For those patients who are diagnosed with esophageal cancer, esophagectomy is the standard therapy, unless the cancer has spread beyond the esophagus and adjacent tissue. The proportion of esophageal cancer patients alive five years after diagnosis is between 5 and 30 percent, depending on the stage of cancer they have at diagnosis and how well they respond to treatment. Most patients with localized esophageal cancer stage 1 or 2 disease used to be treated with surgery alone.
In recent years, a combination of chemotherapy and radiation or chemotherapy and radiation followed by surgery is being used more often to treat esophageal cancer, says David Ilson, MD, from Memorial Sloan-Kettering Cancer Center in New York. The addition of chemotherapy to a radiation treatment protocol can enhance the effectiveness of radiation and increase the proportion of patients who achieve a complete remission or a good partial remission with radiation.
Subsequent surgery, done after chemotherapy and radiation, can then be used to remove any residual cancer. Combining chemotherapy, radiation therapy and surgery called combined modality approaches are increasing the cure rate of this cancer.
The current standard chemotherapy given with radiation therapy is a combination of 5-FU plus cisplatin, but this can lead to significant side effects of mouth sores and esophagitis. For patients with metastatic stage 4 disease, surgery is not recommended.
Rather, physicians treat such advanced disease with chemotherapy, which is not likely to cure the cancer but may slow its progress and make the patient more comfortable. But Dr. Ilson says Xeloda is not yet used frequently in the United States for this disease. In addition to traditional chemotherapy agents, physicians are testing the use of newer, less toxic targeted drugs in esophageal cancer.
Unlike standard chemotherapy drugs, which kill all dividing cells, targeted therapies block specific steps in the cancer cell growth pathway and leave most healthy cells undamaged.
Patients with advanced esophageal cancer may experience difficulty swallowing and an inability to take solid food, which can cause malnourishment and an inability to tolerate chemotherapy. In patients who are not candidates for curative surgery or radiation-based treatment, the relief of swallowing difficulties is a primary goal of palliative or symptom-relieving management.
Chemotherapy alone in advanced disease may relieve swallowing problems. Additionally, there are several options for local therapy, and esophageal stenting is one of the most common.
During the procedure, a physician uses endoscopy to place a stent in the esophagus, and, because the stent is a semi-rigid tube, it prevents the tumor from blocking or narrowing the esophagus. Another option that is sometimes used is called photodynamic therapy. The gastroenterologist uses an endoscope to then shine laser light on the tumor, killing the cancer cells. One problem with this approach is that the patient has to avoid light for several weeks after treatment, which can significantly lower his or her quality of life.
Also, the results of this treatment are relatively short-lived. If a patient has failed chemotherapy or they have a stent in place but the tumor is overgrowing the stent, physicians may use radiation to locally control the tumor. In some cases, the doctor may opt to use laser therapy in which a laser is attached to an endoscope to kill off parts of the tumor that are causing swallowing difficulties.
In this situation, however, radiation is used more frequently than lasers, says Dr. For patients who are malnourished and not able to take in adequate amounts of calories, a feeding tube is placed in the stomach. This tube usually called a PEG tube allows food to be administered directly into the stomach, thus ensuring the patient receives adequate nutrition.
The following is a breakdown of the stages of esophageal cancer: Stage 0. This is the best-case scenario for a person diagnosed with esophageal cancer; in this stage of cancer, the disease has just begun to develop and has not spread beyond the lining of the esophagus. There are typically very few or no symptoms in this stage. Between 80 and 90 percent of esophageal cancer patients diagnosed in stage 0 can expect to survive five years following their treatment.
Stage I. At this stage of esophageal cancer, the disease has spread deeper into the tissues of the esophagus, but has not yet affected nearby lymph nodes or organs. The five-year survival rate for people diagnosed with esophageal cancer during this stage is 34 percent. Stage II. By this stage, the cancer has moved into the deeper tissues of the esophageal wall and may now affect lymph nodes near the esophagus. The five-year rate of survival is 17 percent when esophageal cancer is diagnosed at stage II.
Stage III. In stage III, the cancer has progressed beyond the wall of the esophagus and nearby lymph nodes to surrounding tissues, but other organs are not yet affected. At this stage, people often complain of throat pain and difficulty swallowing. Twenty to 30 percent of patients in stage III who receive both chemotherapy and radiation are likely to survive between three and five years. It is important to remember that statistics on the survival rates for people with esophageal cancer are an estimate.
The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics. The next section in this guide is Medical Illustrations.
It offers drawings of body parts often affected by esophageal cancer. Use the menu to choose a different section to read in this guide. Esophageal Cancer: Statistics Approved by the Cancer. Types of Cancer. Esophageal Cancer Guide. Net Guide Esophageal Cancer.
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