Esophageal cancer is a disease in which malignant cells in the esophagus grow in an uncontrolled fashion with the ability to travel to other parts of the body and disrupt the normal function of the affected organ. It is caused by a genetic mutation in normal cells that turns them into malignant cells. It can develop spontaneously or from environmental factors such as long standing reflux, alcohol abuse, or smoking.
Esophageal cancer typically starts in the mucosa or first inner layer of the esophagus and grows over time. Esophageal cancer is either detected very early in the process or when it is locally advanced or the disease has gone to other parts of the body. Patients with a long-standing history of reflux often have an endoscopy that can show Barrett’s esophagus. This is thought to be a precursor lesion that can lead to esophageal cancer. Patients undergo endoscopic therapy and close surveillance. During the surveillance endoscopy, patients can be diagnosed with very early esophageal cancer. Often when patients have symptoms, patients typically have locally advanced cancer or cancer that has gone to other parts of the body. The most common symptom of esophageal cancer is difficulty swallowing and weight loss.
Esophageal cancer is diagnosed and treated based on the type of esophageal cancer. There are two major types of esophageal cancer: squamous cell carcinoma and adenocarcinoma.
Once the patient is diagnosed with esophageal cancer, he or she undergoes studies to determine the clinical stage of the esophageal cancer. Typically, esophageal cancer is found in the esophagus, has spread to nearby lymph nodes and finally to other organs such as the liver and bone. Two main studies that we use to determine the extent of disease are:
- PET-CT—This study is performed in radiology. It provides information about the spread of cancer to lymph nodes and other parts of the body except for the brain.
- EGD/EUS—A gastroenterologist or thoracic surgeon performs this study. It provides information about the depth of the tumor invasion through the wall of the esophagus and whether any tumors have spread to nearby lymph nodes.
This provides the clinical stage of the lung cancer. Our treatment recommendations are based on the extent of the tumor.
- Very early tumor—If the patient’s tumor is found very early, typically the patient is recommended to undergo endoscopic procedure to remove the cancer.
- Early cancer—If the patient has cancer that is not amenable to an endoscopic procedure, the patient is recommended to undergo esophagectomy.
- Locally advanced cancer—If the patient has locally advanced disease with the possibility of surgery, the patient undergoes induction chemoradiation therapy followed by surgery.
- Distant disease—If the patient has distant disease, the patient is recommended to undergo systemic therapy by a medical oncologist.
If surgery is recommended, we perform additional tests to determine if patients can safely undergo surgery.
- Cardiac testing—These studies are typically performed by a cardiologist. This set of tests determines if the patient’s heart can safely undergo the stress of surgery.
- Pulmonary function test (PFTs)—This study is performed in a pulmonary lab. This provides information on the patient’s lung function and provides information on the patient’s lungs’ ability to tolerate resection.
These studies allow us to advise patients with esophageal cancer about the best treatment option for them.
The surgical options for patients with esophageal cancer are the following based on the location of the tumor:
- Robot-assisted minimally invasive Ivor Lewis esophagectomy
- Robot-assisted minimally invasive McKewon esophagectomy