Esophageal carcinoma develops when cancerous cells form in the esophagus--the tube that carries food and fluids from the mouth down to the stomach. Though treatable, the condition is rarely curable and those diagnosed with very early disease are most likely to have the highest survival rates, according to the National Cancer Institute. The optimal choice of treatment depends upon a number of factors, including the size and location of the tumor and stage of the cancer.
Surgical Treatment
According to OncologyChannel.com, the preferred treatment for esophageal carcinoma is an esophagectomy--partial or complete removal of the esophagus. Patients with metastatic cancer that has spread to distant lymph nodes and other bodily organs, patients whose esophageal tumor has grown into nearby structures such as the trachea, respiratory tract, aorta or lining of the heart, and those with other serious illnesses such as heart and lung disease may not be eligible for surgical treatment.
Surgeons may perform an esophagectomy in one of two ways. During a transhiatal esophagectomy, the physician removes a portion of the esophagus through small incisions in the abdomen and left side of the neck and then connects the remaining esophagus to the stomach. Alternatively, patients may undergo a transthoracic esophagectomy, during which the surgeon makes an incision in the ribs and opens up the chest cavity to complete the operation on the esophagus.
According to the National Cancer Institute, patients treated with surgical resection have 5-year survival rates between 5 and 30 percent. Those diagnosed and treated early are among those with the highest survival rates.
Radiation and Chemotherapy
Radiation therapy--the use of high-energy waves to target and kill cancer cells--can be used to treat esophageal cancer. In addition to or instead of radiation, some patients with esophageal carcinoma may receive one or more chemotherapy drugs--such as Cisplatin, leucovorin or fluorouracil--intravenously or by mouth or injection.
When used as a singular treatment approach, radiation therapy offers marginal benefit to long-term survival, except in those patients with early-stage disease, according to the Cleveland Clinic. Research on treatment with chemotherapy alone--administered before surgery, after surgery, or both before and after surgery--has produced mixed results. While some studies have reported up to 50 percent of patients responding to chemotherapy, only a small percentage of these patients showed complete remission and there was no significant advantage to long-term survival.
Researchers have also reported mixed results from studies looking at the effectiveness of combined chemotherapy and radiation administered pre-operatively. Ongoing clinical trials continue in an effort to identify the most effective, least toxic multimodal treatment options for patients at various stages of disease.
Palliative Treatment
Patients with stage IV, metastatic esophageal cancer typically receive palliative therapy--treatment designed to reduce pain and suffering as opposed to curing the disease. According to the Cleveland Clinic, patients with an obstructed esophagus or dysphagia--difficulty swallowing--may benefit from endoscopic esophageal dilation and endoscopic stenting--procedures designed to open up areas of blockage. Laser and light-based therapies, such as photodynamic therapy, and radiotherapies, such as intraluminal brachytherapy, may also help to improve swallowing.
According to the National Cancer Institute, clinical trials involving palliative treatment of metastatic disease with various combinations of chemotherapy drugs--including hydroxyurea, fluorouracil, topoisomerase inhibitors, taxanes and vinorelbine--typically report a 15 to 30 percent response rate to treatment, with marginal improvements in overall survival.
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