Esophageal Cancer Treatment by TNM Stages

The treatment of esophageal cancer mainly depends on the stage, location of the tumor, performance status of the patient, presence of certain genetic abnormalities, along with other factors.

Following are the preferred treatment approaches for different stages of esophageal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Esophageal Cancer - Treatment (Non-Metastatic Disease) - Infographics
Esophageal Cancer - Treatment (Non-Metastatic Disease)
Esophageal Cancer - Treatment (Metastatic Disease) - Infographic
Esophageal Cancer - Treatment (Metastatic Disease)
Tis or T1a Endoscopic resection with or without ablation is considered as the first choice of treatment
Surgery can be employed if the patient is medically fit
T1b N0 M0 Surgical resection of esophagus is the preferred treatment.
Chemotherapy with/without radiotherapy if surgically unresectable or inoperable.
T1b N1-2 M0
T2-T4a N0-2 M0
Surgical resection in combination with chemotherapy with/without radiotherapy is the preferred treatment.
Chemotherapy with/without radiotherapy if surgically unresectable or inoperable.
Cervical esophagus inv.
T4b N0-2 M0
Chemotherapy with/without radiotherapy is the standard treatment.
Any T Any N M1
(Metastatic disease)
Chemotherapy is the mainstay of treatment in case the disease has spread to distant body parts
Along with the chemotherapy, radiotherapy and/or surgery may be employed as palliative therapy as and when required

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And in the following video, CancerBro explains the TREATMENT OF METASTATIC ESOPHAGEAL CANCER.

Following is the brief description of various treatment types employed for esophageal cancer:

  1. Surgery: Surgery is the treatment of choice for some earlier stage cancers that can be completely removed. Surgery can also be employed for some higher stages cancers that have not spread to distant parts and if the patient is medically fit. Sometimes, surgery is combined with other treatments such as chemotherapy and/or radiation therapy as per physician discretion and patient’s condition.

  2. Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy).

    Radiotherapy is commonly combined with other treatment options such as surgery and/or chemotherapy for higher stage disease. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.

  3. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts.

    Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.

  4. Targeted Therapy: Targeted drugs are designed to target a specific gene or protein characteristic of the stomach cancer cells. With the advancement in diagnostic techniques, genetic abnormalities for esohageal cancer have been identified that can be targeted with the help of targeted drugs.

    Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy. For example, trastuzumab targets HER2 protein. They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.

  5. Endoscopic Treatment: Various endoscopic treatment options are now available for the treatment of some early-stage esophageal cancers or for providing symptomatic relief from advanced stage disease. Treatments like endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic ablation, mainly aim to treat very early stage esophageal cancers, or to prevent them from developing, for example, Barrett’s esophagus and dysplasia.

    Other treatments like laser ablation, esophageal stent or feeding tube placement, mainly aim to relieve symptoms of more advanced staged esophageal cancers.

  6. Palliative Treatment: These may help in improving the overall quality of life by providing relief from the symptoms caused by esophageal cancer. However, they do not directly treat esophageal cancer. They are generally given as supportive care for advanced staged cancer. These include but are not limited to placing stent or feeding tube, using drugs to reduce pain and other symptoms such as vomiting, external-beam radiation therapy for bleeding or pain, etc.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating esophageal cancer:

-Prolongation of life

-Reduction of symptoms

-Improvement of overall quality of life

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