Stages of Esophageal Cancer | Dr Meenu Walia | DNB Medical Oncologist

Stages of Esophageal Cancer

In this stage the cancer has grown into some of the deeper layers of the esophagus wall (past the innermost layer of cells) but has not reached the lymph nodes or other organs.

• T1 cancers: Some very early stage I cancers that are only in a small area of the mucosa and haven’t grown into the submucosa (T1a tumors) can be treated with EMR, usually followed by some type of endoscopic procedure to destroy any remaining abnormal areas in the esophagus lining.
• But most patients with T1 cancers who are healthy enough have surgery (esophagectomy) to remove the part of their esophagus that contains the cancer. Chemotherapy and radiation therapy (chemoradiation) may be recommended after surgery if there are signs that all of the cancer may not have been removed.

T2 cancers:For patients with cancers that have invaded the muscularis propia (T2 tumors), treatment with chemoradiation is often given before surgery. Surgery alone may be an option for smaller tumors (less than 2 cm). If the cancer is in the part of the esophagus near the stomach, chemo without radiation may be given before surgery. The targeted drug trastuzumab (Herceptin) may be given with chemo if the cancer is HER2 positive and no radiation is given.

• If the cancer is in the upper part of the esophagus (in the neck), chemoradiation may be recommended as the main treatment instead of surgery. For some patients, this may cure the cancer. Close follow-up with endoscopy is very important in looking for possible signs of cancer returning.
• People with stage I cancers who can’t have surgery because they have other serious health problems, or who don’t want surgery, may be treated with EMR and endoscopic ablation, chemo, radiation therapy, or both together (chemoradiation).

Stages II and III

• Stage II includes cancers that have grown into the main muscle layer of the esophagus or into the connective tissue on the outside of the esophagus. This stage also includes some cancers that have spread to 1 or 2 nearby lymph nodes.
• Stage III includes some cancers that have grown through the wall of the esophagus to the outer layer, as well as cancers that have grown into nearby organs or tissues. It also includes most cancers that have spread to nearby lymph nodes.
• For people who are healthy enough, treatment for these cancers is most often chemoradiation followed by surgery. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are sometimes treated with chemo (without radiation) followed by surgery. The targeted drug trastuzumab may be given with chemo if the cancer is HER2 positive and no radiation is given. Surgery alone may be an option for some small tumors.
• If surgery is the first treatment, chemoradiation may be recommended afterward, especially if the cancer is an adenocarcinoma or if there are signs that some cancer may have been left behind.
• In some instances (especially for cancers in the upper part of the esophagus), chemoradiation may be recommended as the main treatment instead of surgery. Patients who do not have surgery need close follow-up with endoscopy to look for possible signs of remaining cancer. Unfortunately, even when cancer cannot be seen, it can still be present below the inner lining of the esophagus, so close follow-up is very important.
• Patients who cannot have surgery because they have other serious health problems are usually treated with chemoradiation.

Stage IV

• Stage IV esophageal cancer has spread to distant lymph nodes or to other distant organs.
• In general, these cancers are very hard to get rid of completely, so surgery to try to cure the cancer is usually not a good option. Treatment is used mainly to help keep the cancer under control for as long as possible and to relieve any symptoms it is causing.
• Chemo may be given (possibly along with the targeted drug trastuzumab if the cancer is HER2 positive) to try to help patients feel better and live longer, but the benefit of giving chemo is not clear. Radiation therapy or other treatments may be used to help with pain or trouble swallowing.
• For cancers that started at the gastroesophageal (GE) junction, treatment with the targeted drug ramucirumab (Cyramza) may be an option at some point. It can be given by itself or combined with chemo.
• Some people prefer not to have treatments that have serious side effects and choose to receive only treatments that will help keep them comfortable and add to their quality of life.

Prevention of Esophageal Cancer

Tumour Board Evaluation

• All patients who come to Dr. Meenu Walia for oncology care start their treatment only after they have been discussed in the Tumor Board and given a Tumor Board Number. In the tumor board all our specialists (Medical Oncologists, Radiation Oncologists, Surgical Oncologists, Oncopathologists, Radiologists and Microbiologists) evaluate and discuss the findings, and chart out the optimal plan of treatment for each patient based on established national and international guidelines and protocols. This treatment plan takes into account the overall health of the patient, the extent (stage) of the cancer and their preferences. The primary treatments for gastric cancer (stomach cancer) include surgery, radiation therapy and chemotherapy.
• Oncologists at Dr. Meenu Walia see several thousand patients who have esophageal cancer each year. That experience helps them to guide patients toward the most appropriate treatment approach. We take great care to ensure patients understand the benefits and risks associated with each treatment option.

Dr. Meenu Walia offers all treatment options for esophageal cancer, including surgery, external beam radiation therapy, Brachytherapy, chemotherapy and targeted therapy.

• Tremendous advances have occurred in esophageal cancer treatment over the past decade. DHRC offers an exceptionally comprehensive treatment program that makes full use of the latest therapies.