Esophageal Cancer

Esophageal cancer staging is important for planning treatment. Endoscopic ultrasound, CT scan, and PET/CT scan are used in the staging process.

Esophageal cancer stages include:

• Stage in situ. Cancerous cells involving the lining of the esophagus and have not invaded the deeper parts of the inner lining of the esophagus.
• Stage I. Cancer starts in the superficial layers and invades the first layers of the inner lining of the esophagus and may have spread to the lymph nodes nearby
• Stage II. Cancer has invaded deeper muscular layers of the esophagus and may have spread to the lymph nodes nearby.
• Stage III. Cancer has spread to the deepest layers of the wall of the esophagus and invades into the tissues and/or lymph nodes nearby.
• Stage IV. Cancer has spread to other parts of your body.

Treatment is multimodality depending on the staging of cancer. Treatment involves surgery, chemotherapy and radiation therapy.

If the cancer is small and limited to the superficial layers and has no evidence of spread, it can be removed via endoscopic surgery. Surgery may include partial or complete removal of the esophagus called esophagectomy. Occasionally surgery may also include partial removal of the upper end of the stomach along with the esophagus and is called esophagogastrectomy.

Drug treatment using medications to kill cancer cells is called chemotherapy. Chemotherapy for esophageal cancer can be used before surgery called neoadjuvant chemotherapy, or after surgery called adjuvant chemotherapy. In people with advanced cancer, chemotherapy can be combined with radiation therapy. However, if the esophageal cancers have spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by cancer.

Radiation therapy uses high-powered X-ray beams to kill cancer cells. Radiation typically can be from a machine outside the body that aims the beams at cancer called external beam radiation. Radiation therapy can also be placed inside the body, near cancer called brachytherapy. Radiation therapy is typically used before surgery, or occasionally after surgery and is also used to relieve complications of advanced esophageal cancer. Treatment can last from two to six weeks of daily radiation treatments. Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.