Doctor's Notes on Esophageal Cancer
Esophageal cancer is a disease where the tissues of the esophagus (the tube-like structure that connects the throat to the stomach) start to grow abnormally and become malignant. There are two major types of esophageal cancers: squamous cell carcinoma, which arises from the surface (epithelial) cells that line the esophagus, and adenocarcinoma arises from the esophageal glands or within a segment of Barrett's esophagus. Although tumors can develop anywhere in the esophagus, adenocarcinomas appear more frequently in the lower portion while squamous cell carcinoma develops more frequently in the upper portion of the esophagus.
Symptoms of esophageal cancer may not occur until the disease is at an advanced stage and may include
- difficulty swallowing,
- weight loss,
- central chest pain and/or pain behind the breastbone,
- pain upon swallowing,
- vomiting, chronic cough,
- hoarseness, and
- symptoms of gastrointestinal bleeding such as black stools or vomiting blood or material that looks like coffee grounds.
What Is the Treatment for Esophageal Cancer?
- Endoscopic resection
- Removal of the tumor and part of the esophagus
- Total esophagectomy
- Removal of the entire esophagus and nearby lymph nodes
- Feeding tube placement (gastrostomy or jejunostomy tube)
- With a feeding tube, liquid nutrition can be put directly into the intestine to help prevent and treat malnutrition
- Esophagus stenting
- In cases where there is an obstruction to food entering the stomach
- Palliative surgery for unresectable cancer
- Used to help control cancer or relieve symptoms when the tumor is unable to be removed completely
- Chemotherapy used alone or in combination
- Targeted therapies
- Larotrectinib (Vitrakvi)
- Entrectinib (Rozlytrek)
- Ramucirumab (Cyramza)
- Fam-trastuzumab deruxtecan (Enhertu)
- Pembrolizumab (Keytruda)
- Nivolumab (Opdivo)
- Photodynamic therapy
- Light therapy may be used to treat esophageal cancers that are small and have not spread (metastasized)
- A photo-sensitizing drug is injected into the body and absorbed by cancer cells
- The patient is exposed to a special light from a laser, causing the drug to kill the cancer cells
- Radiation therapy
- External beam radiation therapy
- Three-dimensional conformal radiation therapy (3D-CRT)
- Intensity-modulated radiation therapy (IMRT)
- External beam radiation therapy
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.