Esophageal cancer

Diagnosis

• Barium swallow study: Requires the patient to swallow liquid that contains barium, then undergo X–rays. The barium that covers the inside of the esophagus will signify any changes in the tissues, which will appear on the X–ray.

• Esophagoscopy: Is an endoscopic procedure of the esophagus. A flexible tube with a camera attached to the tip will be inserted in the throat through the mouth and into the esophagus to examine the esophagus and detect irritations.

• Biopsy: Doctor will take a sample of tissues during the esophagoscopy. The sample will then be sent to a laboratory for cancer test.

Determining the stage of the cancer

After esophageal cancer has been diagnosed, the doctor could recommend further tests to find out whether the cancer has spread.
The following tests may include:

• Bronchoscopy
• Endoscopic ultrasound (EUS)
• Computerized tomography (CT)
• Positron emission tomography (PET)

The information from the tests above will contribute to the evaluation of the cancer staging. The stages of the disease are signified Roman numerals that range from 0 to IV. The lowest stage is an indication of cancer affecting the superficial layers of the esophagus. The cancer has progressed to an advanced level and has invaded other parts of the body, when stage IV indicated. The stage of the cancer will determine the appropriate treatment option for the patient.

Treatment

The treatment option depends on the type of cancer cells, the severity of the disease and the patient’s health status.

Surgery

Surgical removal of the cancer can be done on its own or in combination with other treatment options.

• Surgical removal of very small tumors: If the cancer is tiny and has only occupied the surface level of the esophagus and has not spread to other parts, the cancer and healthy surrounding tissues will be removed by surgery. An endoscope will be passed down to the throat and into the esophagus to remove the cancer.
• Esophagectomy: A surgical removal of part of the esophagus that has cancer. A part of the upper stomach, and surrounding lymph nodes may also be removed. The rest of the esophagus will then be reattached to the stomach by lifting the stomach towards the esophagus.
• Esophagogastrectomy: A surgical removal of a part of the esophagus and the upper portion of the stomach. This procedure includes the operation a part of the esophagus, surrounding lymph nodes and a bigger part of the stomach. The remaining part of the stomach is lifted to join the esophagus. A part of the colon may be used to reconnect the two organs, if needed.

Surgical procedure for esophageal cancer can have complications, such as infection, bleeding, and leakage, which could occur in the area where the remainder of the esophagus is reconnected to the stomach. Removal of the esophagus can be done by an open surgery with large incisions or with minimally invasive laparoscopic surgery. The technique that will be used depends on the treatment plan of the doctor.

Treatments for complications

• Treatment for esophageal obstruction. In case when esophageal cancer causes the esophagus to become narrow, a metal tube or a stent will be placed inside the esophagus to hold it open. This will be done by an endoscope. Surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy could be an alternative option to relieve the obstruction.
• Providing nutrition with the help of a feeding tube if there is difficulty swallowing or if the patient has esophagus surgery. The feeding tube will carry nutrition and deliver them directly to the stomach or small intestine, allowing the esophagus to restore. 

Chemotherapy 

Chemotherapy is a treatment that uses chemicals to destroy cancer cells. This type of drug is commonly used before or after the esophageal cancer surgery. Chemotherapy can be used with radiation therapy.

When the cancer has progressed and spread further than the esophagus, the use of chemotherapy only, can help relieve the symptoms.

Radiation therapy 

Radiation therapy is use of powerful energy beams, such as X–rays and protons, to cause the cancer cells to die. Radiation therapy is given to patients with esophageal cancer in combinations with chemotherapy. It is usually given before the surgery. Complications that arise from an advanced level of esophageal cancer can be relieved by radiation therapy.

Combined chemotherapy and radiation 

Combination of chemotherapy and radiation therapy can increase the effectiveness of each treatment. Combined treatment could be the only to treatment for certain patients or before the surgery.

Targeted drug therapy 

Targeted therapy kills cancer cells by blocking the weak factors. The combination of targeted therapy and chemotherapy are typically used to treat advanced level of esophageal cancer or when other treatments have not shown any results.

Immunotherapy 

Immunotherapy uses drugs to help the immune system to fight against cancer by identifying the cancer cells that have been hidden by proteins.
Immunotherapy is used to treat advanced level of esophageal cancer or when the cancer is recurrent or metastasized.