Esophageal Cancer

Types of Esophageal Cancer

The treatment approach that a doctor will choose for a specific patient depends on the tumor location. According to it there are two major types of this disease:

• epidermoid cancer;
• adenocarcinoma.

In the first type of this disease the tumor is located in the upper part of esophagus. To remove it a surgeon needs to open the thoracic cavity for getting the full access to the tumor.

In second case there is no need in opening the thoracic cavity, as the tumor is located in the lower part of esophagus. That is why laparotomy is applied (incising the abdominal wall).

Methods and Approaches to Esophageal Cancer Treatment

Esophagus resection surgery is performed if cancer is detected in the upper part of the stomach (in the case of cancer in the distal third). The surgery may also involve resection of the esophagus and the proximal stomach. This procedure is usually performed to treat the disease in the early stages. It is technically difficult and demands advanced professional skills and a very high qualification of the surgeon.

There are several surgical approaches, and before surgery each individual case is always widely discussed by thoracic surgeons. With advances in technology, new methods of esophagus resection surgery appear.

Many thoracic surgeons consider Lewis esophagectomy or the transthoracic approach to be the “gold standard”. This surgery is a combination of two separate surgical procedures ‒ a laparotomy through an incision to mobilize the stomach and a right-sided thoracotomy to remove and resect the esophagus.

It is believed that Ivor Lewis esophagectomy is often better than other methods of esophageal resection, since open laparotomy provides a higher degree of abdominal exposure for lymph node dissection and is crucial for detecting more widespread metastases. The presence of metastases dramatically changes the survival results and makes esophagectomy ineffective for the treatment of esophageal cancer.

Esophagectomy is a surgical removal of a tumour of the esophagus through the use of one of the most appropriate techniques, followed by the restoration of the esophagus with a part of another organ, usually the stomach.

Esophagectomy is the main treatment option for esophageal cancer, and it is sometimes used to treat Barrett’s esophagus on condition that precancerous cells are detected.

Minimally invasive esophagectomy performed by means of the da Vinci robotic system helps patients recover faster. Sometimes, in order to shrink the tumour, several cycles of chemotherapy and irradiation are instituted before the operation. Instead of the open, traumatic approach, now doctors use robotic technologies. This makes it possible for surgeons to work with their hands and fingers in the ways they could not do before. Through small incisions, the tumour is removed and a new esophagus is created. If the cancer has not spread beyond the esophagus and the lymph nodes are free of cancer, the patient can quickly return to a normal lifestyle and his favourite dishes.

Surgery and chemoradiation oncotherapy work well against localized malignant tumours, but in the advanced stages of multiple metastases, the main strategy is the systemic one. After biogenetic analysis of cancer cells, patients with metastatic HER2-positive esophageal cancer are prescribed Trastuzumab (Herceptin), and when VEGFR2 mutations are detected, many experts recommend Ramucirumab (Cyramza). Immunotherapy with the Pembrolizumab (Keytruda) has also proved to be highly effective in the advanced stages of cancer.

Currently, clinical trials are actively being conducted abroad to test the effectiveness and safety of such types of treatment for metastatic esophageal cancer as checkpoint inhibitors, immune modulators, adoptive cell therapy, monoclonal antibodies, therapeutic vaccines, cytokines, etc.Treatment of esophageal cancer in German clinics is mainly based on the operative intervention. The surgery is recommended in cases when there are no metastases. The tumor is dissected together with the damaged esophagus fragment that is replaced by a special prosthesis. If the tumor was spread on the nearby organs, sometimes its partial or total resection is recommended.

In many cases patients are prescribed radiotherapy that affects the organ and the tumor by X-radiation. As a rule, doctors apply this kind of therapy before the surgery to reduce the tumor size. Esophageal cancer treatment by beam therapy can be indicated after a surgery to avoid the disease relapse.

Radiotherapy is often combined with chemotherapy that implies the injection of medications that damage cancerous cells.

Brachytherapy is also used for the treatment of esophageal cancer in Germany. Radioactive capsules are installed inside the esophagus near the tumor, damaging cancer cells.

Rehabilitation After Surgery

Health professionals in Germany pay much attention not only to surgical treatment of esophageal cancer, but also to post-surgery and rehabilitation period. They develop the system of recovery measures individually to restore the physiological functions of the organism and returning a patient into his common social environment. A special diet is developed for each patient, and specialists provide proper psychological assistance.

Due to high level of modern medicine development oncologic diseases like esophageal cancer are no longer a sentence. If you face such disease and look for a qualified specialist, we will be happy to help you to find the proper clinic.

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