Esophageal Cancer Treatment

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). Esophageal cancer has been categorized into two types that include:

• Adenocarcinoma: This type of esophageal cancer starts in the glandular tissue in the lower part of the esophagus. The stomach and the esophagus appear together in this lower part of esophagus.

• Squamous Cell Carcinoma: Squamous cell carcinoma begins in the squamous cells lining the esophagus. This type of esophageal cancer typically occurs in the middle and upper part of the esophagus.

Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include painful or difficulty in swallowing, weight loss and coughing up blood. Risk factors for developing esophageal cancer include:

• Smoking
• Heavy Drinking
• Damage from acid reflux
• Frequent choking while eating
• Chest burning, pain or pressure

Stages of Esophageal Cancer

•  Stage 0: In this stage, the abnormal or unusual cells can only be seen in the layer of cells lining the esophagus.

• Stage 1: The first stage is marked by the presence of cancer cells in the layer of cells lining the esophagus.

• Stage 2: In the second stage, the cancer has reached to the outer wall of the esophagus or to the muscle layer of the esophagus. Also these cancer cells may have invaded 1-2 surrounding lymph nodes.

• Stage 3: The third stage is marked by the spread of the cancer into the connective tissue wall or deep into the inner muscle layer. Also this cancer has spread to more lymph nodes close to esophagus and they may also spread beyond esophagus in the surrounding organ.

• Stage 4: This is considered as the advanced stage of esophageal cancer. Now the cancer has spread to lymph nodes far away from the esophagus or to different organs.

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Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include: difficult or painful swallowing, severe weight loss, pain in the throat or back, behind the breastbone or between the shoulder blades, chronic cough, Vomiting and / or Coughing up blood.

Barium Swallow or Upper Gastrointestinal (GI) X-rays: Esophageal cancers grow from the wall of the esophagus into the opening of the esophagus, creating a tumor or bump inside the esophagus. Barium in liquid form is used to coat the esophagus wall before the x-ray is taken, allowing the x-ray to show the esophagus clearly.

Upper Endoscopy for Esophageal Cancer: Upper endoscopy is a procedure involving use of an endoscope, which is a flexible, very narrow tube with a video camera and light on the end. The patient is sedated to allow for this tube to pass through into the esophagus and stomach. The camera is connected to a television and doctor to sees abnormalities in the wall of the esophagus clearly. Endoscopy is important test for diagnosing esophageal cancer.

Endoscopic Ultrasound for Esophageal Cancer: An endoscope with a small ultrasound probe attached to its end is used. The probe sends very sensitive sound waves that penetrate deep into tissues. The sound waves bounce off the normal tissues and the cancer are picked up by the probe and determine how deeply the tumor has invaded into the esophagus.

Bronchoscopy for Esophageal Cancer: This procedure is similar to an upper endoscopy except in this instance the doctor looks into the trachea (windpipe) and bronchi (tubes leading from the trachea to the lung). The patient is sedated the procedure.

Positron Emission Tomography for Esophageal Cancer: In this test, radioactive glucose (sugar) is injected into your vein. Because cancers use sugar much faster than normal tissues, the cancerous tissue takes up the radioactive material. A scanner can spot the radioactive deposits. It may be a useful test for staging the cancer.

Thoracoscopy and Laparoscopy for Esophageal Cancer: These procedures allow the doctor to see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. The surgeon can operate instruments through the tube and remove lymph node samples and biopsy organs to see whether they contain cancer cells. It is often important to decide whether a person is likely to benefit from surgery.

Biopsy for Esophageal Cancer: During an endoscopy or other procedure, the doctor will remove a small piece of tissue. This tissue is then examined by a pathologist who examines the tissue to determine whether cancer cells are present and if so, their type. It usually takes a couple of days to get the results of a biopsy.

• Surgery: The surgical procedure for removing the entire or a part of the esophagus depends on the location and size of the tumor. There are a number of surgical procedures for reaching to the esophagus. The surgical procedure can remove nearby soft tissues, a section of the esophagus and the lymph nodes. The entire or a part of the stomach can also be removed. The cancer is removed by making several incisions in the abdomen and chest. In majority of cases, the stomach is pulled up and is then joined with the remaining portion of the esophagus. Also, a part of the intestine is used for connecting the stomach with the esophagus remaining part. A part of large intestine or small intestine may also be used. A part of the intestine is used when the stomach is removed for joining it with the left over part of the esophagus to the small intestine.

• Radio Therapy: High-energy radiation beams are targeted on the cancerous tissue in order to destroy it. Radiotherapy is usually used in addition with either chemotherapy or surgery. Radiotherapy can be categorized into two different types for treating esophageal cancer that include :

o Internal Radiotherapy: A small radioactive implant is placed close to the cancerous tumor for removing and destroying it.

o External Radiotherapy: This therapy makes use of machine that is placed outside the body. This machine helps in directing the radiation on the cancer for the purpose of destroying it.

• Chemotherapy: People with esophageal cancer can also be treated with the help of chemotherapy. This therapy makes use of certain drugs that helps in destroying the cancer cells. The injection of these drugs is done into a vein (intravenous) that then travels throughout the different parts of the body.

• Radiofrequency ablation (RFA): In this outpatient procedure, controlled bursts of radiofrequency energy burn away thin layers of abnormal tissue on the surface of the esophagus, leaving healthy tissue intact. Radiofrequency ablation takes about 45 minutes, and patients can usually return to their normal activities the next day, though some patient may experience chest pain and difficulty swallowing for about a week.

• Photodynamic Therapy: A form of treatment that uses a photosensitizing agent, administered by mouth or intravenously, which concentrates selectively in certain cells, followed by exposure of the involved tissue to a special light (such as laser or ultraviolet light), in order to destroy as much of the abnormal tissue as possible. For example, photodynamic therapy is used to treat some forms of cancer and psoriasis.