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This information represents
the views of the doctors and nurses serving on the American Cancer
Society's Cancer Information Database Editorial Board. These views are
based on their interpretation of studies published in medical journals,
as well as their own professional experience.
The treatment information
in this document is not official policy of the Society and is not
intended as medical advice to replace the expertise and judgment of
your cancer care team. It is intended to help you and your family make
informed decisions, together with your doctor.
Your doctor may
have reasons for suggesting a treatment plan different from these
general treatment options. Don't hesitate to ask him or her questions
about your treatment options.
After the cancer is found and staged, your doctor will talk to
you about a treatment plan. There is a lot for you to think about when
choosing the best way to treat or manage your cancer. There may be more
than one treatment to choose from. Give yourself time to absorb the
information you have learned.
You may want to get a second opinion. A second opinion can
give you more information and help you feel good about the treatment
you choose. Some insurance companies require you to get a second
opinion before they will agree to pay for treatments.
Surgery, chemotherapy, and radiation are used to treat early
cancer of the esophagus. Other treatments may be used for early cancers
and pre-cancers of the esophagus. There are also treatments to help
relieve symptoms such as pain and blockage.
Surgery
How much surgery is done depends on the stage of the cancer.
Surgery can also be used along with other treatments such as
chemotherapy and radiation treatment.
Esophagectomy
Surgery to remove all or part of the esophagus is called an esophagectomy.
Often a small amount of the stomach is removed, too. When the esophagus
is removed as treatment for cancer, lymph nodes near the esophagus are
also removed. The top of the esophagus is then reattached to the
stomach, or the surgeon may replace the removed part of the esophagus
with a piece of the small or large intestine.
While surgery can cure some patients whose cancer has not
spread beyond the esophagus, often these cancers are not found early
enough. So it's important to know whether the goal of surgery is it to
try to cure the cancer or to ease symptoms.
Different methods of esophagectomy
There are several different ways to do surgery for esophagus
cancer. All of these surgeries are complex. Surgeons who do this
surgery must be experts. You should feel free to ask your surgeon about
his or her experience with these operations and how many were
successful. The success rate is higher when the surgery is done in a
hospital where it is done often.
Open
esophagectomy: The main cut (incision) is in either the
chest or the belly (abdomen). Some methods involve incisions in the
neck, chest, and abdomen. You and your surgeon should discuss in detail
the operation planned for you and what you can expect. The surgeon may
use pictures to describe how the operation will be done. No matter what
approach is used, this is not a simple operation and it may require a
long hospital stay.
Minimally
invasive esophagectomy: Sometimes surgeons are able to do
the operation using a laparoscopic approach. This means that small cuts
are made through which the doctor uses tiny tools, something like a
telescope, to look inside the body. The surgery itself is done through
even smaller cuts.
In order to do this type of surgery well, the surgeon needs to
be highly skilled and have a great deal of experience removing the
esophagus this way. When successful, this surgery allows the patient to
leave the hospital sooner and recover faster. This approach is used
most often for early (small) cancers.
Risks and side effects
Like most serious operations, surgery of the esophagus has
some risks. A heart attack or a blood clot in the lungs or the brain
can happen during or after surgery. There may be a leak at the place
where the stomach is reconnected to the esophagus. After surgery, the
stomach may empty too slowly. This can, in a few cases, lead to
frequent nausea and vomiting.
Infection is a risk with any surgery. And some patients have
trouble swallowing after surgery. To relieve this symptom, these narrow
places can be stretched during an upper endoscopy. After surgery, bile
and stomach contents can enter the esophagus because the lower
esophageal sphincter is often removed or changed by the surgery. This
can cause symptoms such as heartburn. Sometimes antacids or other drugs
can help relieve these symptoms.
Some complications from surgery can be very serious, even
fatal. It is important to have a surgeon with experience and a hospital
where these operations are done often. Don't be afraid to ask the
surgeon about his or her experience and about the survival rates at the
hospital.
Radiation therapy
Radiation therapy is treatment with high energy rays (such as
x-rays) to kill cancer cells or shrink tumors. External radiation uses
a beam from outside the body. This is the kind most often used for
cancer of the esophagus. For internal or implant radiation, radioactive
"seeds" are placed directly inside the tumor.
Radiation therapy by itself will not cure esophagus cancer.
Often it is used along with surgery and/or chemotherapy. It is also
used to relieve problems with swallowing, pain, or other symptoms of
this cancer.
