What Can I Expect If I Have Esophageal Cancer
That depends on factors like your overall health and if you received a diagnosis before the tumor spread. Healthcare providers often successfully treat early-stage esophageal cancer. About 46% of people treated for early-stage esophageal cancer are alive five years after diagnosis.
Healthcare providers may not be able to destroy the cancer, especially if its already spread. They can provide treatment to help you live well as long as youre able, maintain quality of life and ease symptoms. They may recommend palliative care that can help you live comfortably and without pain.
Surgery With Or Without Chemotherapy And Radiation Therapy In Treating Patients With Cancer Of The Esophagus
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|First Posted : May 19, 2004Last Update Posted : July 4, 2016
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known whether surgery is more effective with or without chemotherapy and radiation therapy for cancer of the esophagus.
PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without combination chemotherapy and radiation therapy in treating patients who have cancer of the esophagus that can be surgically removed.
|Drug: cisplatinDrug: fluorouracilProcedure: surgical procedureRadiation: radiation therapy
|Study Type :
|A Prospective Randomized Phase III Trial Comparing Trimodality Therapy to Surgery Alone for Esophageal Cancer
|Study Start Date :
Patients are required to have:
Types Of Esophageal Cancer Surgery
Surgical treatments for esophageal cancer include:
- Transhiatal surgery: In this procedure, the surgeon makes incisions in the neck and abdomen in order to remove the tumor. This approach avoids an incision in the chest but cannot be used if the tumor involves a portion of the stomach or if there are lymph nodes in the chest that must be removed.
- Ivor-Lewis surgery: This approach is most often used when the tumor is located near the stomach or if there are lymph nodes in the chest that need to be removed. The surgeon makes incisions in the abdomen and the right side of the chest.
- Minimally invasive esophagectomy : In this procedure, the surgeon removes all or part of the esophagus using small incisions for shorter recovery times, less pain and fewer complications than standard esophagectomies, which involve larger incisions.
- Robotic surgery: With this technique, a surgeon performs a robotic esophagectomy by using robotic arms to manipulate tiny surgical instruments. This minimally invasive approach allows the surgeon a complete range of motion and better precision than other types of surgery.
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Side Effects Of Radiation Therapy
If you are going to get radiation therapy, its important to ask your doctor beforehand about the possible side effects so you know what to expect. Possible Side effects of external radiation therapy can include:
- Skin changes in areas getting radiation, such as redness, blistering and peeling
- Nausea and vomiting
- Painful sores in the mouth and throat
- Dry mouth or thick saliva
- Pain with swallowing
These side effects are often worse if chemotherapy is given at the same time as radiation.
Most side effects of radiation are temporary, but some less common side effects can be permanent. For example, in some cases radiation can cause a stricture in the esophagus, which might require more treatment. Radiation to the chest can cause lung damage, which may lead to problems breathing and shortness of breath.
If you notice any side effects, talk to your doctor right away so steps can be taken to lessen them.
How Do Healthcare Providers Diagnose Esophageal Cancer
A healthcare provider will ask questions about your symptoms and medical history. They may do the following tests to diagnose the condition:
- Barium swallow:Healthcare providers look at your esophagus through a series of X-rays. Its called a barium swallow because people drink a liquid with barium. Barium makes it easier for healthcare providers to see your esophagus on the X-ray.
- Computed tomography scan:This test helps healthcare providers determine if tumors have spread to your chest and abdomen .
- Esophagogastroduodenoscopy :Healthcare providers use a thin flexible tube called an endoscope to look at the inside of your esophagus.
- Esophageal endoscopic ultrasound:Sound waves create images of the inside of your esophagus. Healthcare providers may do this test as part of an EGD.
- Biopsy: During the EGD, healthcare providers may remove a small piece of tissue to examine under a microscope to see if there are any cancer cells.
Healthcare providers use what they learn in diagnosis to classify or stage esophageal cancer. Cancer staging systems lay the foundation for cancer treatment.
When healthcare providers stage esophageal cancer, they look at factors such as cancer tumor location and depth, if it has spread to nearby lymph nodes and if the cancer has spread to other distant tissues or organs.
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What Are Possible Side Effects Of Radiation Therapy
Radiation treatment can cause side effects. These problems may result from the treatment itself or from radiation damage to healthy cells in the treatment area.
The number and severity of side effects will depend on the type of radiation, dose, and body part under treatment. Talk to your doctor and/or nurse so they can help manage them.
Radiation can cause early and late side effects. Early side effects happen during or right after treatment. They are typically gone within a few weeks. Common early side effects include fatigue and skin problems. Skin in the treatment area may become sensitive, red, irritated, or swollen. Other changes include dryness, itching, peeling, and blistering.
