How is esophagus cancer treated?
Treatment is individualized for each patient. Regardless of the stage, all patients can benefit from some form of treatment. Obviously, the more advanced the disease, the less likely a cure. Even then, treatment can provide relief of symptoms and slow the progression of the disease. Four kinds of treatment are commonly used. They may be used individually, or most commonly, in combination.
- Surgery (taking out the cancer in an operation)
- Radiation therapy (using high-dose x-rays to kill cancer cells)
- Chemotherapy (using drugs to kill cancer cells)
- Endoscopic therapy to destroy some of the tumor with possible stent placement
Surgery is the most common treatment for cancer of the esophagus, but less than 25% of patients are discovered early enough to offer a chance at curative surgery. Most often, it only helps symptoms and delays the progression somewhat. The esophagus is removed and the stomach is connected to the throat so that the patient can still swallow. Sometimes a part of the intestine is used to make the connection. The doctor may also remove lymph nodes around the esophagus and look at them under a microscope to see if they contain cancer.
Radiation therapy uses high energy x-rays to kill cancer cells and shrink tumors. Radiation can be given as an external beam that focuses radiation into the body. It can also be given internally by placing radioative material directly inside the esophagus near the cancer. Internal radiation is called brachytherapy. Radiation treatments are sometimes used before surgery to shrink the tumor before the operation. Radiation therapy can also be used when surgery can't be performed to slow down progression of the tumor and reduce symptoms. This is called palliative therapy.
Chemotherapy uses medications to kill cancer cells. Chemotherapy is called a systemic treatment because the drug is taken by mouth or vein, enters the bloodstream, and can kill cancer cells throughout the body. The problem with chemotherapy is that most drugs not only kill cancer cells, but also some normal cells in the process. This leads to side effects which can be serious, and at times, even life-threatening. The effects of chemotherapy alone are only temporary and cannot cure esophageal cancer, but recent studies suggest that chemotherapy given before surgery may improve overall survival, especially when combined with radiation therapy.
In the most advanced cases, gastroscopy, the scope test mentioned above, can be used to destroy part of the tumor and reopen the passageway. This does not remove the tumor, but does allow the patient to at least swallow a semisolid diet. As the tumor grows, the treatments have to be repeated. This can be done by laser therapy given through the scope to destroy some of the tumor bulk and open the passageway temporarily.
A relatively new technique called Photodynamic Therapy (PDT) is also helpful in some special cases. This procedure is performed by first giving an intravenous injection of a photosensitive chemical that selectively collects in the tumor over a period of several days. Using a gastroscope, a special type of laser light is focused on the cancer activating the concentrated chemical within the cancer cells. This light activation selectively kills the cancer cells and spares the adjacent normal esophagus lining. This procedure is best used to treat early superficial cancer since the wavelength of laser light cannot penetrate beyond the surface of the cancer and cannot treat cancer that has invaded deeper into the body. PDT is being studied as a way to eliminate glandular cells of Barrett's esophagus and early esophageal cancers. It can also help debulk large lesions and help temporarily open the passageway to reduce symptoms. One problem is that the chemical also causes skin sensitivity to sunlight, so patients must avoid direct sunlight for 6 weeks after treatment.
Sometimes a plastic covered metal wire stent is placed across the tumor to help keep the passageway open. This is only done in patients who are terminal since the stent can't be removed and does involve some risk. Eventually, it becomes a losing battle and the cancer wins. It is a depressing situation, but the procedure does help make the last few months more comfortable.
Each case is different, and it is important that patients with this cancer of the esophagus are treated by a team effort. This team is usually made up of their personal physician, a gastroenterologist, an experienced thoracic surgeon, a radiation specialist, and an oncologist (cancer specialist) to coordinate care and provide chemotherapy.
There are certain questions a patient should ask their oncologist once they get over the shock of learning that they have this type of cancer:
- What kind of cancer is it?
- What stage is the cancer in?
- What treatment choices are available?
- What is the expected benefit of each treatment?
- What are the risks and expected side effects of treatment?
- What is the chance for cure?
- If it cannot be cured, how can symptoms be reduced?
- How can my nutrition be maintained?
- Are there any research protocols that would be of benefit?
How is esophagus cancer treated?
