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Surgical Procedures for Esophageal Cancer
Surgery is a common treatment option if the tumor has not spread far. The goal is to remove as much of the cancer as possible and spare healthy tissue. Surgery may also be combined with other treatments such as radiation and chemotherapy. Surgery is not always an option since the tumor may have spread too far by the time it is found. However, surgery may still be done to relieve symptoms or blockage.
Esophageal surgeries are long and difficult. They often have complications after the surgery. It is important to seek out an experienced surgeon and hospital for these procedures.
Surgery for High Grade Dysplasia and Early Stage Esophageal Cancer
High grade dysplasia is a precancer change in cells. Surgery for dysplasia and early stage cancer offer the best chance for a cure. Options include:
Endoscopic Mucosal Resection
Small, noninvasive cancer can be removed during an endoscopy. A tube with a camera is passed through the mouth and throat. It can also be passed through small incisions in chest and/or belly if the surgeon needs to get to the tumor from a different angle. The tumor and a ring of healthy tissue is removed. This will make sure that all the cancer is gone. The edges may be tested for cancer cells.
Photosensitizers, or light-sensitive molecules, are injected into the blood. These molecules are absorbed by cells throughout the body, but tend to stay longest in cancer cells. A special red light causes damage and death to cancer cells with these molecules. The light will be directed to the tumor with an endoscope.
Surgery for Advanced Esophageal Cancer
An esophagectomy is the removal of part or all of the esophagus. The amount of tissue removed depends on the location and size of the tumor. In some cases, the stomach is stretched up into the chest and neck. It is attached to the remaining part of the esophagus. If large amounts of tissue are removed, a connection between the mouth and stomach may be made. A plastic tube or part of the intestine may be used.
Nearby lymph nodes may also be removed and tested for the presence of cancer. Cancer in the lymph nodes means the cancer may have spread to other areas of the body.
Esophagectomies can be done as:
- Open—a cut is made in the belly, neck, and/or chest. The entire area is open to the surgeon.
- Minimally invasive—Small cuts are made in the chest or belly. Tubes with camera are passed through cuts so that the surgeon can see the area. Tools are passed through the cuts to remove tissue. Healing time and recovery may be faster with this option than with an open.
A feeding tube can deliver nutrition straight to intestines or stomach. An opening can be made in the belly wall. A tube will connect the stomach or intestine to the opening. This is done when swallowing becomes difficult.
Surgery can not treat later stage cancer. However, it may relieve problems caused by the cancer. All of these procedures are done during an endoscopy.
- Esophageal dilation —A balloon or plastic dilator is used to slowly widen the esophagus.
- Laser ablation—Cancerous tissue is removed with the high heat of a laser beam. Since cancer cells grow back, the procedure will need to be repeated on a regular basis.
- Electrocoagulation—An electric current is used to burn off cancer cells.
- Argon plasma coagulation—Argon gas is heated with a high-voltage spark. The super-heated gas is used to burn off cancer cells.
- Esophageal stent—A metal stent can be placed at the point of obstruction. The stent is placed over the tumor, then expanded. The stent flattens the tumor against the esophageal wall, which helps open the passageway.
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Esophagus cancer. American Cancer Society website. Available at http://www.cancer.org/acs/groups/cid/documents/webcontent/003098-pdf.pdf. Accessed December 31, 2018.
General information about esophageal cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/all. Updated September 7, 2018. Accessed December 31, 2018.
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- Reviewer: Mohei Abouzied, MD
- Review Date: 12/2018
- Update Date: 12/31/2018