Esophageal Cancer Treatment
The Thoracic Center
(732) 235-7802 • (732) 235-8150 (fax)
Esophageal Cancer Overview
Esophageal cancer is an increasingly common malignancy in the United States. Last year, almost 30,000 people in this country developed this serious disease. Although squamous cell carcinoma is the most common subtype globally, in North America the incidence of adenocarcinoma is rapidly rising. Treatment can involve medical therapies, such as radiation and chemotherapy, or operations on the esophagus itself.
Esophageal Cancer Causes
Alcohol consumption and smoking are major risk factors in the development of squamous cell esophageal cancer, but their role in adenocarcinoma is less clear. Barrett’s esophagus with high grade dysplasia is associated with a high incidence of invasive adenocarcinoma. Barrett’s esophagus develops after the lining of the esophagus is exposed to gastric acid due to gastroesophageal reflux disease. People with Barrett’s are at a 30 – 40 fold increased risk of developing esophageal cancer as compared to the general population.
Esophageal Cancer Symptoms
Most esophageal cancers do not cause symptoms until the cancer has reached an advanced stage. The most common symptom is difficulty swallowing, or dysphagia. Individuals often have a sensation that food is getting stuck in the throat or chest. Without realizing it, people often change their diet and eating habits and avoid foods that are difficult to swallow. Even liquids are not able to pass when the cancer is advanced. People produce additional saliva to assist the food and liquids to pass through the esophagus.In rare cases, people can have chest pain or discomfort, chest pressure, or chest burning. Pain with swallowing is a late sign of a large cancer blocking the esophagus. Unintended weight loss is associated with the inability to swallow and a decreased appetite. Other symptoms include hoarseness and hiccups.
Esophageal Cancer Diagnosis
Esophageal cancer is diagnosed and cancer spread is determined with any combination of the following exams, tests, and procedures:
- History and physical examination
- Barium swallow or upper gastrointestinal X-rays. Barium is a dense liquid that is used to coat the esophagus wall before an X-ray is taken. A barium swallow is usually the first diagnostic test performed in people with suspected esophageal cancer.
- Endoscopy. An endoscope is a flexible tube with a video camera and light on its end. The tube is passed through the mouth and into the esophagus and stomach. The physician can see the esophagus clearly and can detect a tumor and determine its size and spread.
- Computed Tomography (CT) Scans. These scans take many pictures of your body when the CT scanner rotates around you. The CT scan helps confirm the location of the cancer and visualizes the organs next to the esophagus, the lymph nodes, and the distant organs where the cancer may have spread.
- Bronchoscopy. An endoscope is inserted into the trachea (windpipe) and bronchi (tubes leading from the trachea into the lung). This procedure enables the physician to see if the cancer has grown into these structures.
- Positron Emission Tomography (PET) Scans involve the injection of radioactive glucose (sugar) into the patient’s vein. Cancerous tissue take up the radioactive material and enable the physician to see the cancer and its spread.
- Thoracoscopy and laparoscopy are used to examine lymph nodes in the chest and abdomen, respectively.
Esophageal Cancer Treatment/Surgery
Esophageal cancer remains one of the most difficult solid tumors to treat. A variety of treatment modalities are available, dictated by the stage of the disease. Here at Robert Wood Johnson University Hospital and The Cancer Institute of New Jersey, we take a team approach to the management of this disease. Medical oncologists, radiation oncologists, surgical oncologists, thoracic surgeons, and gastroenterologists work together to map out the best treatment plan for each individual patient.
The goals of treatment are cure and restoring the ability to swallow. Surgery offers the best chance to achieve these goals in the appropriate patient. Surgical approaches include transhiatal esophagectomy (resecting the esophagus without opening the chest cavity) and esophagectomy with thoracotomy (with opening the chest ). The choice is dictated by the location and stage of the tumor. Our gastrointestinal oncology team works in concert to determine the best approach for each particular patient.
Because of the specialized nature of esophageal cancer, treatment by experienced clinicians has been shown to be important. Esophagectomy is one the few surgical procedures where “practice makes perfect.” According to The Leapfrog Group for Patient Safety, a leading group of Fortune 500 companies and large health care purchasers, studies have demonstrated better results following esophagectomy at high-volume hospitals. Instead of relying on traditional sources of information such as recommendations from physicians, opinions of family and friends, or simply location and convenience, The Leapfrog Group suggests that the most important factor to consider is surgical volume --- how many procedures the hospital performs each year. Robert Wood Johnson University Hospital is the only hospital in the state of New Jersey that meets The Leapfrog Group’s safety standard for esophagectomy (based on 2003-2004 statewide data). Robert Wood Johnson University Hospital performed esophagectomy surgery more than any other hospital in the state of New Jersey each year since 1999.
Multimodality therapy may include any combination of surgical, radiation therapy, chemotherapy, and endoscopic approaches. Depending upon the circumstances, chemotherapy and radiation therapy may be offered before (neoadjuvant) or after (adjuvant) surgery. Treatments are carried out within the Departments of Surgery and Medicine at UMDNJ-Robert Wood Johnson Medical School, The Cancer Institute of New Jersey, and Robert Wood Johnson University Hospital.
Esophagectomy is performed at Robert Wood Johnson University Hospital. Please call (732) 235-7802 to schedule an appointment with one of The University Thoracic Surgeons.
Esophageal Cancer Prevention
Our team also diagnoses and manages precancerous conditions of the esophagus, including Barrett’s esophagus. We perform endoscopic screening procedures and, when necessary, surgery to detect precancerous conditions of the esophagus and to prevent the development of an actual cancer.
Esophageal Cancer Research
Through the auspices of the Divisions of Thoracic Surgery and Gastroenterology at UMDNJ-Robert Wood Johnson Medical School and The Cancer Institute of New Jersey, we are also able to offer participation in clinical trials for the prevention and treatment of esophageal cancer. Clinical trials afford patients access to the latest and most promising developments in the field.
(732) 235-7802 • (732) 235-8150 (fax)