The tumor involves more than 5 cm (2 in.) of the esophagus and may involve the entire circumference in one area, causing blockage problems. The cancer has not spread to adjacent organs but may have spread to regional lymph nodes . Most cancers larger than 5 cm (2 in.) have positive lymph nodes.
Standard Treatment Combination therapy with radiation (3,000-5,000 cGy) and a chemotherapy infusion of 5-FU and mitomycin-C or cisplatin has produced local response rates of up to 80 percent. Treatments are toxic and side effects are increased. About 20 percent of patients had complete remission locally, meaning that no tumor was found at surgery. There is an average survival of one and a half years and up to three years for selected patients who experienced complete remission before surgery.
Surgery holds out some potential for cure, but there is high operative mortality . Stomach reflux and inflammation are common side effects. It should also be noted that because the esophagus has unusual lymphatic drainage, metastatic tumors may be found quite distant from the primary tumor .
Palliation Successful surgery will alleviate swallowing problems for two to three months in 90 percent of patients; radiation therapy will provide relief for 70 percent. Overall survival is about 11 months.
