Staging of the Cancer
Esophageal cancer is staged with a CT scan of the chest and abdomen, endoscopic ultrasound (EUS) and PET scan. Biopsies of the tumor by the EUS are often helpful to determine tumor stage. If the tumor is early stage (typically not involving lymph nodes), then an esophagectomy, or removal of the esophagus, may be appropriate for potential cure.
An esophagectomy involves removal of the esophagus and replacement of it with stomach. A successful procedure will remove the malignant tissue and the patient will be able to eat normally. Minimally invasive surgery is performed through small incisions with the use of specially designed instruments and cameras. The minimally invasive esophagectomy (MIE) procedure was developed in the past decade but is only performed at several specialized centers in the nation. The procedure involves laparoscopy and video-assisted thoracoscopic surgery (VATS) to remove the esophagus and replace it with the stomach. Early results of the technique suggest a shorter hospital stay and fewer complications when compared with an esophagectomy done through larger incisions.
Chemotherapy and Radiation
When staging of esophageal cancer reveals involvement of the lymph nodes, then appropriate treatment may be chemotherapy and radiation to shrink the tumor. The esophageal cancer would then be staged again with CT scan, EUS and possibly PET scan to determine whether an esophagectomy could be done to potentially cure the patient.
Palliation of Esophageal Cancer
Approximately half of patients with esophageal cancer are never candidates for an esophagectomy and they may be treated with chemotherapy and/or radiation. The cancer however may cause blockage in the esophagus and make it difficult to swallow. Chemotherapy and radiation may help improve this problem, but minimally invasive endoscopic therapies are also available to improve swallowing. Some of the techniques include endoscopic laser treatment e.g., photodynamic therapy, and endoscopic stent placement. A large study of over 200 patients treated with (PDT) for palliation of dysphagia resulted in improved swallowing 85% of the time.