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Cancer of the esophagus can be challenging to treat, and when it’s diagnosed a number of studies are appropriate to fully evaluate the disease. That’s according to Richard Battafarano, director of thoracic surgery at Johns Hopkins.

Battafarano: Undergoing endoscopic ultrasound there's a special probe that can look to see how deep these esophageal cancers travel into the wall of the esophagus. This test is especially important for those patients who felt well and were surprised they had esophageal cancer. All patients will undergo a CT scan of the chest and the abdomen and also a pet CT scan to see if the cancer cells had travelled either to lymph nodes nearby or to places outside of where the esophageal tumor is such as the liver.          :31

Battafarano says these tests help plan surgery as well as determine other modalities that should be employed to treat someone’s esophagus cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Esophagus cancer awareness month has just ended, and Richard Battafarano, director of thoracic surgery at Johns Hopkins, says while some people may have this type of cancer and not know it, the majority will have a range of symptoms.

Battafarano: Well sometimes patients are feeling well and are having a routine upper endoscopy and they are found to have a tumor and when the endoscopists biopsy they're often very surprised that they even have a cancer because they feel so well. That's a small group. The vast majority of patients with surgical cancer start to notice that food is getting stuck on its way through the esophagus into the stomach and then they have associated weight loss, and those patients their symptoms is what brings them to the doctor and that's how they're official cancer is found.  :29 

Battafarano says that anyone with esophagus cancer should have complete evaluation to determine the extent of their cancer. He notes that a multidisciplinary approach to treatment is needed as treatment is complex and will likely require surgery and other modalities. At Johns Hopkins, I’m Elizabeth Tracey.

Bladder cancer treatment is about to change dramatically based on a trial showing that adding an antibody to a toxic substance is much more effective than current treatments. Johns Hopkins Kimmel Cancer director William Nelson describes this class of pharmaceuticals.

Nelson: They're called antibody dependent drug conjugates. The antibody itself has the ability to bind something very specifically, in this case it binds something on the bladder cancer cells, so they have attached a toxin to it. There are a little bit more than a dozen or so these antibody dependent drug conjugates have been FDA approved. There's more than 90 in early clinical development across the country. These are going to slowly but surely change the face of cancer care. This was tested along with pembrolizumab.  It doubled the overall survival definitely a successful trial.   :31

Nelson says getting the toxin to stick to the antibody but then release once it gets to the target was successful in this trial and resulted in dramatically improved survival. At Johns Hopkins, I’m Elizabeth Tracey.

Stool based tests to screen for colorectal cancer have been around for some time and work pretty well. Now one of the most utilized ones has been improved, a clinical trial shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the word to the wise is use them annually.

Nelson: This is well known for stool blood tests, they work better if you do them every year or every other year. So the stool test done by Exact Sciences are the people who make the Cologuard test, this is their new and improved better test. They took adults 40 years or older, more than 20,000 of them who are going to undergo colonoscopy and they had a panel that involved a number of methylated gene targets and looking for blood in the stool. Their sensitivity was almost 94% and their specificity was 90-91%.   :30

Nelson says choice helps when it comes to convincing people to be screened. In light of the increasing rate of colorectal cancer among young adults he welcomes improved accuracy. At Johns Hopkins, I’m Elizabeth Tracey.

A blood test to screen for cancer is something of a Holy Grail, and now a new study describes one for colorectal cancer. Kimmel Cancer Center director William Nelson at Johns Hopkins says while there is still quite a bit of work to do on this test, it is promising.

Nelson: These were adults who were going to undergo colonoscopy to look for colorectal cancer or polyps, and it was a large study that was reasonably representative. They looked in particular at some of the genetic alterations. They also looked at the DNA methylation mark that turns out to be a pretty good way to look for cancer DNA and they looked at fragmentation, any patterns such as also correlated a little bit they were able to detect colorectal cancer when it was there remember they just colonoscopy right afterwards at an 83% sensitivity.                  :31

The colonoscopy confirmed or refuted results from the blood test. Nelson says this strategy isn’t ready for widespread use, but notes that some people find blood tests much more acceptable than stool analysis. At Johns Hopkins, I’m Elizabeth Tracey.

Pulse oximeters, vital for measuring how much oxygen is in someone’s blood, don’t work well in people with darker skin, multiple studies have shown. Ashraf Fawzy, a critical care medicine expert at Johns Hopkins, says even the degree to which these devices report aberrant values varies.

Fawzy: Some studies showed that the discrepancy changes throughout the day for the same person, so their skin tone or the skin pigmentation hasn't changed but you may have a discrepancy for one reading but for the next reading there's no discrepancy. And this was much more common in people of black race rather than white race. There's a multifactorial issue going on here and that's why I say it's probably going to take the technological update to really get these devices to be more accurate.   :30

Fawzy says for now, only arterial blood gas measurement will provide correct assessment of blood oxygen levels in people with darker skin. At Johns Hopkins, I’m Elizabeth Tracey.