Esophageal cancer surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]Hadeel Maksoud M.D.[3]
Overview
The predominant therapy for esophageal cancer is surgical resection. Adjunctive chemotherapy and radiation may be required.
Surgery
Stage 0 Esophageal Cancer
Stage 0 squamous esophageal cancer is rarely seen in the United States, but surgery has been used for this stage of cancer[1]
Stage I Esophageal Cancer
Standard treatment options:
- Chemoradiation with subsequent surgery
- Surgery
Stage II Esophageal Cancer
Standard treatment options:
- Chemoradiation with subsequent surgery
- Chemoradiation alone
- Surgery alone
Stage III Esophageal Cancer
Standard treatment options:
- Chemoradiation with subsequent surgery
- Chemoradiation alone
Stage IV Esophageal Cancer
At diagnosis, approximately 50% of patients with esophageal cancer will have metastatic disease and will be candidates for palliative therapy.
Standard treatment options:
- Chemoradiation with subsequent surgery (for patients with stage IVA disease)
- Endoscopic-placed stents to provide palliation of dysphagia
- Radiation therapy with or without intraluminal intubation and dilation
- Intraluminal brachytherapy to provide palliation of dysphagia
- Nd:YAG endoluminal tumor destruction or electrocoagulation
- Chemotherapy has provided partial responses for patients with metastatic distal esophageal adenocarcinoma[2]
Stenting
If the patient cannot swallow at all, a stent may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. A nasogastric tube may be necessary to continue feeding while treatment for the tumor is given, and some patients require a gastrostomy (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for aspiration pneumonia.
[[Image:Stent.jpg|thumb|center|500px|Esophageal stent for esophageal cancer by James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=49111485]
Esophagectomy
Surgery is possible if the disease is localised, which is the case in 20-30% of all patients. If the tumor is larger but localised, chemotherapy and/or radiotherapy may occasionally shrink the tumor to the extent that it becomes "operable"; however, this combination of treatments (referred to as neoadjuvant chemoradiation) is still somewhat controversial in most medical circles. Esophagectomy is the removal of a segment of the esophagus; as this shortens the distance between the throat and the stomach, some other segment of the digestive tract (typically the stomach or part of the colon) is placed in the chest cavity and interposed.[3]
The optimal surgical procedure is controversial. One approach advocates transhiatal esophagectomy with anastomosis of the stomach to the cervical esophagus. A second approach advocates abdominal mobilization of the stomach and transthoracic excision of the esophagus with anastomosis of the stomach to the upper thoracic esophagus or the cervical esophagus.
Laser therapy
Laser therapy is the use of high-intensity light to destroy tumor cells; it affects only the treated area. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help to reduce dysphagia and pain. Photodynamic therapy (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells.
Radiotherapy
Radiotherapy is given before, during or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localized disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.
References
- ↑ Affleck DG, Karwande SV, Bull DA, Haller JR, Stringham JC, Davis RK (2000). "Functional outcome and survival after pharyngolaryngoesophagectomy for cancer". Am. J. Surg. 180 (6): 546–50. PMID 11182415.
- ↑ "Esophageal Cancer Treatment".
- ↑ Deschamps C, Nichols FC, Cassivi SD; et al. (2005). "Long-term function and quality of life after esophageal resection for cancer and Barrett's". Surgical Clinics of North America. 85 (3): 649–656. PMID 15927658.