Treatment

Treatment esophagusWhen esophageal cancer is discovered in a very early stage and is limited to the mucosa, the area can be removed through a long camera device (endoscopy) through the mouth in some cases. Most forms of esophageal cancer are found in a late stage. In that case, the most effective treatment is an operation in which the esophagus and the surrounding lymph nodes are removed. Then a new esophagus is being made from the stomach. This treatment is often combined with chemoradiotherapy.

An operation is not possible if there are metastases far beyond the esophagus or if the tumor shows ingrowth in the surrounding tissues. In these cases, the difficulty in swallowing be can eliminated by irradiation or by the placement of a tube (stent) in the esophagus at the site of the tumor. When metastases far beyond the esophagus are found, chemotherapy is sometimes possible. If after an operation the esophageal cancer recurs, chemotherapy or radiotherapy is possible in some cases.

Here you can find more information about treatment options.

Robot keyhole surgery

Alt

Da Vinci robotic system

In some hospitals, it is possible to undergo endoscopic (keyhole) surgery. Here a few small openings are made in the chest and the abdomen, after which a camera is inserted in the body via an inspection tube. Through the other openings surgical instruments are inserted. Then through these small openings the operation can be performed. The big advantage is that no big carve needs to be created in the chest or abdomen. This leads to less pain after the surgery. Also, the scars are much smaller than following an open approach.

The University Medical Center Utrecht is the only center in the Netherlands that performs keyhole surgery with the aid of a robotic system. Here the surgeon controls the robot operation. The main advantage of the robot is that the operation can be performed more precise. This would possibly for a better removal of the tumor.

If you would like to read more about this, please read the article “New keyhole surgery for esophageal cancer with the robot’.

You can also watch a video of this treatment.

Operation through the chest cavity

In this operation, the abdomen, the chest and the neck are opened. This method is used in tumors that are located in the esophagus. One advantage is that the involved lymph nodes along the entire esophagus can be removed. It is known that metastases may occur around the entire trajectory.

Operation through the abdomen

In this operation only the abdomen and the neck are opened. The chest does not need to be opened in this procedure. This method is used only for tumors that are located low in the esophagus. An advantage of this approach is in particular that complications of the lungs are less common than with the method via the chest. A disadvantage is that not all lymph nodes of the chest can be taken into account. This operation is particularly used in patients that cannot tolerate an operation via the chest cavity.

Scopy

Endoscopy

Endoscopy

Precursor cells of esophageal cancer or very superficial esophageal cancer can be treated by an camera (endoscopic ) investigation via the mouth. A key component is the endoscopic ultrasound, wherein the depth of the tumor and possible metastases to the lymph nodes can be viewed. In the endoscopic treatment, the mucosa is removed over a distance of a few centimeters (endoscopic mucosal resection EMR). This is a low-impact treatment. The tissue is then examined under the microscope to determine whether the tumor is indeed superficial. When tumor growth is yet deeper, the chance of metastases to the lymph nodes is too high and surgical removal of the esophagus must nevertheless occur.

Chemotherapy

Medications

Medications

Chemotherapy uses cell-inhibiting drugs (cytostatics). There are different types of cytostatics. These agents can be administered to the patient in different ways, such as by intravenous infusion, per tablet or per injection.

Usually, chemotherapy is given before or after surgery. This improves both the chance to remove the tumor completely and also the prognosis.

Chemoradiotherapy

Radiation (radiotherapy) is a local treatment, in which cancer cells are destroyed in whole or in part by irradiation. Cancer cells tolerate radiation worse than healthy cells. Therefore damaged cancer cells will not be able to recover. Healthy cells do recover in general though. Usually radiotherapy is given before surgery to reduce the tumor in size. This is often combined with chemotherapy (chemoradiation). This is currently the standard of care for surgery. If investigations reveal that you cannot be operated, you may need palliative radiotherapy. This will try to reduce the symptoms. Palliative radiotherapy will not be able to heal you.

Prospects after treatment

The earlier cancer is detected, the greater the chance of a cure. Because esophageal cancer often leads to complaints in a late stage, it is often discovered late. Therefore a lot of patients are not suited to undergo surgery anymore. These patients receive a treatment aimed at symptom relief and life extension (palliative treatment).

Often talked about in cancer is the 5-year survival. This is the percentage of patients that is still alive 5 years after the treatment. After curative treatment, the average 5-year survival rate is 40%. For patients whose tumor has not spread to the lymph nodes, the 5-year survival rates are better, however, these rates are calculated for groups of patients. These figures are approximate and cannot easily be translated to each individual patient.

Comments are closed.