Early detection and treatment of esophageal cancer

1. Importance of early detection

In esophageal cancer testing, X-ray inspection and upper endoscopy are performed in individuals with a high risk of esophageal cancer, such as those with Barrett’s esophagus (the mucous membrane of the esophagus changes into the mucous membrane type seen in the stomach, and it has high probability of getting cancer), and they are closely observed to check for appearance of early cancers and pre-cancerous lesions, which involve dysplasia or abnormal cells. Early detection/treatment can increase survival rate; therefore, early detection of esophageal cancer is crucial.

2. Methods for the treatment of esophageal cancer

Treatment of esophageal cancer is based on cancer stages, spread of cancer or the measure of how far the cancer has spread, and health condition of patients. In early stages, the cancer can be present on the surface or within the deeper layers of the esophagus, and is most commonly treated with endoscopy, chemotherapy, radiation therapy, surgery, or a combination of any of these. For middle-stage cancers, chemotherapy, chemoradiotherapy (combination of chemotherapy and radiation therapy), or surgery is performed. In late stages, the cancer spreads to distant sites of the body, and treatment focuses on controlling this spread through chemotherapy.

2.1. Methods for the treatment of very early esophageal cancer

Surgery or endoscopic treatment is the preferred treatment mode in the very early stage. In very early stages of cancer, endoscopic treatment is performed, wherein an endoscope is passed through the mouth down the throat into the esophagus, and instruments can be passed through the endoscope to resect lesions. Endoscopic treatment is minimally invasive to the patients’ body, and therefore, quick recovery and early discharge can be expected. The portion of the esophagus (and small portion of stomach) with the tumor can also be surgically removed partly or wholly. This is called thoracotomy, as this is done through open incisions on the chest.

Treatment options(Endoscopic submucosal dissection:ESD)

Surgical resection(illustration)

2.2. Methods for the treatment of early esophageal cancer

Surgery, chemoradiotherapy, or a combined treatment with both is performed in the early stage. If all of the cancer has not been resected through surgery, chemoradiotherapy can be performed after surgery. For patients with problematic health conditions, or those who do not want surgery, then chemotherapy, radiation therapy, or their combination (chemoradiotherapy) is mainly performed.

2.3. Techniques for the treatment of middle- and late-stage esophageal cancer

Surgery, chemotherapy, radiation therapy, targeted therapy, immune therapy, or a combined treatment approach of all these is performed in the middle and late stages. In late stages, treatment focuses on controlling the spread of cancer through chemotherapy.

3. The importance of early detection of esophageal cancers

Surgery is highly invasive; therefore, endoscopy is one of the preferable treatment methods because it is less burdensome for the patient. However, many esophageal cancers are not found early enough to treat them with endoscopy or surgery. Early detection/treatment can increase survival rate; therefore, early detection of esophageal cancer is crucial.

This column has been prepared under the supervision of a physician for the purpose of providing general information on cancer.
It is not a substitute for the advice and services that should be provided by a physician or other healthcare professional. If you notice any health conditions, please consult your family doctor or a specialist.

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