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What are the treatment options?
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For most patients with esophageal cancer, a number of different treatments will be used in combination. Your physician will recommend an individualized treatment plan that may include surgery, radiation therapy, or chemotherapy, or several of these options used in tandem, known as combined modality therapy. Recent studies suggest that combining these treatment approaches can help boost survival rates for esophageal cancer.
Treatments for esophageal cancer are based on the stage of the cancer at time of diagnosis. Determination of your best treatment plan is based on the stage of your cancer, as well as your age, other medical conditions, and your attitude toward the available options.
Surgical Treatment
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For patients with early-stage esophageal cancer, surgery alone may offer a cure. For more advanced cancer, chemotherapy and/or radiation therapy may be used before surgery. The use of preoperative therapy is known as neoadjuvant therapy. Surgeons at John Muir Health offer the latest operative techniques for esophageal cancer:
Esophagectomy - This procedure entails removal of all or part of the esophagus and adjacent lymph nodes. A small section of the remaining esophagus is connected to the stomach to provide a new conduit for food and liquids. Esophagectomy can be performed using the traditional "open surgery" method, or via the new technique of laparoscopic esophagectomy, which offers important patient benefits such as shortened hospital stay, minimized trauma, and decreased risk of complications.
Esophagogastrectomy - Patients with more advanced cancer with spread to the stomach will undergo an esophagogastrectomy, in which part of the esophagus and part of the stomach are removed. To provide a new conduit for food and liquid, the remaining esophagus is connected to the stomach. Sometimes it is necessary to use portions of the colon or small intestine to construct the new conduit.
Chemotherapy
Chemotherapy - or the use of cancer-killing drugs - is most effective against esophageal cancer when used in combination with radiation therapy. Recent studies suggest that combined modality therapy administered before surgery (neoadjuvant therapy) may help boost survivorship in people with esophageal cancer. For patients who have esophageal cancer that is not considered "resectable" (or conducive to surgical removal), combined chemotherapy and radiation therapy may be used as the primary therapy. The most effective chemotherapy drugs in current use for esophageal cancer are cisplatin and 5-FU. Through its active research program, with regional and national affiliations, John Muir Health can provide patients with access to investigational agents as well.
Radiation Therapy
Radiation therapy is most effective against esophageal cancer when used in combination with chemotherapy. Depending on the stage of esophageal cancer, combined radiation and chemotherapy may be administered before surgery, or used as the primary therapy. The goal of preoperative (or neoadjuvant) therapy is to shrink or slow down the growth of tumors prior to surgery, helping to optimize surgical results. In some advanced cancers, radiation therapy may be used alone to help alleviate symptoms.
The type of radiation therapy used in esophageal cancer is external beam radiation, in which the esophagus is radiated from outside the body via a precisely targeted beam of radiation from special equipment called a linear accelerator. Before radiation therapy, patients may be given radiosensitizing chemotherapy drugs, which help to enhance the cancer-killing efficiency of radiation. We are one of northern California's premier centers for radiation therapy, with a reputation for clinical excellence and cutting-edge technology. Our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners to ensure the most precise and effective radiation therapy available. The advanced radiation therapy capabilities at John Muir Health include:
Three-Dimensional Conformal Treatment - This sophisticated form of external beam therapy uses a computerized treatment planning system that optimizes radiation therapy by pinpointing the location of the tumor with the highest level of precision possible. This capability is important in planning the most effective therapies for esophageal cancer. Special features on the linear accelerator called multi-leaf collimators enable the radiation beam to be "shaped" to closely conform to the contours of the tumor. This permits a higher dose of radiation to be administered directly to the esophagus, while diminishing the radiation dose to surrounding tissue, thereby increasing cancer-killing effectiveness while minimizing toxicity.
Intensity-Modulated Radiation Therapy (IMRT) - is a newly introduced enhancement of the technology used in three-dimensional conformal therapy. Specialized treatment planning software is used to development a precise plan that "modulates" or varies the radiation used in each treatment session. The highest possible doses of radiation can be applied directly to the esophagus, while lower doses are applied to areas adjacent to organs and critical structures that need to be protected.
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