Esophageal cancer can be definitively diagnosed only by performing an endoscopy of the esophagus, known as esophagoscopy, and then taking a biopsy of tissue from sites with typical changes. This biopsy is then examined under a microscope. Sometimes a small esophageal cancer can already be removed and thus cured during this examination. If the suspicion of esophageal cancer is confirmed, further examinations follow to assess the size and progression of the tumor. Endosonography, an ultrasound of the esophagus from the inside, is often used. Swallowing a porridge containing a contrast agent allows the esophageal cancer to be well evaluated on the x-ray. Sometimes esophageal cancer produces typical proteins that can be detected as tumor markers in the blood. These are less helpful in making a diagnosis because they can also occur in healthy people and are nonspecific. Nevertheless, they represent a good means of monitoring progress, since a renewed and/or rapid rise in tumor markers may indicate new or increased tumor growth.
Esophageal cancer: treatment by surgery.
Basically, the treatment and chances of cure for esophageal cancer depend on the type and stage of the disease and on the patient’s age and state of health. Surgical intervention holds the best chance of cure. Almost always, the aim is to completely remove and thus cure the esophageal cancer. The diseased part of the esophagus can be removed. The surgeon then attempts to “pull up” the stomach and form it into a tube, creating a replacement for the removed piece of esophagus. Sometimes the tumor is too far up or the removed esophageal cancer is too large, in which case a piece of small intestine is sewn into the esophagus as a replacement. There is a very good chance of recovery if the esophageal cancer is discovered at an early stage. If it is very small and limited to the uppermost layer, an attempt can be made to scrape off the uppermost layer of mucosa and thus achieve a cure. In most cases, not only the tumor itself must be removed during surgery, but also the surrounding tissue in order to remove very small metastases, so-called micrometastases as well. The surrounding lymph nodes are taken out, as the tumor often spreads through the lymphatic channels.
Treatment with radiation therapy or chemotherapy
To increase the success of surgery, it can sometimes be useful to shrink the tumor with chemotherapy or radiation therapy before surgically removing it. Less often, doctors recommend radiation therapy as the sole treatment for esophageal cancer. This is the case, for example, when the patient’s health does not allow surgery. If necessary, radiation can then be administered from the inside by placing small radiating materials inside the esophagus near the tumor (endoluminal brachytherapy). Doctors often also recommend combined radiation and chemotherapy following surgery to destroy any residual tumor cells that may have remained in the body. If the tumor is already in the final stage, so that metastases have already formed in several places in the body, the esophageal cancer is often no longer curable and the patient’s life expectancy is very short. It is then important to enable the patient to have as good a quality of life as possible by alleviating pain and halting the progression of the disease. One way of doing this is to use a stent. A stent is a plastic tube that is inserted into the esophagus. This dilates the esophagus so that the patient can continue to eat normally. If this is no longer possible, a tube can be placed externally through the abdomen into the stomach (percutaneous endoscopic gastrostomy, PEG) to allow food to be absorbed through the gastrointestinal tract and avoid artificial feeding.
Life expectancy in esophageal cancer.
Often, esophageal cancer is discovered late and metastases have already formed in the surrounding lymph nodes or more distant organs. Then there is little chance of cure for affected patients, and life expectancy is only a few years. In the advanced stage, only about 20 percent of patients suffering from esophageal cancer survive five years.Nevertheless, a cure may be possible, especially if the esophageal cancer can be detected early and completely removed. If esophageal cancer has been successfully cured, good aftercare is particularly important. Patients are best advised to have regular checkups at specialized clinics so that any recurrence of esophageal cancer can be treated as quickly as possible.