Depending on the area being treated, other early side effects may include:
- hair loss in the treatment area
- mouth problems and difficulty swallowing
- eating and digestion problems
- secondary cancer
There is a slight risk of developing cancer from radiation therapy. After treatment, your radiation oncologist will regularly check for complications and recurrent or new cancers.
Other common side effects of radiation therapy include:
- dry mouth and other mouth problems
- extreme fatigue
- inflammation in the treated area, such as difficulty with swallowing, a cough or feeling short of breath as a result of radiation to the chest
- pain with or difficulty swallowing
- loss of hair in the treatment area
Most of these side effects go away within two months after radiation therapy is finished.
Chemoradiotherapy For Unresectable Locally Advanced Esophageal Cancer
For patients with local but unresectable lesions, CRT is the only treatment with a potentially curative intent . In a single institution phase II trial, 18 of 54 patients with clinical T4 and/or M1 only in cervical lymph node who received CDDP/5-FU with concurrent 60 Gy irradiation achieved a complete response, and the median survival time and 3 year survival rate was 9 months and 23%, respectively . JCOG9516, a multicenter phase II trial, showed a 15% complete response rate and a 2 year survival rate of 31.5% . Additionally, in JCOG0303, a multicenter phase II/III trial that compared two types of chemotherapy regimen with CDDP/5-FU concomitantly with 60 Gy irradiation, the patients were randomized to standard dose regimen or low dose regimen . The primary endpoint of OS was nearly equivalent in both treatment arms therefore, low dose regimen did not show the advantage over standard dose regimen.
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What Happens During Radiation Therapy
Prior to beginning radiation therapy, some patients who cannot swallow may have a feeding tube inserted into their esophagus. This tube, called an esophageal stent, allows the esophagus to remain open.
The treatment process for external beam therapy begins with simulation and treatment planning.
The goal of simulation is to determine the patient’s daily treatment position and to make devices that will help the patient maintain that position. Body molds, head masks, or other devices may be constructed to help the patient stay still during treatment and temporary skin marks or tattoos may also be applied to help precisely position the patient for each treatment session.
For treatment planning, computed tomography , position emission tomography and magnetic resonance imaging images will be obtained to map the location of the cancer and healthy tissues nearby. Using these images and sophisticated treatment planning tools, a team of professionals including a dosimetrist, radiation physicist and radiation oncologist generate a treatment plan that will deliver the appropriate radiation dose to the tumor while minimizing exposure to surrounding normal tissues.
After the simulation and planning have been completed, the treatment can begin.
External beam radiation therapy can also be delivered using beams of a charged particle called a proton, which are typically generated by a machine called a cyclotron.
Combined Treatment For Esophageal Cancer
Most treatment plans for esophageal cancer involve a combined treatment approach, which is when you receive a mix of radiation therapy, chemotherapy or surgery to target cancerous tissue.
- Neoadjuvant therapy is a combination of radiation and chemotherapy that aims to shrink tumors and prevent their reoccurrence before surgery.
- Treating with chemotherapy and radiation together halts the spread of microscopic tumors that have developed beyond the original tumor site.
- Research also shows patients recover more quickly from radiation and chemotherapy when they are performed before surgery rather than after.
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What Is Esophageal Cancer
Esophageal cancer occurs when cancer cells develop in the esophagus, a long, tube-like structure that connects the throat and the stomach. The esophagus, which carries swallowed food to the stomach, is part of the upper digestive system. The wall of the esophagus consists of several layers of tissue.
There are two main types of esophageal cancer, including:
- squamous cell carcinoma, in which cancer develops in the thin, flat cells that form the inner lining of the esophagus.
- adenocarcinoma, in which cancer develops in glandular cells in the lining of the esophagus.
In the early stages of esophageal cancer, there may be no symptoms. In more advanced cancers, symptoms may include:
- difficulty or pain when swallowing
Combining Chemotherapy With Other Approaches
In most cases, patients treated for esophageal cancer at Memorial Sloan Kettering get both chemotherapy and radiation therapy. Several studies have shown that this combination, called chemoradiation, is the best method for curing or controlling the disease.
In many people with squamous cell carcinoma of the esophagus, chemoradiation drives the cancer into remission .
If chemoradiation alone cannot control the cancer, or if you have adenocarcinoma, we may give chemotherapy and radiation to shrink the tumor and make it easier to remove. When used before surgery, this is called induction chemotherapy or neoadjuvant chemotherapy.
The mix of chemotherapy, radiation therapy, and surgery is known as trimodality therapy, and support for this approach is growing. Chemoradiation followed by surgery offers good results for many esophageal cancer patients who have small tumors that have not spread.
Chemotherapy before surgery improves treatment for esophageal cancer in several ways:
- It can reduce the risk that the cancer will recur after the tumor has been removed.
- It can shrink the tumor, making it easier to remove the cancer in its entirety.
- It can improve a persons ability to swallow, often after just two cycles of treatment, if a tumor is blocking the esophagus.
