Esophageal Cancer Treatment

  • Treatment

    Urgent care is generally not required for esophageal cancer, as the disease usually progresses slowly. However, urgent care is necessary if the cancer has grown to the point where it obstructs the esophagus. If esophageal cancer obstructs the esophagus, the patient will be very uncomfortable, and will need to spit up normal secretions that can no longer pass down the esophagus. The most urgent risk in the event of an obstruction is the possibility that the secretions can be aspirated into the lungs.

    Eating well is important both during and after treatment for esophageal cancer. Esophageal cancer is debilitating, not only because of the growth of the cancer itself, but also because many people with the disease find it hard to eat enough nutrients to control weight loss and maintain strength. People with esophageal cancer should seek out the advice of a doctor, dietician, or other nutritionist to develop a plan to maintain a healthy diet.

    However, there are a few general guidelines a person with esophageal cancer should consider:

    • Eat several small meals or snacks a day rather than a small number of large meals.
    • Eat softened foods when swallowing is too difficult.
    • In severe cases, nutritional supplements or intravenous feeding may be necessary.

    It is important to stop using tobacco after developing esophageal cancer. Stopping smoking or chewing tobacco will help improve your appetite and reduce your risk of developing new cancers, such as lung cancer or head and neck cancer.

    Some people with esophageal cancer require a feeding tube to help them eat.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Radiation therapy, either alone or in combination with chemotherapy, may be used to treat esophageal cancer. Radiation therapy uses high-energy rays to kill cancer cells. It may be applied externally by having a machine shoot high-energy rays into the body, or it may be applied internally, by placing radioactive materials inside or near the tumor.

    In some cases, after radiation therapy, a plastic tube is inserted into the esophagus to keep it open. This technique is called intraluminal intubation and dilation.

    As is the case with chemotherapy, radiation is not intended to cure the cancer. It may be used before surgery to reduce the size of the tumor, to reduce the symptoms of esophageal cancer, or in cases in which the tumor is inoperable.

    Laser ablation and/or photodynamic therapy may be used to treat esophageal cancer. Laser thermal ablation is a technique in which high-intensity laser light is used to burn off layers of the tumor to help reduce difficulty swallowing. Photodynamic therapy is a different type of laser therapy that uses low-power laser energy in combination with chemicals that make the tumor more sensitive to laser light. The process works as follows: a non-toxic chemical is injected into the blood where it collects in the tumor. A special low-energy laser light is then applied to the tumor through a tube that is inserted into the esophagus. This light causes the chemical inside the tumor to become toxic, and to kill the cancer cells. The advantage over traditional chemotherapy is that the procedure harms very few normal cells, so that higher doses of the drug can be used with fewer side effects. Patients usually tolerate photodynamic therapy better than laser ablation, and experience fewer side effects. Photodynamic therapy has been shown to be effective against some surface esophageal cancers, but like laser ablation, it is used most often to reduce symptoms such as difficulty swallowing.

    Balloon dilation may be used to open a blocked esophagus. As described above, a tumor may block the esophagus, making swallowing difficult. In some cases, a physician will use a balloon catheter in order to open the passageway. The process is similar to that used to open up blocked coronary arteries. A thin, flexible tube is inserted into the esophagus. Once in place, a balloon at the end of the tube is inflated, opening the passageway. To keep the passageway open, a metallic tube called an esophageal stent may be inserted into the esophagus to prevent it from closing after the balloon catheter is removed.

    In some cases when the esophagus is blocked by a tumor, or when the tumor has caused a passage to form between the esophagus and the windpipe, an esophageal stent may be inserted to provide structural support. An esophageal stent is a tube of metallic mesh, usually covered with plastic, that is inserted into the esophagus to provide support to keep the esophagus open. A stent may also be implanted when the tumor has caused an abnormal opening between the esophagus and the windpipe or other airway (an esophagorespiratory fistula). An esophageal stent does not affect the cancer itself; it is a treatment intended to allow an affected person to continue to swallow despite having a tumor or fistula.

    Surgery is the most common treatment for esophageal cancer. Depending on the stage of the cancer, the tumor and/or surrounding tissue may be removed. An esophagectomy is a procedure in which the part of the esophagus that has the tumor is removed, and the stomach is reattached to the remaining esophagus. An esophagogastrectomy is a procedure in which the surgeon removes the tumor along with all or a portion of the esophagus, the nearby lymph nodes, and the upper part of the stomach. The stomach that remains is then connected to the remaining esophagus. Sometimes a plastic tube or part of the small intestine is used to make the connection.

    Surgery may cure some patients when the cancer is localized, but in most cases the cancer has spread beyond the esophagus by the time it is diagnosed. In about 25% of cases in the U.S., the cancer is detected before it spreads beyond the esophagus. In these cases, surgery may cure the disease. In the vast majority of cases, however, the cancer has spread beyond the esophagus by the time it is detected, and surgery is intended to alleviate the symptoms, allowing the patient to swallow as normally as possible. Doctors are also investigating ways to treat Barrett's with x-rays and other methods of ablation in order to keep it from coming back.

    The long-term prognosis for patients with esophageal cancer depends on how early it is diagnosed and treated. When esophageal cancer is identified early (eg, in Stage I), the 5-year survival rate is approximately 60% according to the American Cancer Society. The prognosis steadily worsens as the cancer is detected later in its course. At Stage III, when the cancer has spread beyond the esophagus to adjacent tissues, the 5-year survival rate averages 15%. When the cancer has spread to distant organs (Stage IV), the 5-year survival rate is less than 5%.

    Consistent medical follow-up is important to determine whether the cancer will return or progress. After diagnosis and treatment, your physician will schedule periodic follow-up visits. These visits may include upper gastroinstestinal x-rays, barium swallows, CT scans, or endoscopy to watch for a recurrence, spread of an existing tumor, or development of a new tumor.

    After treatment, patients with esophageal cancer should be vigilant for any new symptoms. Because new symptoms may indicate a change in your condition, you should report them—especially difficulty swallowing or pain—promptly to your physician.

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