Esophageal cancer treatment options – Leading thoracic surgeon
Esophageal cancer therapy must be tailored not only to tumor stage but to the individual patient. Brief overview:
Esophageal cancer treatment is also one of your specialties. Esophageal cancer treatment by surgery, whenever possible, is also one of the gold standards of treatment. Now more and more elderly people could be suitable for esophageal cancer surgery. What are the criteria, how do you choose patients for treatment of esophageal cancer? Which is often quite aggressive… Early stages esophageal cancer, which is just in the lining of the esophagus, we now have more tools to manage that. It’s not always with surgery but with things like ablation of the mucosa of the esophagus. It’s called radiofrequency ablation with the technology called BARRX. There’s cryo- or freezing ablation, just like you could do in a lung, you can do in the esophagus. And these are for very early stage esophageal cancer lesions that are only in the lining and have not penetrated the esophageal wall. And when there’s no lymph nodes involved in cancer. – And probably such cancer is found on screening rather than being a symptomatic esophageal cancer… – That’s correct. So esophageal cancer screening, or someone has a lot of reflux who got endoscopy done. And then the more bulky esophageal tumors, where people come in and they are having trouble swallowing. That [ablation] technology I just mentioned is not really appropriate. Those esophageal cancer patients get worked up by a CT scan of the chest and the abdomen, they get usually a PET CT scan, and you assess [these tests]. And they get upper endoscopy. And then they get something called esophageal ultrasound to look for how much the tumor penetrates into the esophageal wall. Surgery is the mainstay for esophageal cancer. But, frankly, surgeries cannot cure people by itself. So we pretty much have to throw everything we have at them – chemotherapy, radiation and surgery. There’s a sequence of how that’s done and different institutions do it differently. But we think that those three modalities of esophageal cancer therapy have the best chance for cure. When you speak of someone who’s young versus old, we now have what’s called minimally invasive esophagectomy. And we can sort of apply it. It’s still a big surgery with a lot of stress on the body. We can do people who are in their 80s but we carefully select them for esophageal cancer treatment.