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Thoracic Oncology Program

Patient and Family Education

Esophageal Cancer

Treatment Overview

• If the tumor is very small and in its early stage, surgery alone may be recommended.
  
  
• If the cancer has spread to other areas of the body, such as the liver or brain, chemotherapy or radiation therapy alone will likely be recommended
  
  
• For patients with early stage esophageal cancer not amenable to standard therapies including surgery, chemotherapy, and radiation therapy, a technique known as cryotherapy ablation may be used. This procedure destroys the abnormal lining of the esophagus by exposing cells to extreme cold using liquid nitrogen. It is a new technique which is done during an EGD (upper endoscopy).
  
  
• For all others, Multimodality Therapy may be recommended. Multimodality is the use of chemotherapy, radiation therapy and surgery in one of several different combinations. Preoperative chemotherapy and radiation therapy are used to shrink the tumor and decrease the chance of cancer cells surviving after surgery. Postoperative chemotherapy and radiation therapy are used to kill any cancer remaining after surgery in order to decrease the chance of tumor regrowth.

Multimodality Initial Consultation (approximately 3 hours)

You will see the Thoracic Surgeon, Medical Oncologist, Radiation Oncologist, and Nurse Coordinator. You may also see the Gastroenterologist. Below is a list of tests you will need to undergo, some of which may be performed by your primary care provider.

Required Testing

• CT of the chest and abdomen
• Upper endoscopy with biopsy
• Esophageal Ultrasound (can be done at the same time as endoscopy)
  • must be performed at UMMS

Additional Testing - these tests may be recommended for you

• Chest x-ray
• Barium swallow
• Pulmonary function tests
• PET scan

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Staging

One of the best indicators of the extent of cancer are the lymph nodes. Lymph nodes are tiny glands that help the body fight infection and tumor. The stage of cancer is determined by the size of the tumor and the number and location of enlarged lymph nodes. Accurate staging helps tailor treatment to your specific needs. Some staging can be done with CT scan, biopsy, esophageal ultrasound and PET scan. Other situations will require surgical staging.

Surgical Staging

This is a minimally invasive surgical procedure using the "TV scope" and 3-4 small incisions through the skin of your abdomen and chest. The surgeon will remove all the lymph nodes he finds and have them checked for cancer. Surgery lasts 2-4 hours. A mediport for chemotherapy may be placed under your skin and a feeding tube may be placed during the operation. You can expect to stay in the hospital for 1-3 days.

For more information, please visit Staging.

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Treatment

Radiation Therapy

Radiation therapy is used to help shrink the tumor with a form of high energy x-rays which are carefully directed at the tumor and the surrounding tissue at highest risk for local spread. The high-energy beams can kill cells and keep them from dividing and spreading. This helps destroy the tumor, because cancer cells divide and grow faster than normal cells. Normal cells usually recover successfully from radiation, but the high-energy beams will be carefully aimed to target your tumor and lymph nodes and minimize the amount of normal tissue affected.

You will not feel the radiation while it is being delivered, and the actual treatment will take less than 5 minutes. Expect to be in the department for 15 to 30 minutes each day, though, so that the machine can be properly set up for your individual needs. Radiation therapy is given as an outpatient for 5 to 6 weeks.

Chemotherapy

Chemotherapy is used to help shrink the tumor and kill any cancer cells in the lymph nodes. There are several chemotherapy medications that work to kill lung cancer and often a combination of 2 of these medications is prescribed. The specific medication or combination of medications you receive will be selected based on your tumor type and your medical history. Exact doses of each medication will be calculated using your weight, height and lab values.

Chemotherapy will be given as an inpatient for 4-5 day sessions twice during your treatment. The chemotherapy will be given through an IV. You will receive other medications before and during your chemotherapy which are designed to minimize and relieve the side effects.

Re-staging

Approximately 4-6 weeks after your last treatments you will undergo several tests to determine the success of therapy. You will meet again with the Thoracic Oncology team to review your test results.

Required Testing

• CT scan of the chest and upper abdomen
• Upper endoscopy and esophageal ultrasound

For more information, please visit Chemotherapy and Radiation Therapy.

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Surgical Resection

If you have had chemotherapy and radiation therapy, surgical resection of the esophagus will occur approximately 5-6 weeks after your last radiation treatment. You will be admitted the morning of the surgery and will stay in the hospital for 12-14 days. Your esophagus, part of your stomach and lymph nodes will be removed. Your surgeon will form a "replacement" esophagus out of your stomach or bowel. If you have not already had a feeding tube inserted, one will be placed during this surgery. When you go home you will be eating regular, soft food, but this tube will remain in until your follow-up appointment in case you need extra nutrition during your recovery.

We understand that there is a lot of information to remember and this is a very stressful time for you and your family. It may help to bring a pen and notebook to your appointments. Write down questions as you think of them, and bring them with you to your appointment.

For more information, please visit Esophagectomy.

This page was last updated on: September 16, 2009.

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