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Esophageal Cancer

Esophageal Cancer Treatment - DC, Maryland & Virginia Esophageal Cancer Surgeons

For more than two decades, the thoracic surgeons at CVTSA have cared for patients in Virginia, Maryland and Washington DC with esophageal cancer. 

The esophagus is a muscular tube located mostly in the chest (thorax) and moves food from the mouth into the stomach. Esophageal cancer entails the growth of malignant (cancerous) cells within the esophagus, creating a tumor. This tumor has a high tendency to spread beyond the confines of the esophagus into surrounding lymph nodes and/or to other distant organs. As a consequence, it can be fatal.

Esophageal cancer is relatively uncommon, affecting approximately 16,000 people in the United States in 2009. There are two main types of esophageal cancer --squamous cell carcinoma and adenocarcinoma. These two types of cells are differentiated under the microscope and have different causes. Squamous cell carcinoma is specifically related to smoking and alcohol ingestion and is rare in the United States. Adenocarcinoma, on the other hand, has been increasing in incidence and is likely linked to the increase in obesity and gastroesophageal reflux disease (GERD).

Symptoms

The most common symptom of esophageal cancer is dysphagia, or difficulty swallowing and the feeling that food is sticking as it travels through the esophagus. This occurs because the esophagus has become narrowed due to the growth of the tumor. Other symptoms include

  • Regurgitation of food
  • Chest pain
  • Vomiting blood
  • Weight loss
  • Heartburn

Staging

Cancer staging is the evaluation of the degree of tumor spreading, either locally or distally, by the use of studies such as endoscopic ultrasound (EUS), CT and PET scans. Staging cancer is important because the stage guides the selection of treatment options (radiation, chemo, surgery or observation) for an individual patient and helps determine prognosis.

Letters and numbers are used to describe one’s individual staging. Anatomic characteristics of the tumor are represented by the letters T (tumor), N (lymph node) and M (metastasis or distant spread), which are followed by a number that denotes progression whenever higher, i.e. T3 > T1, N1 >N0. This combination of letters and numbers defines the overall stage of the tumor into Stage I, IIa, IIb, III, IVa and IVb.

Treatment

When cancer is only in the esophagus and has not metastasized (spread) to other places in the body, surgery is the treatment of choice. Sometimes, chemotherapy, radiation, or a combination of the two will be administered prior to the surgery to shrink the tumor before removing it.

During the surgical procedure, a thoracic surgeon will remove the esophagus from the bottom of the neck all the way down to the stomach. The stomach is then disconnected from its usual attachments in the abdomen and brought up into the chest and connected to the remaining esophagus. In some cases the stomach can not be used for reconnection, in which cases the large intestine (colon) or the small intestine will be used.

Removal of esophagus and stomach 

There are multiple surgical techniques used in the treatment of esophageal cancer, none with clear advantage over the other. Common to all procedures is the need to enter the abdomen, which is then followed by either entry into the chest, the neck or both. A minimally invasive surgical approach is also an option. Here, the operation is performed with small incisions and video assistance. This translates into decreased post-operative pain and shorter time to recovery.

For patients who have severe dysphagia, esophageal stenting may be performed either prior to chemotherapy and radiation or to help the patient be more comfortable in inoperable cases. Esophageal stents are placed in an operating room while the patient is under anesthesia. A stent is a soft synthetic tube which, when expanded, pushes tissue back and creates a larger opening than that which was present without it. This opening will help the patient swallow or drink more easily.

Another adjunct frequently used for patients with severe weight loss and dysphagia is the placement of a feeding tube (jejunostomy or gastrostomy). This tube can be placed by endoscopy (camera through the mouth into the stomach/bowel) or laparoscopy, a surgical procedure performed under general anesthesia and the use of small incisions. This feeding tube allows patients to get adequate nutrition prior to their surgery or while undergoing chemotherapy and radiation therapy.

At CVTSA, our thoracic surgeons perform these procedures year in and year out with excellent results.

Multimodality Treatment for Esophageal Cancer: The Role of Surgery and Neoadjuvant Therapy

Although most experts believe that surgery is the cornerstone of therapy for esophageal carcinoma and that combination ancillary therapy is appropriate for advanced-stage disease, controversy still exists as to whether preoperative multimodality therapy is superior to surgery up front.

Over the past decade our institution has doubled its annual volume of surgery for carcinoma of the esophagus. At the same time, we have reduced the associated operative mortality fourfold, increased the application of neoadjuvant chemotherapy and radiation therapy fourfold, and nearly doubled our long-term survival, achieving complete pathologic response and survival rates rivaling the best reports reported in the literature.

Located just off the Beltway and Rt. 50 in Falls Church, VA, CVTSA proudly serves patients in Virginia, Maryland and DC in need of treatment for espohageal cancer. To schedule an appointment, please call (703) 280-5858.

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