Cancer of the esophagus may be treated surgically. Whether to use surgery, however, will depend on the stage of the cancer. The cancer can be treated by surgery if it has not yet spread beyond the esophagus. Such cases account for less than 25% of esophageal cancer cases diagnosed.
Thus, it is important for the patient to understand exactly what the surgery is for. Is it to cure the disease or to relieve symptoms? Surgery, for instance, may be performed to ease dysphagia in approximately 80% of esophageal cancer patients. This, however, will not cure the disease.
Surgical procedures may be combined with other treatments such as radiation therapy and chemotherapy.
COMMON SURGICAL PROCEDURES
There are two common surgical procedures for esophageal cancer: esophagectomy and esophagogastrectomy. Neither is a simple operation. In both procedures, the patient stays in hospital for two weeks following the operation.
An esophagectomy is usually performed in cases where cancer of the esophagus is still at an early stage, having not yet spread to the stomach. It is not normally considered an option in cases of adenocarcinoma-type cancers of the lower part of the esophagus; in such cases, the upper part of the stomach is often involved.
In an esophagectomy, the surgeon removes that part of the esophagus with the cancer, as well as the connection between the stomach and the upper part of the esophagus. The lymph nodes near the esophagus are likewise removed. The procedure involves an incision that is made either in the upper abdomen or in the chest.
Cancers of the esophagus that are of the squamous cell type often start in the upper and middle areas of the esophagus. This type of cancer often spreads extensively within the esophagus, making it necessary to remove a large part of the esophagus. In cases where the spread is limited, enough normal tissue on either side of the cancer still has to be removed to make sure that all of the cancer is taken out.
Once part of the esophagus has been removed, the remaining part has to be reconnected to the stomach. This is done in two ways.
The more simple procedure involves bringing the stomach up to the esophagus. The stomach is actually placed within the upper part of the chest. The other procedure, known as a colonic interposition, involves the replacement of the part of the esophagus that was removed with a piece of the large intestine. Because the blood supply to that part of the intestine has to be preserved, this is a more complex procedure.
An esophagogastrectomy, the other common surgical procedure, involves the removal of that part of the lower esophagus that contains the cancer; the upper part of the stomach next to the esophagus is surgically removed as well. What remains of the stomach is then reattached to the upper part of the esophagus. This makes it possible for food to enter the stomach.
These operations may sometimes be performed using laparoscopic techniques. Laparoscopes are tubes that are inserted into the patient through small incisions. They allow surgeons to have a good look at the area to be operated on. Surgery can then be performed with special instruments. This procedure requires special skills on the part of the surgeon.
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Reviewed by:
Jiade J. Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)
Medical Director
The Cancer Information Network
Date Modified: 06/10/04
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