Therapy
The treatment of patients requires intensive cooperation between the medical departments of surgery, internal medicine and radiotherapy. During therapy, the TNM classification is used as an essential decision-making aid. There are corresponding therapy guidelines for each tumor stage.
Thus, three treatment goals can be described, which are considered depending on the stage. Healing of the patientThis goal exists in patients in stage I (see above). A recurrence of the carcinoma at the same site is theoretically possible (tumor recurrence) if individual tumor cells should have survived surgery and radiochemotherapy.
Careful aftercare is therefore necessary. Tumor controlIn patients with tumor stages II and III, various therapeutic approaches are used to control tumor growth and prevent its spread. Despite the lack of healing possibilities, in some cases a long-term freedom from symptoms is achieved. Relief of symptomsIn patients with tumor stage IV, a cure is impossible. The main focus of the therapy is the relief of symptoms (especially pain, difficulty swallowing, food intake).
Surgical therapy
If the tumor lies only in the superficial layer of the esophageal mucosa, it can be removed superficially during an endoscopy (mucosal resection).In transthoracic esophagoectomy, both the thorax and abdomen are opened and the affected section of the esophagus is removed at a sufficient distance from the tumor and the surrounding lymph nodes. In some cases, the entire esophagus must be removed. If the lower esophagus or the transition to the stomach is affected, the stomach must also be partially or completely removed. Sometimes it is also necessary to remove neighboring structures as well as the surrounding fatty and connective tissue. The removed section of the esophagus is either replaced by the stomach moved into the chest cavity (gastric uplift) or, if the stomach has also been removed, by a piece of the intestine.
Pathological diagnostics
The removed esophageal tumor is histologically evaluated after removal. For this purpose, the tumor is incised at specific sites and some samples are taken. Wafer-thin slices of these samples are made, stained and evaluated under the microscope.
Here the type of tumor is determined and those with removed lymph nodes are examined for tumor infestation. To completely exclude lymph node involvement, the pathologist must examine at least 6 lymph nodes. Only after the pathological findings, the tumor can be clearly described according to the TNM classification.
