Treatment of oesophageal cancer

The treatment plan will depend on the stage of the tumour together with the age and general medical fitness of the patient.

The mainstays of treatment are surgery, chemotherapy and radiotherapy. Often these treatments are used in combination to maximise benefit; for example, surgery and chemotherapy together.

Surgery

Surgical removal of the oesophagus or "oesophagectomy" is a very major operation, involving an incision in the abdomen and, in most cases, also in the chest.  In some procedures, a further incision is made in the neck.  The gap in the gullet is bridged using the patient's own lower stomach to fashion a tube.  Increasingly, these operations are being performed using laparoscopic (keyhole) techniques to enhance recovery.
Surgery is only appropriate when there is no spread of disease outside the gullet (M0).

The surgery takes approximately 5 hours.  After oesophagectomy, patients can generally eat very well although stomach capacity is reduced.  The convalescence period is 3 – 6 months.

The advantage of surgery is that it offers the best hope of absolute "cure" of the disease.

The disadvantage of surgery is the risk involved with the procedure, the mortality associated with the operation is about 5-10%.

Radiotherapy

After surgery, radiotherapy probably offers the next best hope for cure.  The treatment is given in sessions ("fractions") each day for several weeks.  Initially, symptoms may be worsened by swelling but then begin to improve. It is often used in combination with chemotherapy to boost its effectiveness (“chemo-radiation”).

The advantage of radiotherapy is that the treatment associated mortality is much lower and recovery is faster.  Some patients are naturally afraid of major surgery.

The disadvantage of radiotherapy is that the chance of achieving a cure is less than for surgery.

Chemotherapy

Drug treatment alone will never completely remove a tumour.  However, it has the advantage of being effective against the cancer cells wherever they are located, for example, outside the primary tumour.

Chemotherapy is most useful in combination with other treatments. For example, a patient presenting with a tumour staged T3N1M0 might undergo 3 months of chemotherapy. At the end of this time, repeat scans may show the tumour has been “down-staged” to T2N0M0. The patient could then go forward to a potentially curative operation.

Palliative Treatments

Palliation aims to relieve the symptoms of the disease without necessarily altering the course of the disease or prolonging life. The key is to achieve good quality of life.

Techniques used in palliation include;

Laser treatment - day case endoscopic procedure
Stenting - placing an inner tube inside the gullet
Palliative chemo or radiotherapy
Pain control
As part of the government’s strategy to improve cancer outcomes (IOG – improving outcomes guidance), the country has been divided into 35 “cancer networks”. These are groups of hospitals with roughly equivalent catchment areas.

My own network is based around the world-renowned Mount Vernon Cancer Centre in Northwood (hence, Mount Vernon cancer network or MVCN). I have been the lead clinician for oesophageal and gastric cancer within the MVCN since its inception some years ago.
There is widespread expertise within the network with specialist surgery concentrated at Watford Hospital, and close links to neighbouring networks including the West London network and the North London network. The MVCC itself has excellent facilities including the Lynda Jackson centre for help and advice.

For more information, please follow the links;

The Mount Vernon Cancer Network

Lynda Jackson Macmillan Centre


Mcmillan Cancer Support Network


Cancer arising in Barrett's oesophagitis



Surgical resection specimen



Close-up of residual tumour following
chemoradiation

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