Esophageal Cancer (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
- Esophageal cancer facts
- What is the esophagus?
- What is esophageal cancer?
- What are risk factors and causes of esophageal cancer?
- What are the symptoms and signs of esophageal cancer?
- How do health care professionals diagnose esophageal cancer?
- How do physicians determine esophageal cancer staging?
- What are the stages of esophageal cancer?
- What are the treatments for esophageal cancer?
- What kinds of doctors treat esophageal cancer?
- What are the statistics related to esophageal cancer?
- What support is available for those with esophageal cancer?
- What is the prognosis with esophageal cancer? What is the survival rate for esophageal cancer?
- Is it possible to prevent esophageal cancer?
- Find a local Oncologist in your town
What are the stages of esophageal cancer?
The stages of esophageal cancer can be complicated and are related to the following:
- T1 to T4: This depends on total tumor depth and what layers of the esophagus have been invaded by the cancer.
- N0 to N3: This refers to the number of lymph nodes containing cancer.
- M0 to M1: This refers to whether there are metastases to distant organs, usually lung, liver, and bone.
Stages are as follows:
- Stage IA: T1, N0, M0
- Stage IB: T2, N0, M0
- Stage IIA: T3, N0, M0
- Stage IIB: T1, T2, N1, M0
- Stage IIIA: T4a, N0, M0; or T3, N1, M0; or T1, T2, N2, M0
- Stage IIIB: T3, N2, M0
- Stage IIIC: T4a, N1, N2, M0; or T4b, any N, M0; or any T, any N, M1
- Stage IV: any T, any N, M1
What are the treatments for esophageal cancer?
The approach to cancer treatment is individualized to each patient's situation. Recommended treatments depend on the stage and health of the patient. A team of physicians will help decide with the patient and family what might be the best approach to their specific situation. These providers may include specialists in medical oncology, radiation oncology, and surgery, in addition to the patient's primary care provider.
Esophageal cancer is often found in older patients who have other underlying illnesses that complicate treatment. Esophageal cancer is often diagnosed late in the course of the disease because symptoms often occur only after a tumor has grown and potentially spread. Most often, if the patient can tolerate it, treatment consists of a combination of chemotherapy, radiation therapy, and surgery.
The National Comprehensive Cancer Network maintains up-to-date guidelines based upon ongoing clinical trials that allow cancer specialists to offer treatment advice to patients and family.
The decision to undergo surgery and the type of surgery that might be appropriate depends upon the type of esophageal cancer, its staging, and the underlying health of the patient. Treatment guidelines are continuously being evaluated and revised, based upon the development of new treatments and the results of ongoing clinical trials.
Surgery may involve esophagectomy or removal of the whole esophagus.
Some patients are able to have the removed esophagus replaced with another piece of bowel to connect the mouth to the stomach. If that is not possible, percutaneous gastrostomy may be required to get food and fluid into the stomach to be digested. A tube is placed through the skin and anchored into the stomach to allow tube feedings.
Chemotherapy and radiation
Chemotherapy and radiation therapy (also called external beam radiation) may be administered prior to surgery to help shrink the tumor. There are a variety of chemotherapy protocols that may be considered. Surgery may be delayed after the diagnosis is made to allow the chemotherapy and radiation to be administered.
Chemotherapy and radiation therapy that have been started after surgery have not been shown to increase survival. However, there may be a benefit to survival when these therapies are continued after surgery, if they were started before the operation.
There are specific genes that are associated with esophageal cancer. In certain circumstances, the tumor can be tested to see whether genes like HER2 are present. Targeted medications can attach or bind to different protein sites on the tumor cells and inhibit tumor growth. This is immunotherapy, which tries to kill only tumor cells, unlike chemotherapy, which also kills normal cells as a side effect.
If the esophageal cancer is confined the walls of the esophagus with no spread to the lymph nodes or distant organs (stage I), surgical removal of the tumor may be accomplished via endoscopic procedure.
Light therapy may be used to treat esophageal cancers that are small in size and have not spread or metastasized. In this treatment, a photo-sensitizing drug is injected into the body where it is absorbed by cells, where they can last for two to three days. However, cancer cells seem to keep a concentration of the drug longer. When the patient is exposed to light from a laser, the drug may kill the cancer cell.
This type of treatment is limited because light cannot penetrate deeply into the body and is effective in only small tumors. At present, photodynamic therapy is approved for esophageal cancer and non-small-cell lung cancer.
Get the latest treatment options.