Treatment at Different Stages
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The Swedish Cancer Institute offers a number of excellent treatment options to patients with esophageal cancer. Treatment is based upon the stage of the cancer as well as your physical condition and any other medical conditions you may have. For treatment planning at Swedish, patients fall into one of three categories that are described in this section.
Early Esophageal Cancer (Stages 0-1)
Patients who have early stage esophageal cancer are usually treated with surgical removal of the esophagus (esophagectomy). Chemotherapy and radiation therapy are generally not used in this situation. Depending on your cancer, you may be a candidate for vagal-sparing esophagectomy or minimally invasive esophagectomy.
Locally Advanced Cancer With or Without Lymph Node Involvement (Stage II-III)
The treatment of locally advanced esophageal cancers remains controversial. Two strategies are used in most North American cancer centers. The first strategy is to pre-treat the cancer with chemotherapy and radiation, and then surgically remove the esophagus. In certain instances, patients may receive more chemotherapy after they have recovered from surgery. This strategy is employed by many centers without significant research to support its use.
The second strategy is to perform radical surgery (en bloc esophagectomy) to remove all visible tumor and tissue potentially involved with cancer. Patients that have lymph nodes involved with tumor would be given chemotherapy after surgery. Like the first strategy, there is little research to support this strategy.
At the Swedish Cancer Institute, we use the PET scan and the endoscopic ultrasound to assess whether the lymph nodes are involved with the cancer. If no lymph nodes are involved, most patients are offered en bloc esophagectomy. If lymph node involvement is suspected or confirmed, it is recommended that the patient first undergo pre-treatment with chemotherapy and radiation, unless he or she is unable to tolerate these treatments.
Metastatic or Advanced Cancer (Stage IV)
The vast majority of patients with Stage IV disease will not receive surgery. The goal for these patients is to improve their ability to eat and to control their symptoms. A small, select group of Stage IVa patients with limited lymph node involvement outside the usual locations will be candidates for aggressive therapy with chemotherapy and radiation, followed by surgery and more chemotherapy.
One area that can be substantially improved is swallowing. For many patients, a simple endoscopic procedure can allow them to eat almost normally. This procedure involves placement of a small covered metal stent into the esophagus. The stent restores the opening of the esophagus and allows passage of food from the mouth to the stomach.
Introduction to Esophageal Surgery
In the video below, Thoracic Surgeon, Dr. Brian Louie discusses the procedures described above to treat esophageal cancer.