagus and preserve our patients' quality of life."

Prasad Iyer, M.D.

That confidence, Dr. Iyer says, stemmed not only from the early stage of Mike's cancer, but also the approximately 15 years of experience he and other surgeons at Mayo Clinic have in performing less-invasive endoscopic resections for esophageal cancer patients.

"It allows us to remove chunks of cancerous tissue via the endoscope using a new technique called endoscopic submucosal dissection," Dr. Iyer says "We've actually come to learn that if we take out these early cancers in this manner and treat the remaining precancerous esophagus lining (Barrett's esophagus) with ablation, our results are every bit as good as those you'd expect from traditional esophageal cancer surgery."

While less invasive than an esophagectomy, Dr. Iyer says there's a trade-off to endoscopic resections. "We bring them back every three months, so we can work on removing their cancerous and precancerous tissue step by step," he says. "Our goal is to preserve the esophagus and preserve our patients' quality of life."

A rewarding result

For Mike, that meant five endoscopic mucosal resections spread three months apart. "We started by taking out what appeared to be the worst-looking area," Dr. Iyer says of Mike's cancer. "He came back three months later, and we took out some more, and then we just kept going until it was all gone."

Mike, however, says he only needed one procedure to realize he'd made the right decision. "The first one was kind of long, and I ended up having to spend the night in the hospital," he says. "But here's the funny part: I wasn't in much pain. I was mostly knocked out from the anesthesia."

The same was true for Mike's remaining four procedures. "The only thing I have to complain about at all is they had to stretch my esophagus a little," Mike says. "Other than that, every procedure went like clockwork. I'm now cancer-free, and I still have my esophagus."

"Thanks to Dr. Iyer's willingness to explore other options, I was able to get the same results in a much less invasive way."

Mike DiGennaro

Mike understands that outcome wasn't guaranteed upon his arrival at Mayo Clinic. "Maybe we would have had to have done the full esophagectomy at Mayo, too. But thanks to Dr. Iyer's willingness to explore other options, I was able to get the same results in a much less invasive way," Mike says. "It was a true team effort with my wife, Sue, also playing an integral part in my care by helping to validate research and supporting me in every decision."

For the careful evaluation and comprehensive care he received, Mike will be forever grateful. "I feel good, and my quality of life is good," he says. "I feel really lucky to have found Kristyn and Dr. Iyer. They're the golden nuggets in all of this. They're just awesome. My entire care team at Mayo Clinic is awesome."


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Tags: Cancer, Dr. Prasad Iyer, Endoscopic mucosal resection, esophageal cancer, Gastroenterology, Kristyn Maixner

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