How We Treat Esophageal Cancer

Esophageal-multi-disciplinary care team
A multi-disciplinary team, including radiation oncology, surgical oncology, and medical oncology, are essential to maximize patient outcomes.

Treatment of esophageal cancer often requires multiple treatment modalities working together, including chemotherapy, immunotherapy, radiation and surgery.

The gastrointestinal team at Saint John’s is multidisciplinary and highly experienced, treating thousands of patients each year. Individuals with very early-stage cancer of the esophagus are often treated with endoscopic treatments (endomucosal resection, ablation) or surgery.


Symptomatic Tumors

Few patients present with early-stage disease that is asymptomatic—not revealing any symptoms. Patients with symptomatic tumors may require several therapies to overcome the cancer. Those patients with disease localized to the esophagus and nearby lymph nodes are generally offered a course of chemotherapy and radiation for approximately six weeks and is followed by surgery. Frequently this group of patients will receive immunotherapy after they have completed surgery. Patients with disease that has spread through the blood generally are not candidates for surgery and are treated with a combination of chemotherapy, immunotherapy, and occasionally radiation.

In addition to traditional therapies for treatment of esophageal cancer, there are a number of important areas of care that will be addressed by the treatment team. One of the most critical is nutrition. For symptomatic esophageal cancer, an oncology nutritionist is a critical part of the patient’s care team. Often, patients will require a temporary feeding tube for daily nourishment. In addition, a balanced diet of high-quality food is also critical. Physical therapists and occupational therapists are often needed to assist the patient after surgery.

Surgical therapy is the primary treatment for esophageal cancer and can be performed in a variety of ways. Because this type of operation is not common in many hospitals, while esophageal surgery can last from 6 to 7 hours, it is critical that an esophageal surgeon specialist is consulted. Patients can expect to stay in the hospital between 7 and 10 days. Additional recovery at home can take from 4 to 6 weeks.

Click here to learn more about Esophageal Cancer Symptoms and Risks.

Esophageal Cancer Surgery

Surgery offers the best chance for cure for esophageal cancer. In some cases, esophageal surgery may involve removing part of the stomach, known as a partial gastrectomy. Removal of the entire stomach is called a total gastrectomy. Both surgeries involve removal of surrounding lymph nodes. The surgeons at the Saint John’s Cancer Institute have extensive experience in performing this surgery if necessary, using minimally invasive techniques that result in shorter hospital stays and quicker recovery.

Robot-assisted Surgery – A Minimally Invasive Approach

Robot-assisted minimally invasive esophagectomy uses smaller incisions that result in faster recovery and shorter hospital stays.

Minimally invasive approaches have revolutionized recovery from esophageal cancer resections. At St. John’s, we offer Robot Assist Minimally Invasive Esophagectomy (RAMIE). The surgeon controls the robots’ instruments and viewing tools from a remote console near the patient, which involves using smaller incisions that traditional, open surgery. Our surgeons complete these procedures in just 4 to 5 hours with excellent short term and long-term results. Minimally invasive surgery requires less recovery time, shorter hospital stays, and there is less pain involved.

A variety of other services are offered for esophageal cancer as well, including stenting of unresectable tumors to improve swallowing function. In addition, localized therapies, such as Photodynamic Therapy (PDT)—a two-stage treatment, combines light energy with a photosensitizer (a drug) designed to destroy cancerous and precancerous cells after light activation.

Radiation Therapy for Esophageal Cancer and the Stomach

Radiation therapy uses high-energy particles to bombard and kill cancer cells. There are several ways to deliver radiation therapy.

External beam radiation therapy for esophageal and stomach cancer
External beam radiotherapy uses specialized technology to target the treatment area while avoiding surrounding tissues.

External radiation, also known as external beam therapy, uses high energy x-rays directly to the site of the cancer, which prevents abnormal cells from replicating and causes the tumor to wither. Since radiation is used to kill cancer cells and shrink tumors, special care is taken not to treat the health surrounding tissue. External radiation may be used after surgery to try to kill any remaining cancer cells or for more advanced stomach cancer to ease symptoms such as pain.

Blockage IMRT is a type of 3-D radiation therapy that targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers higher doses of radiation to cancerous tissue with greater precision, working to spare surrounding organs and reducing risk to healthy tissues.

Chemotherapy for Esophageal Cancer

Chemotherapy is used to treat cancer either by itself or in combination with surgery and/or radiation therapy. It may be given to patients whose esophageal cancers have invaded the layers of the stomach wall, lymph nodes, and nearby organs. Chemotherapy may be used before surgery (neoadjuvant therapy) to shrink the tumor, or it may be given after surgery (adjuvant therapy) to kill any remaining cancer cells.

When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to esophagial cancer. In patients with more advanced esophageal cancer where surgery is not possible, chemotherapy may also improve both the length and quality of life.

Immunotherapy for Esophageal Cancer

As a form of biology therapy, immunotherapy uses the patient’s immune system to fight the cancer. Sometimes the body’s natural defenses require a boost to fight cancer, which may require directing it to recognize key parts of the cancer that have allowed it to remain ellusive. If the tumor cannot be removed by surgery or is recurrent (cancer returns after a period of time), immune checkpoint inhibitor therapy may be useful to treat patients with advanced esophageal cancer.

Targeted Therapy for Esophageal Cancer

Targeted therapy is a type of treatment that uses drugs to identify and attack specific cancer cells, which usually causes less harm to normal cells than chemotherapy or radiotherapy. Monoclonal antibody therapy is a type of targeted therapy used in the treatment of esophageal cancer.

Call today to learn more about esophageal cancer diagnosis and treatment. Our multi-disciplinary team is ready to support you.

If you have questions about esophageal cancer treatment, including the stomach, please call today. Click here to request an appointment.

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