What are the treatments for esophageal cancer?
The approach to treatment is individualized to each patient's situation. Recommended treatments depend on the stage and health of the patient.
Esophageal cancer is often found in older patients who have other underlying illnesses which complicates 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 surgical procedure for esophageal cancer is removal of the esophagus (Esophagectomy = esophagus + ectomy = removal). This is often recommended for patients with stage II or III cancer. Those with stage IV cancer may not be surgical candidates because of poor prognosis. Certain patients may not be appropriate candidates for surgery because the cancer has spread to adjacent structures like the heart or lung. Some patients may not be candidates for surgery because of underlying medical illnesses, such as advanced heart or lung disease or diabetes that would increase the risk of death during or shortly after surgery.
Esophagogastrectomy is occasionally required if the cancer also involves parts of the stomach.
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 for four to six weeks after the diagnosis is made to allow the chemotherapy and radiation to be administered.
Chemotherapy and radiation therapy after surgery have not been shown to increase survival.
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.