cancer of the esophegus

[mary-c]

Posted By  HFHSM.D.-ab on March 16, 1998 at 14:15:31:

In Reply to: cancer of the esophegus posted by mary c. on March 11, 1998 at 17:19:09:

: I'm looking for advice on cancer of the esophegus.  We learned 2/16/98 that
  my mom has stage 3 esophegial cancer.  From what I've read, this is nasty.
  What are we looking at here? and basically, what are treatment options? I'm
  afraid her doctor is not treating aggressively as he is only using cisplatin
  and 5-FU flouro...(can't recall the rest of the name).  No plans to radiate.
  I suggested Photodynamic therapy (PDT), surgery, cancer vaccines, and
  thalidime as options to check into, he was very unresponsive.
  I understand PDT is new, but approved by the FDA for stage 3 esophegus
  cancer, but we haven't found where it's available.  Any suggestions?
  Cancer vaccines.  I have read that there are some success with the cancer
  vaccines, both cancer-type specific, as well as some that are developed
  for the individual's cancer.  Do you have any knowledge of this?
  Do you know about the thalidime or have knowledge of other drugs keep new
  blood vessels from forming?  We're searching for help.  Any you can offer will
  be gratefully appreciated.  Thanks,  Mary

[HFHSM.D.-ab]

Dear Mary:

We are very sorry about your mother’s recent diagnosis of esophageal cancer.
Each year, approximately 12,000 new cases of esophageal cancer are diagnosed in the United States.  Like your mother, most patients have stage III disease at the time of diagnosis.
The two most common types of esophageal cancer are called squamous cell carcinoma and adenocarcinoma.
The staging of this cancers is very important.  Staging determines treatment options and predicts the prognosis of the patient.  The “TNM” staging system is universally applied in the United States.  “T” stands for tumor size, “N” for regional lymph node involvement and “M” for distant metastasis. A stage III cancer, implies a tumor that invades the outer lining of the esophagus or adjacent structures, and with regional lymph nodes that are also affected by the cancer.  Unfortunately this is an advanced stage of the disease and for patients undergoing the most aggressive treatment options that survive the surgical procedure, the 5-year survival rate reported from major referral centers in the United States is only 15 to 20%.
There are several different treatment options, depending upon the cancer type (squamous cell carcinoma versus adenocarcinoma), the staging and the patient general condition.  Combined treatment is frequently used.  It uses different combinations of 1) chemotherapy (usually fluorouracil [5-FU] and cisplatin or mitomycin)  2) radiation therapy  and  3) surgery.  Esophageal tumor resection is a risky surgical procedure and is usually contraindicated if the patient has multiple medical problems and/or if the tumor is not “resectable”.
Because most cases of esophageal cancer are currently detected at an incurable stage, several “palliative” treatments have been described.  Palliation means that even though the treatment will not change the prognosis, it will make the patient more comfortable and improve the quality of life.  The most common symptom of advanced esophageal cancer is difficulty or inability to swallow due to the tumor obstructing the lumen of the esophagus.  The different palliative treatments aim to decrease this obstruction.  
Some of the available palliative treatments for esophageal cancer are:
1) Dilatation of the narrowed esophagus with a tube that is passed through the mouth and then pulled out.  The disadvantages include the risk of perforation and the short duration of symptom relief.
2) Metallic expandable “stents” (tubes) that are positioned permanently in the esophagus .  This procedure has a higher risk of perforation, but the symptom relief is long lasting.
        3) A beam of laser can be used  to heat and vaporize the tumor and gradually reopen the lumen of the esophagus.  This therapy is effective and relatively safe.
4) Photodynamic Therapy (PDT) has also been applied to patients with advanced tumors for the purpose of palliation.  It uses a substance that make tissues very sensitive to a special kind of laser light.  When the lining of the esophagus is exposed to this light, destruction (necrosis) of the superficial tissue is produced.
5) Other techniques use very low temperature to destroy tissue (cryotherapy) or injection of substances directly to the tumor.
There are still no cancer vaccines or so called “immunotherapy” for esophageal cancer.  Thalidomide has been used to promote healing of some kinds of esophageal ulcers, but does not appear to be a treatment for esophageal cancer.
This response is being provided for general informational purposes only and should not be considered medical
advice or consultation. Always check with your personal physician when you have a question pertaining to your
health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and
make an appointment to see Dr. Bravo, one of our experts in Gastroenterology.
keywords: esophageal cancer,
HFHSM.D.-ab
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