Episode Transcript
Interviewer: Cancer of the esophagus, what you need to know after diagnosis. That's next on The Scope.
Announcer: 健康小贴士、医学新闻、研究，以及更多让你更快乐、更健康的生活. From University of Utah Health Sciences, this is The Scope.
Interviewer: Dr. John Weis is an oncologist at Huntsman Cancer Institute. Dr. Weis, 对于一个被告知可能患有食道癌的病人来说, I'm sure it's pretty scary and they've got a lot of questions. 所以我想深入研究一下你的病人可能会有的一些问题, 我认为首先要从它们是如何进入你的办公室开始的?
Dr. Weis: They end up in my office in two fashions. The most common fashion is somebody that has symptoms. They have difficulty of swallowing solids or liquids. It may be they throw up blood, those kind of things. But mostly it's difficulty with swallowing and weight loss. 另一种方法是通过筛查确诊的人他们知道巴雷特食道或者做内窥镜筛查测试.
Interviewer: And that is generally done by another physician. 所以他们发现了一些东西，然后他们会把它们推荐给你?
Dr. Weis: Right. The gastroenterologist would likely see them. If they're diagnosed with early stage esophageal cancer, limited to the lining of the esophagus, they would normally treat that themselves. 如果是晚期，他们会把病人转介给我，一个外科医生和一个放射治疗师.
Interviewer: So by the time somebody comes to you, 是否已经确定他们患有某种形式的癌症, or is that still up in the air?
Dr. Weis: 当他们来找我的时候，通常都被告知他们得了癌症.
Interviewer: Okay. 在这一点上，你和病人讨论了什么?
Dr. Weis: There are certain principles of oncology that are important. In order to prognosticate, you start with a diagnosis. And then you stage. 分期可能包括内窥镜超声检查或超声检查, or CAT scans, or even a PET scan to find out how extensive it is. Generally, 大发娱乐试着把这种病分成几类：表面的, local, regional, and distant.
Interviewer: 当谈到食道癌时，他们做了什么呢? Is that a question that you commonly get?
Dr. Weis: Well, that's an interesting question. It leads into a relatively long discussion. But I think I would like to talk about that.
Interviewer: Okay.
Dr. Weis: 很明显，我就是一个超重的坏例子, 这个国家体重最高的四分之一人群患食道癌的风险是八倍. 吸烟和酒精与一种叫做鳞状细胞癌的癌症密切相关. 反射性食管炎、巴雷特食管、食管裂孔疝多与腺癌相关. The squamous cell carcinomas, the smoking-alcohol-associated tumors, have been falling in incidence in this country. 它们在法国东部、北部、东欧和亚洲仍然非常普遍. 但在这个国家，腺癌正在迅速占据主导地位.
Interviewer: 说到食道癌，这种癌症有多严重? Because some cancers . . .
Dr. Weis: Esophageal cancer is a lethal cancer. It's a very dangerous cancer.
Interviewer: Quick moving?
Dr. Weis: It's aggressive, but it's also . . . tends to be very difficult to treat in a curative fashion. There are about 16,美国每年有1万5千例食道癌，每年有1万3千5百人死亡, 这告诉你发病率和死亡率并没有那么大的不同.
Interviewer: 所以对于那些来到你办公室的人来说，当他们被诊断出患有这种疾病时，他们一定很有压力，因为它是如此具有攻击性，可能是如此致命?
Dr. Weis: Right. And the first question is, usually, can it be cured? That really is it the salient question. And that depends on the stage. If it's spread beyond local regional disease, disease confined to the area of the esophagus, then it's probably not curable. 人们通常会问我的下一个问题是，目标是什么? 我认为重要的区别在于你的目标是治愈还是缓和要么是延长病人的生命要么是减轻他们的症状. 作为病人或医生，你愿意接受的毒性程度取决于你的目标是什么.
Interviewer: 食道癌有哪些治疗选择?
Dr. Weis: For the early stage, a mucosally-confined tumor, they can be simple things like a brachytherapy, mucosal resection, local radiation. All of those things have a potential to cure very early stages.
Interviewer: 当病人被诊断出患有这种类型的癌症时你会看到他们经历的一些常见的事情是什么你和他们交谈? Are there kind of any kind of common trends?
Dr. Weis: Well, they come to me for treatment. And so I can quote statistics to patients. The problems is statistics don't apply to a given individual. 给定的个体不会被70%或30%治愈，他会被100%治愈或100%未治愈. And so the fundamental question is, "Do you want to treat aggressively to try and cure something, or do you not want to cure it?然后，他们经常会问我的问题是：“如果我什么都不做，我的寿命有多长？?"; And the problem is their lifespan if they don't do anything is likely to be short, in three to six months. 所以在我看来，掷骰子来尝试更长的寿命并没有什么坏处.
Interviewer: Got you. Somebody's at the beginning of this journey. 在这一点上，你想确保他们记住或知道什么?
Dr. Weis: 他们应该知道一切都在自己的掌控之中肿瘤医生不是他们的母亲也不是上帝, so I don't get to tell them what they have to do. 他们应该清楚地知道治疗的目标是什么，是治愈还是缓解. 他们应该知道，他们愿意忍受多少毒性是他们自己的最终决定. My recommendations are my recommendations. 当你以癌症专家的身份治疗病人时，你不知道结果会是什么. You can make recommendations, but in the final analysis and if God wants you, 不管我给你化疗还是放疗，他都会治好你, or surgery. If it's not your time, you get to stay here. 我认为你会使用大发娱乐提供的工具，努力让自己活得更长寿、更健康.
But as a general rule, you retain control of your life. 当有人对我说：“你让我做什么我就做什么”时，我总是有点不舒服." I would like them to know what they're doing. 我确实认为知情同意这个概念有点用词不当. 我不确定当他们开始接受化疗的时候是否有人知道他们会面临什么, radiation, and surgery. 我认为作为病人，你要做的决定是你是否相信为你大发娱乐提供护理的医生? You sign the document because it's medical-legally required. 但最根本的决定并不是你知道化疗的所有副作用. And so you trust that people are trying to help you.
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