Conditions
Esophageal Cancer
Definition
Esophageal Cancer is cancer that arises from the esophagus which is the tube that transports food from the throat to the stomach. Esophageal cancer can occur anywhere along the esophagus, but in people in the United States, it occurs most often in the lower portion of the esophagus.
This is a serious conditions as the cancer can spread and cause patient not able to swallow and therefore loss weight. By the time such symptoms occur, the disease can be in the later stages.
Causes:
Unknown.
Risk factors:
- Gender: Male
- Age: 60 or older
- Smoking or tobacco use
- Alcohol use
- Chronic gastroesophageal reflux
- Barrett's esophagus (due to Chronic Reflux)
- Achalsia (chronic dilation of the esophagus)
- Trouble swallowing (dysphagia)
- Food getting stuck in the chest
- Painful swallowing
- Hoarse voice
- Pain in the throat, back, or chest
- Nausea or vomiting
- Weight loss
Diagnosis:
Medical history and complete physical exam: Having a complete physical exam and detailed medical history is important as it give the health care professional a complete picture of your medical condition.
Chest X-Ray: X-ray's are a form of electromagnetic radiation. During the chext x Ray, the x-ray technologist will position the patient in front of the x-ray machine. Multiple views may be required.
Upper GI Series (Barium Swallow): A barium swallow is a series of x-rays that show a complete picture of your esophagus. During this study, you will be asked to drink a thick liquid called Barium that temporarily coats your esophagus and makes the esophageal wall more visible on the x-rays.
Esophagoscopy: An esophagoscopy will be performed by a gastroenterologist. During the esophagoscopy, the gastroenterologist will insert a tube (called an endoscope) down your throat and into your esophagus. This tube has a lens that allows the doctor to see your esophagus.
Biopsy: Biopsy is used to confirm that an area of suspicion is cancerous. During the biopsy, a small piece of tissue will be taken from the area of concern and sent to a pathologist.
If the biopsy results come back as being positive for cancer, your doctor will ask for additional tests to be done to determine the stage of the esophageal cancer. It is important to determine the stage of your cancer as this can affect the treatment options. The additional tests to determine the cancer stage are:
Endoscopic Ultrasound: Endoscopic ultrasound combines endoscopy and ultrasound in order to provide a complete look of the digestive tract. Endoscopic ultrasound is also performed by a gastroenterologist.
Endoscopy is a procedure in which a long flexible tube with a lens at the end is inserted into either the mouth or rectum to visualize the digestive tract.
Ultrasound, sometimes called sonography, uses high frequency sound waves to bounce off of body tissues and generate a picture of the tissues and internal organs.
CT Scan: A CT scan, also called a CAT Scan, uses a computer to combine many x-ray images to produce three diminsional images of the body.
PET Scan: Positron emission tomography, also called PET or a PET scan, is a diagnostic examination that involves the development of biologic images based on the detection of subatomic particles. These particles are emitted from a radioactive substance given to the patient. PET scans provide information about metabolic activity and body function.
Treatment of esophageal cancer depends on the size and staging of the tumor.
Treatment is done via a Multimodality (combination of surgery, chemotherapy and radiation therapy) approach.
Surgery:
Surgery is the main stay of treatment of esophageal cancer. Surgery will remove a portion of the esophagus and the stomach. Reconstruction follows, with the remaining portions of stomach, small bowel or large bowel. For more information about surgical treatment of esophageal cancer, please review the procedures section of our website.
Radiation Therapy:
Radiation therapy is treatment with high energy beams (often x-rays) that are directed at the tumor in order to kill the cancer cells or shrink a tumor so it can be removed by surgery. This treatment is coordinated by a radiation oncologist.
Chemotherapy:
Chemotherapy is the use of drugs to kill cancer cells. This treatment is coordinated by a medical oncologist.
Neoadjuvant chemoradiation therapy:
Patients will be treated with chemoradiation (a combination of chemotherapy and radiation therapy managed by oncologists) before surgery. The goal with neoadjuvant chemoradiation therapy is to make the tumor smaller so that it is easier to remove. After neoadjuvant therapy is complete, the patient will undergo a complete restaging of the tumor (using CT scan and PET scan). If there is no disease progression, surgical removal of the esophageal cancer will be offered. This is also called trimodality therapy and it has been shown to be a most aggressive form of therapy. It may be the best way to cure a patient of their disease.
Multidiscipline team
Managing esophageal cancer required a multidiscipline team as it is complex. Studies had shown that patients received better care and therefore better clinical and oncologic outcome when a team approach is used.
The surgeons at Northwest Surgical Specialists, LLP are members of the Northwest Specialty Clinics Cancer Care Alliance (NSC Cancer Care Alliance). At NSC cancer Care Alliance, we bring together a team of specialists that include well trained surgeons, gastroenterologists, medical and radiation oncologists, radiologists, pathologists, physical therapists, and nutritionists to assess each patient's needs. Working collaboratively, these experts provide a comprehensive diagnosis and treatment plans for compassionate, individualized care.