Diagnosis
The most important examination for the diagnosis of esophageal cancer is the endoscopy of the esophagus, stomach and duodenum (esophagogastroduodenoscopy). In this procedure, either after anaesthetising the throat with a local anaesthetic spray or after administering a sleeping syringe, a tube is inserted through the mouth and throat into the oesophagus, stomach and duodenum. A camera is attached to the tube.
With the help of this camera one can look at the organs. If an area is noticeable, a small tissue sample (biopsy) can be taken from it. This is sent for a fine tissue examination.
During this examination, the piece of tissue is examined under a microscope, for example, and the pathologist can then make a diagnosis. In many cases, the external appearance of the conspicuous area can already be used during the mirroring to suspect that a malignant disease is present, but a reliable diagnosis is always only possible under the microscope. Especially in the area of the stomach and duodenum, even a simple ulcer can sometimes look very similar to a tumor.
Endosonography, a mixture of mirroring and ultrasound, can be used for further diagnosis. With the help of this, for example, the depth of the ulcer in the surrounding tissue can be assessed. This is often important to decide which treatment options are possible.
It is also important to search for tumor plaques. This is usually done by means of computer tomography. Possible metastasis sites of esophageal cancer are mainly lymph nodes, lung and liver.
Therapy
Conservative therapy means non-invasive therapy, i.e. there is no surgical intervention. Conservative treatment options for esophageal cancer include, above all, radiotherapy (radiotherapy) and chemotherapy or a combination of both. Which type of therapy is used depends largely on the stage of the tumor and on how old the patient is and, above all, on his or her state of health.
Radiotherapy or chemotherapy alone, without subsequent or previous surgery, is often only used in palliative treatment. Palliative means that a cure is no longer possible, but the symptoms should be contained as far as possible.Radiation and chemotherapy can be used to try to inhibit or slow down further growth of the tumor. A more recent procedure is the so-called photodynamic therapy.
Here, the patient is administered a substance that accumulates relatively selectively in the tumor tissue. The tumor tissue is then irradiated with light of a specific wavelength. This leads to a so-called phototoxic reaction, a part of the tumor cells is destroyed.
This is used in the oesophagus, for example, to slightly reduce severe constrictions and thus improve the passage of food. A combination of radiation and chemotherapy, the so-called radiochemotherapy, is not only used in a palliative situation. In some cases, it can be helpful to reduce the size of the tumor before surgery using a combination of radiotherapy and chemotherapy to make the operation more promising.
This is called neoadjuvant radiochemotherapy. Another conservative treatment option is the insertion of a metal tube (stent) into the esophagus. This therapy also only serves to alleviate symptoms and not to cure them.
The stent can push the tumor mass a little bit to the edge and thus make swallowing somewhat easier again. When an esophageal cancer can be operated on depends on the stage of the cancer, the patient’s age and overall condition. Depending on the height of the tumor in the esophageal region, different operations are possible.
The esophagus runs through the chest down to the upper abdomen. If the tumor is located far below, only the abdominal cavity needs to be opened. Often, however, a so-called 2-cavity operation is necessary, i.e. the chest and abdomen must be opened to remove the tumor.
If the tumor is located at the transition from the esophagus to the stomach, an additional partial removal of the stomach may be necessary. In most cases a partial or complete removal of the esophagus is necessary. In most cases, a so-called gastric uplift can then be performed.
This means, as the name suggests, that the stomach is pulled up from the abdomen and reduced to a kind of tube. It then serves as a replacement for the oesophagus. If the stomach cannot be used as an oesophageal replacement, the surgeon uses part of the large or small intestine, which he then inserts between the stomach and the rest of the oesophagus.
Often a combination of radiation and chemotherapy, radiochemotherapy, is used before the operation. This can reduce the size of the tumor, which increases the chances that the tumor can be completely removed with the operation. For some years now, tumors can be removed at a very early stage using a purely endoscopic procedure, i.e. gastroscopy. In this procedure, the tumor tissue is “scraped” from the mucous membrane with an electrical loop. Risks of the operation can include bleeding, infection with germs, allergic reaction to the anaesthetic, injuries caused by the surgical instruments, injury to neighbouring organs and damage to nerves.
