Treatment for esophageal cancer has improved significantly with advances in imaging technology and more precise staging of the disease. Patients are now living longer and with a greater quality of life than they were just 10 years ago.
Treatment will depend on the size and extent (stage) of the tumor, its location, and your overall general health. The Thoracic Oncology Tumor Board — a multi-disciplinary group of experts from thoracic surgery, medical oncology, radiation oncology, gastroenterology, radiology and pathology — reviews each patient's case and creates a comprehensive treatment plan.
Because Virginia Mason is a high-volume medical center for treating esophageal cancer, our patients have survival outcomes that exceed national averages. Patients come to Virginia Mason from all over the United States to be treated for this disease.
Individuals who are not candidates for surgery benefit from medical and technological advances available at Virginia Mason.
Endoscopic mucosal resection (EMR) is a procedure in which the top layer of esophageal tissue, called the mucosal layer, is removed by an endoscope. In time, another layer of tissue will grow back in its place. This procedure is often used in precancerous conditions, such as Barrett's Esophagus, and even some very early stage esophageal cancers.
Photodynamic therapy, a form of light or laser therapy, is currently being studied in clinical trials as a potential treatment for early stage cancer. Patients receive an injection of a light-sensitive drug that is “taken up” in cancer cells. Laser light at the end of an endoscope is then applied to the tumor, which activates the drug and kills the cancer.
Results can be remarkable — some patients who could not swallow solid food are able to eat a nearly normal diet within four to five days of treatment.
Surgery is the most common treatment for esophageal cancer and often is curative when the cancer has not spread beyond the esophagus. In more than 50 percent of cases, we can perform esophageal surgery with the use of a robot. This improves recovery and minimizes post-operative pain.
There are two types of surgery for esophageal cancer:
During this procedure, your surgeon will remove the portion of the esophagus that contains cancer along with the nearby lymph nodes. The doctor will then connect the remaining portion of your esophagus to your stomach.
An esophagectomy is performed in patients with early stage disease, in which the cancer has not spread to the stomach.
In this procedure, the portion of the esophagus with cancer, the upper portion of the stomach and nearby lymph nodes are removed. The remaining portion of the stomach is then connected to the remaining portion of the esophagus. Your surgeon may first replace the part of the esophagus that was removed with a section of the large intestine before connecting it to the stomach. This procedure is called a colonic interposition.
Chemotherapy is the use of powerful anti-cancer drugs that kill cancer cells by interfering with their ability to reproduce. These drugs are used to shrink the tumor and help stop the spread of the disease.
Chemotherapy for esophageal cancer may be used before or instead of surgery. Chemotherapy drugs commonly used for esophageal cancer include cisplatin and 5-fluorouracil (5-FU). Other chemotherapy drugs, such as paclitaxel (Taxol), carboplatin and CPT-11 (Irinotecan), are being investigated in clinical trials. Typically, chemotherapy is given over a period of three to six months.
Radiation therapy uses high-energy rays aimed at the tumor site to kill or shrink cancer cells. Radiation therapy, when used in combination with chemotherapy, is more effective in helping shrink esophageal cancer tumors than radiation therapy on its own.
Radiation therapy may consist of treatment with an external beam of radiation focused on the cancer site, or placement of radioactive seeds, called brachytherapy, near the tumor. The seeds deliver higher doses of radiation because the radiation is not first passing through normal tissue.
Palliative therapy is intended to relieve symptoms rather than treat the disease. Patients who receive palliative treatment have cancer that is too far advanced to be treated surgically, including cancer that has spread to distant organs or lymph nodes, or have cancer that has recurred and is inoperable.
Palliative care treatments include:
Even with palliative measures, many patients experience pain because an esophageal tumor can press on nerves. Your doctor will talk to you in more detail about how to control any pain you may be experiencing.
We also understand how esophageal cancer impacts our patients' quality of life, and we are committed to helping them lead productive lives beyond their treatment. We offer extensive nutritional counseling both before and after surgery and we continually monitor our patients following surgery in an ongoing quality-of-life study.
This study, begun more than a decade ago, found that patients treated at Virginia Mason show improvements in quality of life within the first year of surgery and that 82 percent who were employed full time prior to surgery returned to their presurgical work levels.
To learn more about esophageal cancer care at Virginia Mason or to make an appointment, please call (206) 223-6193.