Esophageal Cancer Treatment Options: From Early Ablation to Advanced Multimodal Therapy

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• Esophageal Cancer Treatment by Stage
• Radiofrequency Ablation for Early Cancer
• Diagnosing Advanced Esophageal Cancer
• Multimodal Therapy for Advanced Cancer
• Esophageal Cancer Surgery in Elderly
• Patient Selection for Treatment

Esophageal Cancer Treatment by Stage

Esophageal cancer therapy is critically dependent on the stage of the disease at diagnosis. Dr. Michael Lanuti, MD, a thoracic surgeon, explains that treatment strategies vary significantly. For Stage 1 esophageal cancer, less invasive procedures like ablation are often effective. In contrast, Stage 3 and Stage 4 esophageal carcinoma typically require a much more aggressive approach. This advanced approach involves extensive surgery combined with radiotherapy and chemotherapy to achieve the best possible outcome.

Radiofrequency Ablation for Early Cancer

For very early-stage lesions confined to the esophageal lining, ablation techniques offer a non-surgical cure. Dr. Michael Lanuti, MD, highlights radiofrequency ablation, specifically using technology like BARRX, as a primary tool. Cryoablation, or freezing ablation, is another effective method for destroying these superficial cancerous cells. These procedures are ideal when the cancer has not penetrated the esophageal wall and there is no lymph node involvement. Dr. Michael Lanuti, MD, notes that such early cancers are most often discovered during screening endoscopies, particularly in patients with chronic reflux, rather than when symptoms like trouble swallowing appear.

Diagnosing Advanced Esophageal Cancer

The diagnostic workup for advanced esophageal cancer is comprehensive and precise. Dr. Michael Lanuti, MD, outlines the standard process, which begins with a CT scan of the chest and abdomen. A PET CT scan is also crucial, as it helps assess metabolic activity and detect distant metastases. Patients then undergo an upper endoscopy to visualize the tumor directly. Finally, an endoscopic ultrasound (EUS) is performed. This procedure is vital for determining the depth of tumor penetration into the esophageal wall and for assessing nearby lymph nodes, which is essential for accurate staging.

Multimodal Therapy for Advanced Cancer

Treating locally advanced esophageal cancer requires a combination of therapies for the highest chance of a cure. Dr. Michael Lanuti, MD, states that surgery alone is often insufficient. The standard of care involves a triad of treatment modalities: chemotherapy, radiotherapy, and surgery. The sequence of these treatments can vary between medical institutions, but the goal remains the same. This aggressive, multimodal approach is necessary to address the aggressive nature of the disease comprehensively. Dr. Anton Titov, MD, and Dr. Lanuti discuss how this strategy has improved survival rates.

Esophageal Cancer Surgery in Elderly

Age alone is not a definitive barrier to curative esophageal cancer surgery. Advances in surgical technique, specifically minimally invasive esophagectomy, have reduced the physical stress of the operation. Dr. Michael Lanuti, MD, confirms that this has expanded treatment options. It is now possible to consider patients who are 80 years old or even older for this major procedure. However, Dr. Lanuti is quick to emphasize that the decision is never based on age alone. A meticulous evaluation of the patient's overall health and physiological reserve is paramount to ensuring safety and a positive outcome.

Patient Selection for Treatment

The cornerstone of successful esophageal cancer therapy is careful and thoughtful patient selection. Dr. Michael Lanuti, MD, underscores that this process is especially critical for elderly patients considering major surgery. The evaluation integrates findings from all diagnostic tests, including PET CT and endoscopic ultrasound, to create a complete clinical picture. A patient's functional status, comorbidities, and overall fitness are weighed against the potential benefits and risks of aggressive treatment. This holistic assessment ensures that each patient receives a personalized treatment plan with the best chance for success, as discussed by Dr. Anton Titov, MD.

Full Transcript

Esophageal cancer therapy by stage: radiofrequency ablation can treat Stage 1 esophageal cancer. Stage 3 and stage 4 esophageal carcinoma requires extensive surgery and radiotherapy. Chemotherapy can also affect esophageal cancer treatment success rate and prognosis.

Dr. Anton Titov, MD: Esophageal cancer treatment is one of your expertise areas. 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 for esophageal cancer surgical treatment?

Dr. Anton Titov, MD: How do you choose patients for treatment of esophageal cancer?

Dr. Michael Lanuti, MD: Esophageal cancer is often quite aggressive. We now have more tools to treat early stage esophageal cancer, when cancer is just in the lining of the esophagus. It's not always with cancer surgery but with things like ablation of the mucosa of the esophagus.

It's called radiofrequency ablation with the technology called BARRX. There's cryoablation, or freezing ablation. You could do it in a lung, and you can do it in the esophagus. Radiofrequency ablation is for very early stage esophageal cancer lesions that are only in the lining of esophagus.

Cancer cells have not penetrated the esophageal wall, and when there's no lymph nodes involved in esophageal cancer. Probably such esophageal 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 there are the more bulky esophageal tumors. People come in and they are having trouble swallowing.

Cryoablation technology is not really appropriate for patients with advanced esophageal cancer. Those esophageal cancer patients get worked up by a CT scan of the chest and the abdomen. They usually get a PET CT scan. You assess PET CT in these advanced esophageal cancer patients.

Patients get upper endoscopy. Then they get something called esophageal ultrasound. Esophageal ultrasound determines how much the tumor penetrates into the esophageal wall.

Dr. Anton Titov, MD: Surgery is the mainstay of therapy for esophageal cancer.

Dr. Michael Lanuti, MD: But, frankly, surgical operation cannot cure people by itself. So we pretty much have to throw everything we have at them. We have to do chemotherapy, radiotherapy, and surgery.

There's a sequence of how esophageal cancer therapy is done. Different hospitals do it differently. But we think that those three modalities of esophageal cancer therapy have the best chance for cure.

Sometimes you speak about patients with esophageal cancer who are young or who are old. We now have a minimally invasive esophagectomy. And we can apply minimally invasive esophageal cancer treatment.

It's still a big cancer surgery with a lot of stress on the body. We can treat esophageal cancer patients who are 80 years old or older.

Dr. Anton Titov, MD: But we carefully select patients for esophageal cancer treatment.