Treatment of oesophageal cancer should be tailored to each patient depending on the location of the cancer, the stage of the cancer, the patient’s general health and state of nutrition. The overall stage of the cancer is determined by the depth of invasion through the esophageal wall (T-stage), the number of involved lymph nodes (N-stage) and the presence of distant spread (M-stage).
Surgery is the traditional mainstay of curative treatment for oesophageal cancer. Provided the patient’s overall state of health and nutrition is adequate, early-stage cancers are ideally treated with oesophagectomy to remove the oesophageal cancer with its associated lymph nodes. Surgery can be performed through a combination of incisions in the abdomen, chest and the neck, depending on the location of the cancer and the involvement of surrounding anatomical structures. More recently, minimally invasive surgery using combined thoracoscopic and laparoscopic techniques has been shown to be beneficial. After surgery, patients may undergo adjuvant chemotherapy and/or radiotherapy to reduce the risk of recurrence.
Patients with advanced oesophageal cancer or those with poor general health may still be candidates for curative surgery after a period of tube feeding or intravenous feeding combined with neo-adjuvant chemotherapy and/or radiotherapy. Some patients who have significant medical conditions not compatible with major surgery, or patients with cancers in the cervical oesophagus (neck) may be treated with definitive chemoradiation therapy.
When there is evidence of distant spread or spread to vitally important organs in Stage 4, then only palliative treatment is recommended. This may involve chemotherapy or radiotherapy to improve symptoms and reduce the tumour size. Options to improve feeding include endoscopic insertion of self-expanding stents to temporarily ‘reopen’ the oesophagus or insertion of external feeding tubes.
Patients with early disease limited to the mucosa (T1) or precancerous Barrett’s oesophagus have the best chance of long-term survival after curative surgery with 5-year diseasefree survival rates approaching 80%. Otherwise, the overall 5-year survival rate for oesophageal cancer after surgical resection ranges from 5% to 30%. Early diagnosis is vital as the options and results of treatment vary greatly depending on the cancer stage.
