An esophagectomy is a surgery that removes some or most of the esophagus. The amount of the esophagus removed depends upon the stage of the tumor and its location. Removing the esophagus (and nearby lymph nodes) may cure the cancer If it hasn’t yet spread far beyond the esophagus.
There are several different ways to perform esophagectomy, each of which requires a complex operation that may require an extended hospital stay:
Open esophagectomy. In an open esophagectomy, the surgeon makes large incisions in a combination of the neck, chest, or abdomen (and sometimes in all three).
- A transhiatal esophagectomy has its main incisions in the neck and abdomen.
- A transthoracic esophagectomy has its main incisions in the chest and abdomen.
Minimally invasive esophagectomy. If the cancer is small enough or caught early enough, the esophagus can sometimes be removed through a much less invasive procedure involving several smaller incisions. The surgeon will insert a laparoscope (a thin flexible tube with a light) into one small incision and surgical instruments through other small incisions. Because it doesn’t involve the large incisions of other procedures, minimally invasive esophagectomy may help reduce time in the hospital and speed up recovery time.
Lymph node removal
No matter the type of esophagectomy, nearby lymph nodes (typically at least 15) will also be removed to see if they have cancer cells. If they do show cancer, the prognosis isn’t as strong and your doctor may recommend additional treatments like chemotherapy and/or radiation post surgery.
Surgery for palliative care
Palliative care involves minor surgery designed to prevent or relieve problems caused by the cancer instead of trying to cure the cancer itself. An example of this would be placing a feeding tube directly into the stomach or small intestine of a patient who wasn’t getting enough nutrition on their own.
Radiation therapy uses concentrated x-rays to destroy cancer cells and is often used as the main treatment for people who either can’t have or don’t want surgery. To most effectively treat esophagus cancer, radiation therapy is often combined with chemotherapy (chemoradiation) and/or surgery.
Radiation therapy used before surgery is called neoadjuvant treatment and it tries to shrink the cancer to make removal easier.
Radiation therapy used after surgery is called adjuvant treatment and it attempts to kill any remaining cancer cells that may still exist.
Types of radiation therapy. Doctors can offer two main types of radiation therapy to treat esophageal cancer.
- External-beam radiation therapy (EBRT), the most common type of treatment for esophageal cancer, uses a machine outside the body to direct intense radiation at the cancer. The frequency and duration of the treatments depends on why the radiation is being given as well as other factors. Treatments can span a few days to weeks.
- Internal radiation therapy (brachytherapy) uses an endoscope (a long, flexible tube) to go down the throat and place radioactive material right next to the tumor for a short time. Because the radiation only has to travel a short distance, it effectively reaches the tumor without impacting nearby normal tissues. The result is fewer side effects than with EBRT.
As research reveals more about the mutations in cells that cause cancer, doctors develop breakthrough drugs designed to target those exact changes. Because they’re made to work differently than standard chemotherapy drugs, targeted drugs will sometimes be more effective than, and have different side effects from, standard chemo drugs.
Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells more effectively. It can be used to treat some people with esophagus cancer.