Treatment of esophageal cancer

Oct 14, 2018

Esophageal cancer treatment is dependent on the staging of the cancer. If the cancer has not spread surgery is the treatment of choice. Surgery aims to remove the cancer.

Other modalities of therapy like radiation therapy and chemotherapy are also of use in oesophageal cancer.

Combining these therapies is also applied at times to ease the surgery and improve the chances of a better outcome.

If the patient is too ill to have major surgery or the cancer has spread to other organs, chemotherapy or radiation may be the first choice to reduce the symptoms as much as possible. This is called palliative therapy. The disease at this stage is not curable. (1-5)

Which therapists are involved in treating esophageal cancer?

The teams for therapy of esophageal cancer are usually multidisciplinary.

The team includes a gastroenterologist, who specializes in treating problems of the digestive organs, chest surgeons, thoracic surgical oncologists (cancer specialists), radiation oncologists etc.

There may also be an oncology nurse and a registered dietitian.

If lungs are affected a chest physician may be included.

Therapy depends on the stage of esophageal cancer

Therapy modalities in oesophageal cancer include (1-5) –

For Stages 1 to 3 – Surgery is recommended. This type of surgery is called esophagectomy. Chemotherapy is usually given before surgery to decrease the risk of the cancer recurring.
Stage 4 cancer - Radiotherapy and chemotherapy are sometimes offered to slow down the spread of the cancer and reduce the symptoms. Surgery usually does not help.

Surgical therapy

Esophagectomy – The surgery involves removal of the affected part of the esophagus and examination and possible removal of the surrounding lymph nodes.

If the lymph nodes are affected they may need removal. The remaining part of the esophagus will then be reconnected to the stomach.

The surgery is performed under general anesthesia and needs an incision over the chest, abdomen or over the neck depending on the location of the tumor.

Chemotherapy

Anticancer drugs are administered in cycles. These kill the cancer cells or stop them from multiplying.

These medicines can either be injected or given by mouth.

Since these drugs are powerful and attack normal cells as well as cancer cells there are numerous side effects of chemotherapy medications.

Common side effects include nausea, vomiting, hair loss, diarrhea, sores in the mouth, weakness, vulnerability to infections etc.

These side effects reduce after completion of chemotherapy.

Radiotherapy

Radiotherapy uses radiation from high energy beams to reduce the size of the tumor and reduce the pain and other symptoms.

Radiation therapy causes side effects like skin rashes and burns, tiredness, loss of appetite and sores in the mouth and esophagus. These side effects reduce with time.

Radiation therapy is usually of two types – external or internal (brachytherapy).

In external radiation therapy a large machine outside the body sends in the radiation into the affected area. Treatments are usually several sittings over several weeks.

For brachytherapy the throat is numbed and a tube is placed within the esophagus. It emits radiation steadily. Once therapy is complete the tube is removed. This takes only a single session.

Supportive or palliative therapy

Some measures to reduce symptoms and improve swallowing include (1-5) :

Endoscopic dilation – Sometimes the constricted esophagus is dilated and a stent is placed to keep it open. This helps in swallowing and reduced symptoms.
Photodynamic therapy – A special drug is injected into the tumor and it is exposed to laser therapy or light. The light activates the medicine to attack and kill the tumor cells.
Electrocoagulation is another type of palliative treatment that helps kill cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing an obstruction caused by the tumor.
Nutritional therapy – If there is severe difficulty in swallowing, the patient may be at risk of malnutrition and dehydration.

The problem is aggravated if there is a tracheoesophageal fistula. This is a hole and a passage between the esophagus and the trachea or windpipe.

This may lead to movement of the swallowed contents in the lungs and complications like aspiration, choking, pneumonia etc.

Nutrition may be provided intravenously in the form of liquids. Sometimes a percutaneous endoscopic gastrostomy (PEG) tube is inserted surgically into the stomach and food is passed directly into it.

Prevention of esophageal cancer

Risk of esophageal cancer may be reduced by taking certain lifestyle measures and precautions. These include (1):

Avoidance of smoking and drinking
Early management of acid reflux disorder and Barrett’s esophagus
Eating a healthy balanced diet and exercising regularly.