First, we will discuss the treatment for localized esophageal cancer.
Earlier stages of esophageal cancer are carcinoma in situ (Tis) and T1a.
Endoscopic mucosal resection is the technique which is used for the treatment of Tis and T1a disease. This procedure is performed through an endoscope, in which first a fluid is injected into the lesion, and the lesion is removed from surrounding structures.
As you can see in the figure, only the superficial cancerous portion is removed, while the remaining tissue remains unaffected.
Esophagectomy or removal of esophageal is also an option for the early-stage disease but is practiced less commonly.
As you can see in the figure, in esophagectomy, most of the esophagus is removed. And the stomach is pulled up to be joined to the remaining part of the esophagus.
Now we come to the treatment for T1b disease, or the disease that infiltrates into the submucosa, without the involvement of lymph nodes.
For T1b disease without lymph nodes involvement, esophagectomy is the preferred treatment.
Now, we will discuss the treatment of T2 or T3 disease. That is the disease which has infiltrated into muscularis propria or serosa.
And for the treatment of esophageal cancer, which has spread to the regional lymph nodes.
In these cases, surgery alone may not be sufficient for the treatment, so different combination of surgery, radiotherapy and chemotherapy are used.
Cancerbro, how it is decided what combination of modalities to be used?
It is decided by oncologist on an individual basis, depending upon the exact stage of the disease, the comorbidities and the performance status of the patient.
Now we come to the treatment for T4 disease, in which the disease extends to involve the adjacent structures. In this figure, the disease has extended to involve the heart or pericardium. And here, cancer has spread to the great vessels of the heart. Here, it invades the lungs or pleura.
And here, cancer has infiltrated into the diaphragm. And here it has spread to the trachea.
In some cases of T4 disease, surgery may not be possible, so a combination of chemotherapy and radiation therapy may be used.
And if it is possible, then surgical resection of the tumor, with or without chemotherapy and radiation therapy is done.
In T4 disease also, the decision to do surgery or not, and to give chemotherapy or radiotherapy is taken by the oncologist on an individual patient basis after assessing the exact stage of the disease and understanding the comorbidities and the performance status of the patient.
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