What is esophageal cancer and how is it treated?
Esophageal cancer is a malignancy of the esophagus. There are two main types, squamous cell carcinoma and adenocarcinoma. Squamous cell is often associated with smoking and alcohol consumption, and adenocarcinoma is often associated with gastroesophageal reflux disease (GERD) and Barrett’s esophagus. Difficulty swallowing (dysphagia) and painful swallowing (odynophagia) are the most common symptoms. Often it is hard to swallow bulky food, but liquids may be tolerated. Pain behind the sternum is common as are weight loss and poor appetite. The doctor usually orders a barium swallow, which often shows a defect concerning for cancer but must be definitively diagnosed by an upper endoscopy (EGD) with biopsies. Once diagnosed, other tests, such as endoscopic ultrasound, CT scan and PET scan, are performed to assess for local or distant metastasis (cancer spread).
Treatment is based on the stage of your cancer. The stage is determined by the size of your tumor and whether your tumor has spread locally to lymph nodes or surrounding structures, or to distant organs. Your oncologist, gastroenterologist and surgeon will determine your best course of treatment depending on the stage of your cancer. This typically includes surgery, with chemotherapy and radiation therapy given either before (neoadjuvant) or after (adjuvant). Surgical treatment involves removing the esophagus (called an esophagectomy), pulling the stomach up through the chest cavity and attaching it to the remaining portion of the esophagus either in the chest or the neck, and placing a feeding tube into the small intestine for feeding until you have healed and are able to eat normally. You will have incisions in your abdomen and either your neck or chest, depending on the approach your surgeon feels is best for you.
What should I expect after my esophagectomy?
After your surgery, you will be in the hospital seven to 10 days. Approximately seven days after your surgery, a swallow study will be performed to check for a leak at the anastomosis (connection). If no leak is present, you will begin a soft diet. A dietician will go over your diet restrictions, and you will be sent home with tube feeds, which will be set up by your home health nursing provider through your feeding tube at night. The feeding tube is typically removed at your follow-up appointment with your surgeon in the clinic. Additional treatment in the form of chemotherapy and/or radiation therapy will be determined by your team of physicians, based on the final pathologic stage of your tumor from the operation.