Side effects of radiation treatment may include:
- skin changes -- ranging from something like a sunburn to
blistering and open sores
- nausea and vomiting
- diarrhea
- extreme tiredness (fatigue)
- painful sores in the mouth and throat
These side effects may be worse if chemo and radiation are
given at the same time. And often these side effects go away when
treatment ends. Radiation to the chest may cause lung damage and lead
to trouble breathing and shortness of breath. If you have these or
other side effects, talk with your doctor since there are often ways to
relieve them.
Chemotherapy
Chemotherapy (often called simply "chemo) refers to the use of
drugs to kill cancer cells. Usually the drugs are given into a vein or
by mouth. Once the drugs enter the bloodstream, they spread throughout
the body.
Chemo by itself rarely cures esophageal cancer. Often it is
combined with radiation or surgery.
Chemo is used in 3 ways:
- It can be used to ease the symptoms of advanced cancer.
- It can be given along with radiation to shrink the cancer.
- It can be used before surgery to shrink a tumor and make it
easier to remove.
Chemo can have some side effects. These side effects will
depend on the type of drugs given, the amount taken, and how long
treatment lasts. The most common side effects can include:
- nausea and vomiting
- loss of appetite
- hair loss
- mouth sores
- increased chance of infection (from a shortage of white
blood cells)
- bleeding or bruising after minor cuts or injuries (from a
shortage of blood platelets)
- tiredness or shortness of breath (from a shortage of red
blood cells)
Most side effects go away once treatment is over. Anyone who
has problems with side effects should talk with their doctor or nurse
as there are often ways to help.
People with esophageal cancer often have problems with weight
loss before the cancer is even found. Treatment like chemo and
radiation can cause painful sores in the mouth and throat, which can
make it hard to eat and get good nutrition. Some people with esophagus
cancer need to have a feeding tube put in before treatment. This allows
liquid "food" to be put right into the intestine. A feeding tube can
help prevent further weight loss. It may help make treatment easier to
tolerate.
Other types of treatments
PDT (photodynamic therapy)
This method may be used when the cancer has been found very
early or has come back after other treatment. First, a harmless
chemical is put into the bloodstream. It collects in the tumor for a
few days. Then a special type of laser light is focused on the cancer
through an endoscope. The light changes the chemical collected there
into a new chemical that can kill cancer cells.
PDT is useful because it can kill cancer cells with very
little harm to normal cells. But because the light must be used, it can
reach only cancers near the surface of the esophagus. It doesn't work
for cancers that have spread deeper or into other organs.
Side effects of PDT include redness or discoloration of the
skin and sensitivity to the sun or other light sources. Because of
this, people having this treatment may be told to stay indoors for
about 6 weeks.
At this time, the main use of PDT is to relieve symptoms of
advanced cancer that are blocking the esophagus. It is also being used
to treat Barrett esophagus and very early cancers found in Barrett
esophagus. Researchers are looking at the use of PDT in comparison to
other treatments such as surgery or the use of lasers.
Laser ablation
This method uses a laser that is aimed through the endoscope
to kill cancer cells. It is used to open up the esophagus when it is
blocked. This can help improve problems with swallowing.
Radiofrequency ablation (RFA)
In this method, a balloon is passed into an area of Barrett
esophagus. It is inflated so that the surface of the balloon is in
contact with the inner lining. Then high-power energy is passed through
the balloon to kill the cells in the lining. Normal cells grow in to
replace the Barrett cells. The patient needs to stay on drugs to block
acid production after the procedure. Endoscopy (with biopsies) then is
done to watch for any further changes in the lining of the esophagus.
Argon plasma coagulation
This is a method something like laser ablation. It is also
used to unblock the esophagus when the patient has trouble swallowing.
Electrocoagulation
This method involves burning the tumor off with electric
current. In some cases, this treatment can help relieve esophageal
blockage.
Survival rates by stage
Because this cancer is usually found at an advanced stage,
many people will die of the disease. But survival rates have been
getting better. Talk with your cancer care team if you have questions
about your own chances of a cure, or how long you might survive your
cancer. They know your situation best.
The 5-year survival rate is the percentage of patients who are
alive 5 years after diagnosis (leaving out those who die of other
causes). Of course, patients might live more than 5 years after
diagnosis.
| Stage |
5-year
relative survival rate |
| 0 |
greater than 95% |
| I |
50% to 80% |
| IIA |
30% to 40% |
| IIB |
10% to 30% |
| III |
10% to 15% |
| IV |
less than 5% |
These numbers describe the outcomes of patients whose cancer
was found and treated several years ago (before 2000). Treatment and
care has improved since that time, and people diagnosed today may have
better outcomes.
Last Medical Review: 05/28/2009 Last Revised: 05/28/2009
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