The treatment approach for esophageal cancer hinges on the cancer stage (whether the cancer cells are confined to the esophagus or have spread elsewhere) and the patient's overall health.
Palliative Treatment for Esophageal Cancer
Medical professionals administer this treatment to alleviate the suffering caused by symptoms of esophageal cancer. For instance, when an individual experiences dysphagia, characterized by difficulty swallowing due to an obstructed esophagus, an esophageal stent might be recommended. This option is especially considered for patients not undergoing surgery, as surgery may pose potential challenges.
Surgical Treatment For Esophageal Cancer
Surgical procedures entail the removal of the esophagus or a portion of it, referred to as Esophagectomy. The esophagus, a tubular structure extending from the mouth to the anus, can undergo a range of surgical techniques, including Endoscopic Resection, Endoscopic Resection with Ablation (the destruction of tumor cells), and esophagectomy.
Surgical decisions are based on the clinical tumor stage, which is determined through diagnostic procedures such as CT Scans (Computed Tomography), FDG - PET CT (Fluorodeoxyglucose Positron Emission Tomography), and EUS (Endoscopic Ultrasound). Tumors localized or within the esophageal wall are considered resectable, while tumors that have spread to distant regions or organs such as the heart, lungs, major blood vessels, trachea, liver, pancreas, lung, and spleen are classified as unresectable.
For patients with localized cancer following chemotherapy, an Esophagectomy may be performed. The gastric conduit is a commonly employed method, with alternatives including the jejunum or colon. Surgical attachment involves a section of the stomach.
Chemotherapy For Esophageal Cancer
Chemotherapy, which involves administering drugs to destroy cancer cells, can be conducted before or after surgery. Chemoradiotherapy, a combination of chemotherapy and radiation therapy, is recommended for localized Squamous Cell Carcinoma, whereas chemotherapy or chemoradiotherapy is employed for localized adenocarcinoma.
Chemotherapy aims to shrink tumors to facilitate surgical resectability and prevent tumor recurrence after treatment. Frequently utilized drugs include Fluorouracil, cisplatin, epirubicin, and docetaxel. The selection of specific drugs is contingent upon the patient's health and potential side effects.
For patients who have not undergone pre-surgery chemoradiation, it is crucial to assess at least 15 lymph nodes for staging purposes, as this provides critical insights into the extent of cancer spread.
Chemotherapeutic regimens are selected based on the patient's overall health, the presence of other diseases, and treatment-related side effects. For instance, patients with high-Performance Status may receive a three-drug treatment.
In general, chemotherapy often involves the use of 2-3 drugs. In cases of adenocarcinoma with HER2 overexpression, drugs like Trastuzumab may be employed. HER2 represents Human Epidermal Growth Factor Receptor 2.
Different treatment plans can be adapted based on drug availability and medical practitioners' preferences. After completing chemotherapy or chemoradiation, patients are carefully monitored for complications.
For advanced stages, a two-drug treatment approach might be employed to minimize toxicity and reduce potential harm.
Radiation Therapy For Esophageal Cancer
In radiation therapy, treatment planning ensures the delivery of a higher dose to the tumor while minimizing exposure to nearby healthy tissue. Various radiation therapy techniques are employed:
- Intensity-Modulated Radiation Therapy (IMRT) employs multiple beams with adjustable intensities. This controlled dose distribution targets the tumor while minimizing exposure to normal tissues.
- 3D Conformal Radiation utilizes multiple radiation beams for precise tissue targeting.
- Proton Beam Therapy reduces the risk to vital organs.
Radiation therapy doses vary for different clinical scenarios
- Medically unfit or nonsurgical cases typically receive doses ranging from 20 to 50.4 Gy.
- Preoperative treatments involve doses ranging from 41.4 to 50.4 Gy.
- Postoperative scenarios often involve doses of approximately 45.5 to 50.4 Gy.
The unit for radiation dose absorbed is Gy. Overall, radiation therapy, surgery, and chemotherapy options are tailored to provide the most effective treatment while minimizing potential risks to the patient's health.
At Cion Cancer Clinics, we offer a comprehensive range of effective treatment options for esophageal cancer.