Chemotherapy is typically given with radiation therapy for six to ten weeks before surgery.
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Preoperative Chemotherapy Radiation Improve Survival In Esophageal Cancer
Patients with esophageal cancer who received chemotherapy and radiation before surgery survived, on average, nearly twice as long as patients treated with surgery alone. The findings, from a large randomized trial of neoadjuvantchemoradiotherapy for the disease, were published May 31, 2012, in the New England Journal of Medicine.
Patients treated with carboplatin and paclitaxel chemotherapy plus radiation prior to surgery had a median overall survival of nearly 50 months, compared with 24 months for patients treated with surgery alone.
Pieter van Hagen, M.D., of Erasmus University Medical Center and his colleagues enrolled 368 patients who had cancer of the esophagus or of the junction between the stomach and the esophagus that had not spread to other organs. Participants in the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study were mostly men, and the median age was 60. Patients benefited from preoperative therapy regardless of whether they had adenocarcinoma, the most prevalent form of esophageal cancer in the United States, or squamous cell carcinoma, the most prevalent form of the disease worldwide.
- August 31, 2015
When Is Chemotherapy Used For Esophageal Cancer
Chemo may be used at different times during treatment for esophageal cancer.
- After surgery : Adjuvantchemo might be given to kill any cancer cells that might have been left behind or have spread but are too small to see on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. It isnt clear that adjuvant chemoradiation is as helpful as giving it before surgery.
- Before surgery : For some cancers, neoadjuvant chemo might be given to try to shrink the cancer so it can be removed with less extensive surgery. This can lower the chance of the cancer coming back and help people live longer than using surgery alone.
- Chemo for advanced cancers: For cancers that have spread to other organs, such as the liver, chemo can also be used to help shrink tumors and relieve symptoms. Although it is not likely to cure the cancer, it often helps people live longer.
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Radiation Therapy For Esophageal Cancer
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often combined with other types of treatment, such as chemotherapy and/or surgery, to treat esophageal cancer. Chemotherapy can make radiation therapy more effective against some esophagus cancers. Using these 2 treatments together is called chemoradiation.
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Esophageal Cancer Treatment: Chemo & Radiation
In February 2000, I began a new chapter in my life when I started esophageal cancer treatment. The top-notch medical team at Memorial Sloan Kettering Cancer Center had diagnosedÂ a Phase III, 5-centimeter cancerous tumor at the junction of my esophagus and stomach.Now I was preparing for a six-week course of simultaneous chemotherapy and radiation designed to shrink the size of the tumor.Despite their assurances that this was the right course for me, I was not sure if this esophageal cancer treatment would work. Even if it did, my future was so uncertain that I called on God to help me through this part of my journey.
Proceeding In Faith
One evening, in response to my prayers, I came up with the saying: God sits on my right shoulder and there is nothing that He and I together canât handle. That statement stayed with me each time I went through another treatment.I faced six weeks of simultaneous chemo and radiation, and there were many days in which I was attacked by doubt. When I was overwhelmed by the uncertainty of my future, I would recall that statement and be comforted, knowing that God was with me.
Esophageal Cancer Treatment Begins
Simultaneous Chemo and Radiation Therapy
Support From Family and Friends
Esophageal Cancer Treatment Reactions
Rest And Recovery
Surgery For Esophageal Cancer
Esophageal cancer surgery requires special expertise because tumors are usually located in the chest, near the heart, lungs and main arteries. Research shows esophageal cancer patients experience better results when they undergo surgery at a center that performs a high number of esophageal cancer surgeries per year.
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Esophagitis: A Common Radiation Side Effect
Radiation-induced esophagitis, the inflammation of the esophagus, is an unpleasant but temporary side effect of radiation therapy.
Radiation-induced esophagitis, the inflammation of the esophagus, is an unpleasant but temporary side effect of radiation therapy. Esophagitis is common in people who receive radiation therapy to the chest area for cancer of the esophagus as well as other cancers, including lung cancer and lymphoma.
Esophagitis feels like an internal sunburn and usually develops two to three weeks after the initiation of radiation therapy. In addition, the person might feel a sharp, burning pain or food getting stuck in the chest when swallowing.
The cells that form the lining of the esophagus renew themselves rapidly and are vulnerable to chemotherapy and radiation. Unlike chemotherapy, which affects the entire body because it is distributed throughout the bloodstream, radiation only affects the body structures within the irradiated area.
Esophagitis is more common in people who receive chemotherapy immediately prior to and/or during radiation. The longer the radiation field , the more the esophagus is included and the greater the incidence of esophagitis. And the higher the daily dose of radiation, the more likely it is the person will develop esophagitis.
Once radiation is completed or suspended, esophagitis usually resolves uneventfully within two to four weeks. The person can resume a regular diet, and esophagitis is not likely to recur.