We have a team comprising exclusively in caring for people with esophageal cancer. As we specialize in Foregut and liver pancreas cancer, we are the leading provider in care of patients at any stage, precancerous to metastatic cancer.
Most patients who come to St. Joseph center for foregut and HPB disease, have dysphagia or diagnosis of esophageal cancer. Our promise, we will arrange to see you within one business day to meet our Surgeon. We will work together with gastroenterologists, pathologists, radiologists, and other esophageal cancer experts to determine the specific type of cancer you have. We will discuss with you the detailed treatment approach. Whether you need surgery or chemotherapy, your treatment will start within one week of diagnosis.
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Using results from your diagnostic studies, our surgeons will classify the cancer into one of four stages. The stage indicates how large the tumor has grown and how widely it has spread in the body.
Diagnosis of Esophageal cancer is very important as it determines the direction of the treatment Surgery or chemotherapy. This is done by the gastroenterologist. We work with highly specialised gastroenterologist both at St. Joseph as well as other gastroenterologist in town who specialise in endoscopic ultrasound. Using a ultrasound probe at the end of the endoscope, the highly trained gastroenterologist is able to say which layer of your esophagus the tumor has extended upto. If it is very superficial and involving only one layer, Dr. Sukharamwala will recommend undergoing surgery first. If the tumor has involved the deeper layers, a preoperative chemoradiation will be recommended. This will be followed by surgical resection.
Several other studies including CT scan of chest, abdomen, PET/CT scan may be useful to further evaluate the stage of the tumor.
What to expect at the meeting with the Surgeon?
You are required to bring all the studies, medical records and CT scan disc at your doctors meeting. After reviewing the records and scans you bring one or more of the following may happen We may order more studies to evaluate better the stage of the cancer. If it is determined that your cancer is resectable, we will work with your cardiologist or pulmonologist to evaluate the condition of your heart and lungs to make sure that you are fit to undergo major esophageal resection. We will work with you to get those clearance pretty quickly and promise to get your treatment started within one week. i.e chemotherapy or esophageal resection.
When diagnosed with esophageal cancer, surgical resection is the only curative approach. If the cancer is small and superficial, we will perform a resection of your esophagus , a procedure called transhiatal esophagectomy. If the esophageal cancer is found to have involved deeper layer of your esophagus, we will recommend you undergo chemoradiation first. This will help tumor shrink in size and allow us successful resection of the complete tumor. Often times preoperative chemoradiation will cause your tumor to completely disappear i.e complete pathologic response on endoscopy. This means two things ; 1. your cancer has better biologic behaviour as it responded well to the chemoradiation. 2. Even though the tumor had complete pathologic response, there are few cancer cells still present and esophagectomy is still required despite complete disappearance of the cancer. Esophagectomy after chemoradiation therapy helps prevent recurrence. In this procedure , the goal is to remove all of the tumor in order to prevent its regrowth and spread.
In unfortunate cases, the esophageal cancer may be unresectable due to cancer spread elsewhere or invading lungs and other organs . In such cases, palliative care is recommended for symptoms control, nutrition.
If there are issues with nutrition, we would recommend liquid foods intake or bypass the esophageal cancer by placing a feeding tube.
If a tumor is nearly blocking the esophagus, our gastroenterologist can implant a covered metal or plastic tube called a stent into the esophagus to keep the esophagus open.
For severe back pain, celiac plexus block can be placed by our gastroenterologist by injecting the nerve ganglion called celiace ganglion near the origin of celiac artery.
Per National Cancer Institute guidelines , chemotherapy and radiation is recommended in the majority of patients treated for esophageal cancer . Several recent studies have shown that combining both chemotherapy and radiation therapy offers most effective method for curing or controlling the disease.
If the variety of esophageal cancer is squamous cell carcinoma, chemoradiation is all you need as these tumors respond well to chemoradiation sufficient to drive the cancer into remission. Remission means there are no signs of cancer – it does not necessarily mean the patient is cured.