After an esophageal cancer diagnosis has been made, your doctor will try to determine if the cancer has spread, and if so, how far, through a process called staging. The stage of cancer determines how severe the cancer is, as well as the best approach for treatment.
One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to determine:
Your doctor will label your cancer as stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. The stages are often broken in to sub categories such as Stage 1A or 1B.
The exact stages for squamous cell carcinoma are slightly different from adenocarcinoma esophageal cancer.
The grade of cancer is determined based on how different the cancer cells look from healthy esophagus cells. The higher the grade, the more abnormal the cells look under a microscope.
Grade 1: Low grade which means the cancer cells look rather similar to normal esophagus cells.
Grade 2: Intermediate grade esophageal cancer is somewhere between low grade and high grade.
Grade 3: High grade which means the cancer cells looks very different from healthy cells.
There are several different types of treatment available for patients diagnosed with esophageal cancer. Some treatments are standard and commonly used, while others are being tested in clinical trials. Based on each patient’s specific case, the treatments for esophageal cancer will vary but may include: surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy. A combination of these treatment types may be used in your care plan.
The type of surgery commonly performed to remove the cancerous part of the esophagus is called an esophagectomy. This removes a portion of the esophagus where the cancer is located. The surgeon then reconnects the esophagus to the stomach using either a section of intestine or a plastic tube.
Radiation therapy is the use of high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. It can be used before surgery to shrink the tumor first and it can be used after surgery to be sure all of the cancer cells in the area have been killed. The most common type of radiation therapy used for esophageal cancer is external beam radiation, which is radiation therapy given from a machine outside the body.
At Radiotherapy Clinics of Georgia, we typically use intensity-modulated radiation therapy (IMRT) — an advanced form of external beam radiation treatment that precisely targets tumor cells while avoiding other organs and tissue nearby. It also makes it possible for the radiation oncologist to vary the intensity of some of the beams of radiation to focus more carefully in some areas than in others.
When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope. Brachytherapy can be given 2 ways, either high-dose rate (HDR) brachytherapy or low-dose rate (LDR) brachytherapy.
Treatments using medication are used to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Medications may be given through the bloodstream (called systemic therapy) to reach cancer cells throughout the body or they may be given directly at the site of the cancer (called local therapy).
The types of medications used for esophageal cancer include:
When the symptoms and side effects associated with esophageal cancer need to be managed, patients may receive endoscopic therapy — treatments that use a long, flexible tube called an endoscope. Endoscopic therapy could include:
Esophageal cancer can potentially make it difficult for patients to eat due to trouble with swallowing. The esophagus may become partially blocked by the tumor or as a side effect of treatment. A dietitian can help patients going through treatment for esophageal cancer understand how to get the nutrition they need to stay strong during treatment.
It is a possibility for some patients to receive a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they can eat on their own. This is discussed with the oncologist and dietitian to determine if this is needed and for how long.
If your suggested treatment plan includes radiation therapy, it’s important to carefully consider where you will receive treatments. When choosing our clinics, you will have a dedicated team of radiation oncologists, radiation therapists, and support team members to help you along your esophageal cancer journey. The RCOG team is conveniently throughout the Atlanta area, with locations in Blairsville, Conyers, Covington, Decatur, and Snellville. Request an appointment online today to see one of our radiation specialists.