Morrissey’s Been Battling Cancer

British singer and lyricist, Morrissey, 55,best known for his lead vocals for 80’s band  The Smiths as well as a successful solo career, is now revealing the reason he had to cancel a number of tour dates over the past 18 months. Morrissey told Spanish newspaper El Mundo he’s been battling cancer:

“They have scraped cancerous tissues four times already, but whatever. If I die, then I die. And if I don’t, then I don’t. Right now I feel good. I am aware that in some of my recent photos I look somewhat unhealthy, but that’s what illness can do. I’m not going to worry about that, I’ll rest when I’m dead.”

We originally reported that Morrissey was diagnosed with a condition of the esophagus called Barrett’s esophagus in February 2013. At that time he was hospitalized with a bleeding ulcer. Although Morrissey did not specify what kind of cancer he has, those with Barrett’s esophagus have an increased risk of esophageal cancer.

What is Barrett’s Esophagus?

Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that connects the mouth to the stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia.

normal esophagusBarrett's Esophagus

 

 

 

No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD) (see below). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus.

Barrett’s esophagus affects about 1 percent of adults in the United States. The average age at diagnosis is 50, but determining when the problem started is usually difficult. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races. Barrett’s esophagus is uncommon in children.

Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that connects the mouth to the stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia.Barrett's-Esophagus

No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus.

Barrett’s esophagus affects about 1 percent1 of adults in the United States. The average age at diagnosis is 50, but determining when the problem started is usually difficult. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races.

The exact causes of Barrett’s Esophagus are not known, but GERD is a risk factor for the condition. Although people who do not have GERD can have Barrett’s Esophagus, the condition is found about three to five times more often in people who also have GERD.

What is the risk of esophageal adenocarcinoma in people with Barrett’s esophagus?

The risk of esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5 percent per year. Typically, before esophageal adenocarcinoma develops, precancerous cells appear in the Barrett’s tissue. This condition is called dysplasia and is classified as low grade or high grade.

Barrett’s esophagus may be present for many years before cancer develops. A periodic upper GI endoscopy with biopsy is often used to monitor people with Barrett’s esophagus and watch for signs of cancer development. This approach is called surveillance. Experts have not reached a consensus regarding how often surveillance endoscopies should be performed; therefore, people with Barrett’s esophagus should talk with their health care provider to determine what level of surveillance is best for them. In most cases, more frequent endoscopies are recommended for people with high-grade dysplasia compared with low-grade or no dysplasia.

How is Barrett’s esophagus treated?

A health care provider will discuss treatment options for Barrett’s esophagus based on the person’s overall health, whether dysplasia is present, and, if so, the severity of the dysplasia. Treatment options include medication, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.

Medications

People with Barrett’s esophagus who have GERD are treated with acid-suppressing medications, called proton pump inhibitors. These medications are used to prevent further damage to the esophagus and, in some cases, heal existing damage. Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength. Anti-reflux surgery may be considered for people with GERD symptoms who do not respond to medications. However, medications or surgery for GERD and Barrett’s esophagus have not been shown to lower a person’s risk of dysplasia or esophageal adenocarcinoma.

Endoscopic ablative therapies

Endoscopic ablative therapies use different techniques to destroy the dysplastic cells in the esophagus. The body should then begin making normal esophageal cells. These procedures are performed by a radiologist—a doctor who specializes in medical imaging—at certain hospitals and outpatient centers. Local anesthesia and a sedative are used. The procedures most often used are photodynamic therapy and radiofrequency ablation.

  • Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in the esophagus. When porfimer is exposed to laser light, it produces a form of oxygen that kills nearby cells. Porfimer is injected into a vein, and the person returns 24 to 72 hours later to complete the procedure. The laser light passes through the endoscope and activates the porfimer to destroy Barrett’s tissue in the esophagus. Complications of photodynamic therapy include sensitivity of the skin and eyes to light for about 6 weeks after the procedure; burns, swelling, pain, and scarring in nearby healthy tissue; and coughing, trouble swallowing, stomach pain, painful breathing, and shortness of breath.
  • Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells. An electrode mounted on a balloon or endoscope delivers heat energy to the Barrett’s tissue. Complications include chest pain, cuts in the mucosal layer of the esophagus, and strictures—narrowing of the esophagus. Clinical trials have shown a lower incidence of side effects for radiofrequency ablation compared with photodynamic therapy.

Endoscopic mucosal resection

Endoscopic mucosal resection involves lifting the Barrett’s lining and injecting a solution underneath or applying suction to the lining and then cutting the lining off. The lining is then removed with an endoscope. The procedure is performed by a radiologist at certain hospitals and outpatient centers. Local anesthesia and a sedative are used. If endoscopic mucosal resection is used to treat cancer, an endoscopic ultrasound is done first to make sure the cancer involves only the top layer of esophageal cells. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.

Complications can include bleeding or tearing of the esophagus. Endoscopic mucosal resection is sometimes used in combination with photodynamic therapy.

Source: National Digestive Diseases Information Clearinghouse (NDDIC)

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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