Esophageal adenocarcinoma describes cancer that starts in cells of the mucosal lining in the esophagus, usually near the stomach. This cancer affects mostly older white males and is linked to changes in the mucosa associated with gastroesophageal reflux disease, or GERD.
Signs of esophageal cancer include difficulty or pain when swallowing, particularly while eating dry foods, and unexplained weight loss. Symptoms may be mild and easy to ignore until the disease is advanced. Treatment depends on the location and size of the malignancy, whether or not cancer cells have spread, and patient preferences.
Presurgical Chemoradiotherapy
Chinese researchers reviewing eleven randomized controlled trials involving 1,308 patients found improved five-year survival rates in patients with esophageal adenocarcinoma who underwent a combination of chemotherapy and radiation therapy, or chemoradiotherapy, prior to surgery, compared to subjects who were treated with surgery alone. The study was published in the December 2009 issue of "World Journal of Gastroenterology." Scientists from the University of Texas in Houston compared the outcomes of presurgical chemoradiotherapy to outcomes using only chemotherapy prior to surgery in 157 subjects with advanced esophageal cancer, 85 percent of whom had adenocarcinoma. The findings, published in the September 2010 "Annals of Thoracic Surgery," showed improved overall and disease-free survival rates in patients who underwent the combined treatment.
Surgery
The Mayo Clinic describes three surgical procedures used to treat esophageal cancers. When malignancy is confined to a small area in the throat, it may be possible to remove it using an endoscope, or camera on a hollow tube that is inserted through the mouth. For cancers that may have spread to surrounding tissues, part of the esophagus needs to be removed. The operation is called an esophgectomy; a portion of the stomach or the colon is used to restore missing tissues. An esophagogastrectomy is a more extensive surgery in which the esophagus, lymph glands and upper part of the stomach are removed. As with any surgery, risks and complications may include bleeding and infection.
Palliative Treatment
The goal of palliative treatment is to reduce symptoms and increase comfort, usually when disease is far advanced or when patients prefer not to undergo procedures that have side-effects which may outweigh possible benefits. Pain control with medications is an example of palliative treatment. Difficulty swallowing may be remedied by the insertion of a stent, or metal tube, that holds the esophagus open. Alternative feeding methods, such as insertion of a tube into the stomach through the abdominal wall, may be appropriate. In a review of studies published in the June 2006 "American Family Physician," reference is given to good results obtained from a trial of palliative surgery in which 82 percent of patients gained lasting relief from swallowing difficulties and 89 percent of patients were able to eat a regular diet.
References
- MayoClinic.com: Esophageal Cancer Treatment
- "World Journal of Gastroenterology," Neoadjuvant Chemoradiotherapy for Resectable Esophageal Carcinoma: A Meta-Analysis, Jin HL, et. al., Dec. 21, 2009, 15(47)
- "Annals of Thoracic Surgery," Improved Long-Term Outcome With Chemoradiotherapy Strategies in Esophageal Cancer, Swisher SG, et.al., September 2010, 90(3)
- "American Family Physician," Esophageal Cancer: A Review and Update, Layke J., et. al., June 15, 2006, 73(12)
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