Esophagus Cancer Treatment
Treatment of esophageal cancer often times requires multiple treatment modalities including chemotherapy, immunotherapy, radiation and surgery.
As such, a highly experienced multidisciplinary team is critical to successful treatment. Individuals with very early stage disease are often treated with endoscopic treatments (endomucosal resection, ablation) or surgery.
Symtomatic Tumors
Few patients present with early stage disease that is asymptomatic. Patients with symptomatic tumors may require several therapies. 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 some sort of 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 often a mainstay of esophageal cancer treatment and can be performed in a variety of ways. Because this type of operation is not common in many hospitals, it is critical thtat an esophageal surgeon is consulted. Surgery can last from 6 to 7 hours. Patients can expect to stay in the hospital between 7 and 10 days. Addtional recovery at home can take from 4 to 6 weeks.
Esophageal Cancer Surgery
Surgery offers the best chance for cure for esophageal cancer. In some cases, surgery may involve part of the stomach, known as a partial gastrectomy. Removal of the entire stomach is referred to as 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 using minimally invasive techniques resulting in shorter hospital stays and quicker recovery times.
Robot-assisted Surgery – A Minimally Invasive Approach
Minimally invasive approaches have revolutionized recovery from esophageal cancer resections. At St. John’s, we offer Robot Assist Minimally Invasive Esophagectomy (RAMIE). The surgeon constrol robotic instruments and tools from a control console near the patient which uses 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, as well as local therapies such as Photodynamic Therapy (PDT)—a two-stage treatment that 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 rays or particles to kill cancer cells. There are several ways to deliver radiation therapy.
External radiation, also known as external beam therapy, uses high engery radiation directly to the site of the cancer, which prevents abnormal cells from replicating and cause 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 high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury 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 stomach cancer. In patients with more advanced stomach cancer where surgery is not possible, chemotherapy may also improve both the length and quality of life.
Immunotherapy for Esophageal Cancer
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 parts of the cancer that have remained illusive. Immunotherapy is a form of biologic therapy. If the tumor cannot be removed by surgery, or is recurrent, immune checkpoint inhibitor therapy may be useful to treat patients with advanced esophageal cancer.
Targeted Therapy for Esophageal Cancer Cancer
Targeted therapy is a type of treatment that uses drugs to identify and attack specific cancer cells, which usually cause 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.
Our Esophageal Cancer Team
If you have questions about esophageal cancer treatment, including the stomach, please call today. Click here to request an appointment.
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