All forms of treatment—radiation therapy, surgery, laser therapy, combination chemotherapy—have been of modest help.
Cancers in the lower two-thirds of the esophagus are generally treated with surgery. Tumors in the upper third (which may have invaded the trachea or larynx) seem to respond better to radiation, but patients with cancers in that area have a poorer prognosis . Unfortunately, 80 to 90 percent of patients have local tissue or lymph node invasion. Nutritional support is necessary. Those with more than a 10 percent weight loss have a poorer prognosis, with an average survival of six months.
Surgery Since most patients in North America have advanced (Stage III) esophageal cancer before
diagnosis, only 25 to 40 percent have tumors that can be removed in an attempt at cure. Before surgery, an evaluation for metastases is performed.
Radical surgery for cure involves removing the entire esophagus (or a good part of it) and the surrounding tissues and lymph nodes . If the lesion is in the lower esophagus near the stomach, the top of the stomach has to be removed as well. Once the esophagus is removed, the stomach can be brought all the way up to bridge the gap (esophagogastrostomy). A portion of the colon may be used instead. This operation is rather demanding of both patient and surgeon. It should be performed only in major medical centers because complex care will be needed during and after surgery.
