Esophageal Cancer: Picking the Best Treatment Option
- There are several treatment options available for esophageal cancer and for many patients, treatments will be combined.
- If esophageal cancer is diagnosed at a very early stage (something called T1), it may be able to be removed with surgery alone.
- When cancer is more advanced, when it has penetrated further into the wall of the esophagus, that may require chemotherapy and/or radiation and then surgery.
- Symptoms and whether the disease has spread to distant parts of the body will help determine which treatment or combination of treatments should be used.
“As a surgeon, you’re trying to figure out what kind of patient requires surgery, chemo-radiation plus surgery, or just chemotherapy, or just chemotherapy and radiation,” Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. “So, how do you figure that out? Basically, if you have a tumor that is considered a T1 legion, so basically just a tumor that is on the surface of the esophageal mucosa (the inner surface of the esophagus) … sometimes they can remove that with an endoscope (surgery).”Read More
“When it gets a little more advanced, T2, T3, where it goes through the thickness of the wall of the esophagus, that frequently requires chemotherapy and radiation, followed by surgery,” Dr. Flores added.
When a patient comes in with a large “obstruction,” which cannot be removed with just surgery, Dr. Flores said the first move may be to send this patient to the radiation oncologist to get treatment started. “The majority of the times, you’ll get a response, things will open up, you will be able to eat,” Dr. Flores said.
“What determines whether you can get that combination of chemotherapy and radiation depends on your symptoms. Symptoms really dictate whether or not you’re going to get radiation there, but also, do you have distant disease? If you have a tumor in the middle of the chest but a metastasis [somewhere else], if you don’t need radiation to open things up so you can swallow, usually in those cases they will just give you chemotherapy.”
Questions to Ask Your Doctor
- Will I need surgery for my esophageal cancer?
- Will I need to undergo chemotherapy and/or radiation before surgery?
- What type of side effects can each of these therapies cause?
- What is likely to be the most effective treatment combination for me?