Surgical Procedures for Esophageal Cancer
If esophageal cancer is localized and has not spread beyond the original site, surgical removal of the cancer is the most common treatment. The goal is to remove as much of the cancer as possible while preserving as much function of the esophagus as possible. It may also be done with chemoradiation, a combination of radiation therapy and chemotherapy to shrink the tumor before surgery or to try to kill off any remaining cancer cells after surgery. Surgical removal is not always an option since most esophageal cancers are found in advanced stages. In this case, surgery may be done as palliative care to improve the function of the esophagus.
Surgery for High Grade Dysplasia and Early Stage Esophageal Cancer
High grade dysplasia is a change in cell structure that is a precursor to cancer. Surgery for high grade dysplasia and early stage cancer offer the best chance for a cure. Options include:
Endoscopic Mucosal Resection
Small, noninvasive cancer can be removed during an endoscopy. A tube with a lighted tip and camera are inserted through the mouth and throat. It can also be inserted through small incisions in chest and/or abdomen if the surgeon needs to access the tumor from a different angle. The tumor is removed along with a margin of healthy tissue to try to ensure that all the cancer is completely removed. The doctor will examine and take samples of the removed tissue. Tissue samples will be examined under a microscope for the presence of cancer.
Photosensitizers, or light-sensitive molecules, are injected into the bloodstream. These molecules are absorbed by cells throughout the body, but tend to remain longest in cancer cells. When these molecules are exposed to a special red light, they cause cell damage and death. The light will be directed to the tumor using an endoscope.
Surgery for Advanced Esophageal Cancer
An esophagectomy is the removal of part or all of the esophagus. The amount of tissue removed depends on the location and size of the tumor. In some cases, the stomach is stretched up into the chest and neck, and attached to the remaining part of the esophagus. If large amounts of tissue are removed, a plastic tube or intestinal tissue may be used to create a connection between the mouth and the stomach.
Nearby lymph nodes may also be removed and tested for the presence of cancer. Cancer in the lymph nodes means the cancer may have spread to other areas of the body.
Esophagectomies can be done as:
Open—During open surgery, an incision is made in the abdomen, neck, and/or chest. Doing so exposes the organs so they can be accessed by the surgeon. The esophagus and nearby lymph nodes are removed through the incision. Open surgeries may be referred to as transhiatal or transthoracic depending on where the incision is made.
Minimally invasive—Tubes with a lighted scope and camera are inserted through small incisions in the chest (thoracoscopy) or abdomen (laparoscopy) to access the tumor site. The esophagus and nearby lymph nodes are removed through the tubes. Healing time and recovery are somewhat faster than with this option than with an open esophagectomy.
An esophagectomy is a long and difficult procedure that often has postoperative complications. It is important to seek out an experienced surgeon and hospital for this procedure.
can be inserted through the abdominal wall and directly into the stomach or small intestine. This is done when swallowing becomes difficult and nutritional needs are not able to be met. Nutritional support helps prevent starvation, as well as aspiration of material into the lungs.
The feeding tube can be placed as part of a scheduled surgery or done separately. The opening through the abdomen is called a stoma. The rubber tube from the stoma is fixed and secure. Complete, balanced liquid meals and medications can be delivered through the tube.
If a surgical cure is not an option, there are a few options available to help keep the esophageal channel open as long as possible. All of these procedures are done during an endoscopy.
—A balloon or plastic dilator is used to slowly widen the esophagus where it narrows.
Laser ablation—Cancerous tissue is removed with the high heat of a laser beam. Since cancer cells grow back, the procedure will need to be repeated on a regular basis.
Electrocoagulation—An electric current is used to burn off cancer cells.
Argon plasma coagulation—Argon gas is heated with a high-voltage spark. The super-heated gas is used to burn off cancer cells.
Esophageal stent—If the tumor is blocking the esophageal channel, a metal stent can be placed at the point of obstruction. The stent is placed over the tumor, then expanded. The stent flattens the tumor against the esophageal wall, which helps open the passageway.
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