Esophageal Cancer Treatment at World Class Hospitals in India.

Cancer that begins in the esophagus (also called esophageal cancer) is divided into two major types, squamous cell carcinoma and adenocarcinoma, depending on the type of cells that are malignant. Squamous cell carcinomas arise in squamous cells that line the esophagus. These cancers usually occur in the upper and middle part of the esophagus. Adenocarcinomas usually develop in the glandular tissue in the lower part of the esophagus. The treatment is similar for both types of esophageal cancer.

If the cancer spreads outside the esophagus, it often goes to the lymph nodes first. (Lymph nodes are small, bean-shaped structures that are part of the body’s immune system.) Esophageal cancer can also spread to almost any other part of the body, including the liver, lungs, brain, and bones. Risk factors for developing esophageal cancer include:

• Smoking
• Heavy Drinking
• Damage from acid reflux

Description

During minimally invasive esophagectomy, small surgical cuts (incisions) are made in your upper belly, chest, or neck. A viewing scope (laparoscope) and surgical tools are inserted through the incisions to perform the surgery. (Removal of the esophagus can also be done using the open method. Surgery is done through larger incisions.)

Laparoscopic surgery is generally done in the following way:

• You’ll receive general anesthesia at the time of your surgery. This will keep you asleep and pain-free.
• The surgeon makes 3 to 4 small cuts in your upper belly, chest, or lower neck. These cuts are about 1-inch (2.5 cm) long.
• The laparoscope is inserted through one of the cuts into your upper belly. The scope has a light and camera on the end. Video from the camera appears on a monitor in the operating room. This allows the surgeon to view the area being operated on. Other surgical tools are inserted through the other cuts.
• The surgeon frees the esophagus from nearby tissues. Depending on how much of your esophagus is diseased, part or most of it is removed.
• If part of your esophagus is removed, the remaining ends are joined together using staples or stitches. If most of your esophagus is removed, the surgeon reshapes your stomach into a tube to make a new esophagus. It is joined to the remaining part of the esophagus.
• During surgery, lymph nodes in your chest and belly are likely removed if cancer has spread to them.
• A feeding tube is placed in your small intestine so that you can be fed while you are recovering from surgery.

Some medical centers do this operation using robotic surgery. In this type of surgery, a small scope and other instruments are inserted through the small cuts in the skin. The surgeon controls the scope and instruments while sitting at a computer station and viewing a monitor.

Treatment Options available for Esophageal Cancer at World Class Hospitals in India

The stage of cancer is determined first of all by analysing the size of the tumour and the number and location of enlarged lymph nodes. Accurate staging helps tailor treatment to the patient’s specific needs. Staging can be done with CT scan, biopsy, esophageal ultrasound and PET scan.

Surgery: Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery is used as the main treatment only for patients with early-stage esophageal cancer.

For patients with locally-advanced esophageal cancer, a combination of chemotherapy and radiation therapy (see below) may be used before surgery to shrink the tumor. For people who cannot have surgery, the best treatment option is often a combination of chemotherapy and radiation therapy.

The most common surgery to treat esophageal cancer is called an esophagectomy, where the doctor removes the affected part of the esophagus and then connects the remaining healthy part of the esophagus to the stomach so that the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The surgeon also removes lymph nodes around the esophagus. Talk with your health care team about the possible side effects of this surgery and how they will be managed.

Radiation Therapy : Radiation therapy is first deployed to shrink the tumor with carefully directed radiation at the tumor. This helps destroy or reduce the tumor, because cancer cells divide and grow faster than normal cells. Normal cells usually recover successfully from new age radiation like Linac, Gamma Knife, Novelis or Cyberknife. Radiation therapy is given as an outpatient for 5 minutes for 5 to 6 weeks.

Chemotherapy : Chemotherapy is used to help shrink the tumor and kill any cancer cells in the lymph nodes. There are several chemotherapy medications that work to kill lung cancer and often a combination of 2 of these medications is prescribed. The specific medication or combination of medications you receive will be selected based on your tumor type and your medical history. Chemotherapy will be given as an inpatient for 4-5 day sessions twice during your treatment. Other medications before and during chemotherapy are prescribed which are designed to minimize and relieve the side effects.

Re-staging : Approximately 4-6 weeks after your last treatments you will undergo several tests to determine the success of therapy. You may be required to undergo another set of tests like CT scan of the chest and upper abdomen and Upper endoscopy and esophageal ultrasound.

Surgical Resection : If you have had chemotherapy and radiation therapy, surgical resection of the esophagus will occur approximately 5-6 weeks after your last radiation treatment.

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