Fighting Esophageal Cancer

Prognosis and Treatment of Cancer of the Esophagus

Sep 26, 2009 Roger Tunsley

Five-year survival statistics for late-stage esophageal cancer are poor but improving over time as the medical profession gains experience with its treatments.

Esophageal cancer is a particularly nasty disease. In its early stages, it is largely asymptomatic (lack of symptoms) so by the time it is noticed the cancer may be quite advanced. If swallowing has been restricted for some time, the sufferer may have already lost weight and be in poor health. It affects mainly older adults, a population whose general health is statistically likely to be poorer than a younger population.

Prognosis of Cancer of the Esophagus

The overall prognosis for esophageal cancer is dependent on many factors, but the main factors are:

• the stage of the disease; how far the disease has spread by the time it is diagnosed
• the age and general health of the patient

Survival from Cancer of the Esophagus

Attributing survival rates to this disease is difficult and a search on the internet often offers wildly different figures. Generally the rates are based on survival to five years and do not take into account if the patient has died because of the cancer or due to some other cause. Obviously, in a largely elderly population, this alone skews the survival rates in a negative direction.

With this in mind, here are the survival figures as presented on the American Cancer Society internet site:

• Stage 0 - >95%
• Stage 1 - 50 to 80%
• Stage 2a - 30 to 40%
• Stage 2b - 10 to 30%
• Stage 3 - 10 to 15%
• Stage 4 - less than 5%

Note that these figures relate to patients prior to 2000 and that improved knowledge and treatments are in turn improving these figures. Also note that these are stated as 'relative' survival rates, thus an attempt has been made to provide a correction for deaths that occur in the population from causes other than esophageal cancer.

Remember to be a critical reader when looking for information on this disease; there is much conflicting information on the internet. Look carefully at your information sources and remember that these are statistics whereas a patient is a single individual.

Treatments for Cancer of the Esophagus

There are three basic treatments for esophageal cancer:

• chemotherapy
• radiation therapy
• surgical excision (removal) of the esophagus

These may be used individually or in conjunction with each other depending upon the needs of the patient.

Chemotherapy for Cancer of the Esophagus

Chemotherapy is the introduction of chemicals into the body that are toxic to the cancer cells. The chemicals are introduced by mouth or directly into the bloodstream.They may be administered all at once or slowly fed into the body over a period of hours or days.

Unfortunately the chemicals are also toxic to the body and give rise to side effects that can range from mild to severe. Common side effects from chemotherapy are:

• Nausea
• Vomiting
• Neuropathy (numbness) of fingers and toes
• Hair loss
• Mouth sores

Chemotherapy alone is not usually curative for cancer of the esophagus but it can help to reduce tumor size prior to surgery or, when surgery is not an option, to reduce the tumor size to help the patient swallow and improve the quality of life. It also is used to increase the effectiveness of radiation therapy when both are administered together.

There are many chemicals used in chemotherapy, and research trials are ongoing to evaluate doses and combinations of chemicals to produce the greatest benefit with the least side effects.

Radiation Therapy for Cancer of the Esophagus

High-energy, focused radiation kills cancer cells. Radiation may be administered externally by focusing a tightly controlled beam of radiation to the tumor, or internally by placing radioactive beads directly into the tumor, a process known as brachytherapy. Radiation is often used in conjunction with chemotherapy to eradicate the cancer without resorting to surgery or to shrink the tumor prior to surgery.

Where surgery is not an option because the cancer is advanced or the patient's health is poor, it may be used as a palliative measure to shrink the tumor, improving swallowing and therefore the patient's quality of life.

Esophageal cancer is particularly difficult to treat with radiation due to the location of the esophagus deep inside the chest and its proximity to other organs and structures such as the lungs and the spinal column.

Radiation for esophageal cancer can have the following side-effects:

• Skin reddening and burning
• Pain when swallowing
• Fatigue
• Nausea
• Vomiting
• Diarrhea

Surgery for Cancer of the Esophagus

The aim of surgery for esophageal cancer is complete removal of the tumor. If the tumor is in the upper or middle part of the esophagus, then the esophagus is removed; an operation called an esophagectomy. If the tumor is located at the junction of the esophagus and the stomach, then a portion of the stomach is removed as well; this is called an esophagastrectomy. The stomach is then pulled up into the chest and reconnected to the remaining esophagus high in the chest or in the neck. In some cases where this is not possible, a section of the bowel may be used to replace the missing esophagus.

There are several techniques employed for this surgery. The surgeon may choose to perform the surgery through the abdomen or through the chest wall. These techniques are called trans-hiatal esophagectomy (THE) and trans-thoracic esophagectomy (TTE) respectively. Alternatively, both techniques may be employed together.

More recently, esophagectomies are being performed using minimally invasive surgical techniques which offer the hope of improved post-operative recovery times.

Esophageal cancer is increasing at a faster rate in the US than any other. However, as more of the medical community become practiced at recognizing and treating this disease, the dire survival rates should improve over time.

Important Note

The author is not a medical professional and is writing from both experience of open surgery and research carried out before and after surgery.

Related Articles

Identifying and Assessing Esophageal Cancer:Symptoms, Diagnosis, and Staging of Cancer of the Esophagus

Recovery From Esophageal Cancer Surgery:What to Expect After Surgery for Cancer of the Esophagus

Sources

American Cancer Society Web Site for Esophageal Cancer

Society of Thoracic Surgeons Web Site for Esophageal Cancer

The copyright of the article Fighting Esophageal Cancer in General Medicine is owned by Roger Tunsley. Permission to republish Fighting Esophageal Cancer in print or online must be granted by the author in writing.

Surgical Staff

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