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Treatment

By Costas Bizekis, M.D.

The Thoracic Oncology team at NYU Medical Center will determine the different types of treatment to be used, either as sole treatment or in combination, based on both the stage of cancer and overall patient health.

Treatment of Stage 0, or carcinoma in situ, usually involves surgery. However, photodynamic therapy (PDT) (link to photodynamic therapy page) is an option available for patients who are not good surgical candidates.

Stages I, II, and III can all be treated with surgery. Clinical trials of chemoradiation with or without surgery are also options available for these stages of esophageal cancer.

Treatment of Stage IV most commonly does not include surgery. Chemotherapy, including clinical trials, radiation therapy, and PDT are options. Stents may also be used when necessary.

Types of Treatment

Esophagectomy

Esophagectomy is the most common surgical treatment for esophageal cancer.

In this procedure, all or part of the esophagus is removed along with nearby lymph nodes and surrounding tissue. Either the stomach or part of the intestine is pulled up to connect to the remaining portion of the esophagus to replace the part removed. This connection is called the anastomosis.

Types of esophagectomy, include:

  • Ivor-Lewis (Transthoracic): Incisions in the upper abdomen and between the ribs on the right side of the chest. The anastomosis is performed in the upper part of the chest.

  • Transhiatal: Incisions in the upper abdomen and the lower neck, without entering the chest. The anstomosis is performed in the neck.

  • Three-Incision: Incisions in the upper abdomen, right chest and lower neck. The anastomosis is performed in the neck.

  • Minimally Invasive Esophagectomy: Small incisions in the abdomen, chest and lower neck. Involves video-assisted thoracoscopy (VATS) and laparoscopy, where the scopes and instruments are placed through very small incisions in the abdomen and chest to allow for resectioning of the esophagus. The anastomosis is performed in either the neck or chest.

If the patient has a tumor blocking a significant portion of the inside of the esophagus, making it very difficult to swallow food and even liquids, we often use temporary esophageal stents which have been proven safe even in patients who later to receive chemotherapy and/or radiation therapy. These stents give patients the ability to eat and maintain their weight while preparing for surgery.

Other Treatment Options

Additional treatment options, which are sometimes combined, include:

  • Radiation Therapy: High energy X-rays are used to destroy cancer cells. Often used in conjunction with chemotherapy, radiation therapy may also be used prior to surgery (neoadjuvant therapy) to help shrink the cancer or after surgery (adjuvant therapy) to help kill any remaining cancer cells.

  • Chemotherapy: A combination of drugs is used to kill cancer cells throughout the body. Chemotherapy is usually administered into a vein, is often used in combination with radiation therapy, and can be given before surgery or after surgery.

  • Photodynamic Therapy (PDT) : May be used in patients who are not good surgical candidates and is used in the treatment of Barrett's esophagus .

  • Nutritional Treatment: A plastic feeding tube is placed into the intestine to allow the patient to receive the necessary nutrients immediately following surgery. This allows patients to regain strength while progressively improving their oral intake. Patients with significant nutritional problems may sometimes have feeding tubes inserted prior to surgery. Nutritional treatment is also used in patients whose advanced-stage cancer prohibits them from surgery.