When the cells of the esophagus, which moves food through the throat and down into the stomach become malignant, it is called esophageal cancer or cancer of the esophagus. A cancerous tumor can develop at any point along the esophagus. The most prevalent forms of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinomas occur along the lining of the esophagus in the flat squamous cells. Adenocarcinomas occur when cancer develops in the cells that produce fluids like mucus; these are called glandular cells.
Most individuals who develop esophageal cancer will not have any symptoms during its early stages. When it becomes advanced, symptoms such as vomiting, chest pain, fatigue, heartburn, indigestion, weight loss, painful swallowing, choking while eating, and chronic cough may manifest. Esophageal cancer is diagnosed using endoscopy and a biopsy of esophageal tissues. Various methods may be used to treat esophageal cancer.
An esophagectomy is a surgical procedure where part of the esophagus is completely removed, and the tissues of all or some of another organ are used to reconstruct it. This surgical procedure is the most commonly used method for treating esophageal cancer. During an esophagectomy, the large intestine or stomach tissues are used to reconstruct the portion of the esophagus that was removed. This procedure is typically performed through an incision in the abdomen, chest, or both. Sometimes, an esophagectomy can be done through minimally invasive surgery with a robot or by laparoscopy.
If esophageal cancer has spread into nearby lymph nodes, those affected will be removed during the esophagectomy. The recovery time for this procedure will significantly depend on the extent of the removed esophageal tissue. On average, a patient will stay in the hospital for between seven and fourteen days following an esophagectomy. The patient is not able to eat for the first five to seven days following the procedure, and they are temporarily fed through a feeding tube installed during surgery.
Specific Tumor Removal Surgery
Specific tumor removal surgery is a surgical method used to treat esophageal cancer where the cancerous tumor and some surrounding tissue is physically removed. This type of procedure is able to help the physician determine how advanced an individual's esophageal cancer is. During the procedure, the surgeon will remove a margin of healthy tissue bordering the tumor to ensure all the cancerous cells are removed. In some cases, the tumor may be too large for complete removal, so debulking or eliminating as much of the tumor as possible is done.
Specific tumor removal surgery can be used to help slow or stop the progression of esophageal cancer, or it can be done as a palliative measure to relieve symptoms. Large tumors in the esophagus can also be treated with radiation and chemotherapy before tumor removal surgery to shrink the tumor and reduce the risk of surgery-related complications. In cases where esophageal cancer has spread into nearby lymph nodes or other tissues, the patient may need to undergo chemotherapy and radiation following the tumor excision surgery.
An esophagogastrostomy is a surgical procedure in which a part of the esophagus and upper part of the stomach are removed, and the remaining parts are mechanically reattached. Nearby lymph nodes may also be removed during this procedure. An esophagogastrostomy is usually utilized to treat esophageal cancer that occurs in the lower region of the esophagus or certain cases where the esophageal cancer is excessive. During the procedure, a part of the esophagus will be removed entirely along with a sizeable superior portion of the stomach. The surgeon will then reattach the esophagus to the remainder of the stomach after pulling it upwards.
Sometimes, a portion of the colon is used to assist with rejoining the stomach and esophagus. There are numerous methods used to reattach or re-embed the esophagus into the stomach, like stitching and stapling. An esophagogastrostomy is used as a last resort treatment because it is the most invasive and carries the highest number of complications out of all the surgical methods used to treat esophageal cancer. Chemotherapy and radiation may also be used before or following an esophagogastrostomy to ensure the eradication of all cancerous tissues.
Feeding Tube For Nutrition
A feeding tube for nutrition may be required as part of the process to treat esophageal cancer. Often times, the surgical methods used to treat cancer of the esophagus can cause food consumption to be too much of a risk for a post-procedural infection. In addition, these types of surgeries can make it difficult or very painful for a patient to swallow food and fluids normally. A feeding tube is often temporarily embedded in a patient's small intestine to deliver nutrition to the body while they are healing.
In other cases, the placement of a feeding tube for nutrition may be required for a more long-term duration. This nutrition support may be a nasogastric feeding tube or a feeding tube fed into the body through the nasal passageway, and then down into the stomach. Some patients are unable to tolerate this type of feeding tube, and the stomach may be inaccessible through the tumor affected esophagus. In such cases, a tube is embedded from the outside of the body through the abdomen, and it is inserted directly into the stomach. Most patients who undergo the recommended treatment for esophageal cancer are able to come off of the feeding tube eventually.
Place A Stent In The Esophagus
A patient's physician may place a stent in their esophagus as part of the esophageal cancer treatment process. A stent is a hollow mesh tube made of plastic or silicone that self expands, or a physician manually expands it once it is in place. The esophageal stent holds the area where the tumor is located open so food and fluids can pass into the stomach normally. Stenting is typically done in patients undergoing chemotherapy or radiation therapy who have trouble with swallowing normally.
A stent is also commonly placed for palliative care in patients who have esophageal cancer that is too widespread for manual removal. In addition, an esophageal stent may be used to relieve symptoms in patients who cannot yet undergo tumor excision surgery due to other medical circumstances. This type of treatment may be chosen over the installation of a feeding tube or manual tumor removal because the placement of a stent does not require general anesthesia or surgery.