Esophageal Cancer Diagnosis and Treatment

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

• Chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  
  
• Upper GI (gastrointestinal) series (Also called barium swallow.) - a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
  

  

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• Esophagogastroduodenoscopy (Also called EGD or upper endoscopy.) - a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
  

  

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• Computed tomography scan (CT or CAT scan) - diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  
  
• Endoscopic ultrasound - this imaging technique uses sound waves to create a computer image of the inside of the esophagus and stomach. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
  

   

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• Thoracoscopy and laparoscopy - these methods allow the physician to examine the lymph nodes inside the chest or abdomen with a hollow, lighted tube, and remove these nodes for further testing.
  

Treatment for esophageal cancer:
Specific treatment for esophageal cancer will be determined by your physician based on:

• Your age, overall health, and medical history
  
  
• Extent of the disease
  
  
• Your tolerance for specific medications, procedures, or therapies
  
  
• Expectations for the course of this disease
  
  
• Your opinion or preference
  

Treatment may include:

Surgical treatment 
Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, only part of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes, and the top of the stomach are removed. The remaining portion of the esophagus is then reconnected to the stomach.

In an esophagectomy, the esophagus is removed and a replacement esophagus is created out of part of the stomach. Esophageal cancer and several kinds of esophageal abnormalities require the surgical removal or “resection” of the esophagus. There are four different approaches to esophagectomy. Your surgeon will choose the right one for you and discuss the reasons for it with you.

The four surgical approaches are Transthoracic, Ivor-Lewis, 3-Hole Esophagectomy and Transhiatal. The surgeon will choose the appropriate approach to remove the esophagus, tumor or obstruction and lymph nodes adequately. Depending on the location of the tumor, an abdominal or a neck incision will need to be made.

Minimally invasive esophagectomy 
In minimally invasive esophagectomy, small incisions are made and video-assisted thoracic surgery (VATS) is performed with laparoscopic instruments to remove the esophagus. Minimally invasive surgery uses smaller incisions than open surgery, which can have several benefits, including:

• Less trauma to the body
• Reduced blood loss
• Reduced need for transfusion
• ter patient recovery
• Decreased post-operative pain
• Shortened hospital stays

• Chemotherapy
  Chemotherapy uses anticancer drugs to kill cancer cells.
  
  
• Radiation therapy
  Radiation therapy uses high-energy rays to kill or shrink cancer cells.

Sometimes, several of these treatments may be combined for treating esophageal cancer.