|Treatment of esophageal cancer depends on many factors: extent of the tumor, your age, general health, medical history, the stage of the cancer, existence of metastases, etc. Knowing these details, your doctor can determine which treatment will be most effective to fight the cancer in your esophagus. Any treatment considered, you will be invited to participate in the final choice.
In general, treatment of esophageal cancer includes surgery, chemotherapy, radiotherapy, and sometimes clinical trials.
If you have a small or superficial cancer, your doctor may reduce the size of the cancer by electrocoagulation (also called radio frequency diathermy or short wave electrolysis), photodynamic therapy, or brachytherapy. In this case, the surgery will involve the removal of the entire tumor and attachment of the esophagus with a portion of your digestive tract.
In advanced cancers, surgery is performed to remove part of the esophagus, surrounding lymph nodes, and the upper part of the stomach. The remainder of your stomach is then reattached to your esophagus. It is a sophisticated surgical procedure reserved for patients with advanced esophageal caners.
Even when the operation is performed by a competent surgeon, it can lead to serious complications: infection, bleeding and leakage from the area where the remaining esophagus is reattached.
Surgery cannot be performed in all cancers of the esophagus; in fact, about 30% of esophageal cancers can be operated. Alcohol-smoking related esophageal cancers often lead to heart and lung complications. In addition, secondary lung or oral cancers are sometimes discovered at the diagnosis.
If the cancer is too advanced, or if you are too old to undergo surgery, your doctor will consider chemotherapy together with radiotherapy. Although rare, for some patients, this combination offers recovery and survival rate similar to those of surgery.
Although can be taken orally, in the treatment of esophageal cancer, chemotherapy drugs are often given by direct injection into a vein to kill cancer cells. To treat your esophageal cancer, your physician can use chemotherapy alone or in combination with surgery. However, it barely leads to a complete cure; chemotherapy helps reduce symptoms associated with the disease such as painful and difficulty in swallowing (dysphagia). Common chemotherapy drugs used to treat esophageal cancer is 5-FU associated with cisplatin. Vinorelbine, with or without cisplatin, may be useful in the treatment of squamous cell carcinoma of the esophagus. Finally the combination of 5–FU and irinotecan is sometimes used if the above protocols do not work.
Those chemotherapy drugs always cause side effects, which may include:
- nausea and vomiting
- loss of hair
- shortness of breath
- Mouth sores.
In advanced esophageal cancers or when the tumor is considered inoperable, a combination of radiotherapy and chemotherapy (radio-chemotherapy) is often used. It includes 5 weeks of radiotherapy (dose of 50 Gy) and chemotherapy. Your physician may also perform a radio-chemotherapy in order to reduce the tumor and make it operable, neoadjuvant radiochemotherapy. Usually, this procedure requires about 5 weeks of treatment, and indication of surgery is considered depending on the response of your body to the therapy.
Like chemotherapy, radiation therapy is often accompanied by several side effects, which may include:
- sore throat
- voice changes
- mouth sores
- loss of taste or smell
- sensitivity of the mouth and gums
- lower production of saliva
- redness and dry skin at the treated site.
Clinical Trials – Clinical trials are new scientific studies aim at evaluating new methods of prevention or/and treatment of a specific cancer. Some clinical trials are conducted on medications aim to reduce side effects of chemotherapy drugs. Most often, physicians are aware of the availability of those drugs. Ask your doctor if there is a trial available for your type of cancer.
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