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 usually 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 carcinoma (squamous cell or adenocarcinoma), its staging, and the underlying health of the patient. Some patients are high-risk for surgery and anesthesia because of pre-existing health conditions like heart or lung disease.
Treatment guidelines are continuously being evaluated and revised, based upon the development of new treatments and the results of ongoing clinical trials. Decisions about treatment effectiveness often involve statistical analysis that combines many treatment studies. This meta-analysis helps adjust treatment options and protocols as more patients are enrolled in studies, more data is obtained, and hopefully, better survival is achieved.
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 disease-specific genes 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, specific cancer-fighting medications that try to kill only tumor cells, unlike chemotherapy, which also kills normal cells as a side effect.
If there is high-grade dysplasia confined to 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. The gastroenterologist may be able to resect (remove) the damaged tissue using different techniques.
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.